Time to treatment and outcomes among Inuit patients from Nunavut treated with palliative radiotherapy at The Ottawa Hospital
We kicked off our inaugural Global Oncology Committee Speaker Series this past week with a presentation from Dr. Jessica Chan, a previous winner of the Global Oncology Committee’s Global Health Scholarship. Dr. Chan is a resident in radiation oncology at the University of Ottawa who presented her work on access to palliative radiotherapy among Inuit from Nunavut at The Ottawa Hospital, which was partly funded by the scholarship. We had an incredible turnout with over twenty participants on the teleconference. They represented a range of specialties including radiation oncology, medical oncology and medical physics, and joined us from across Canada and around the world, including Australia and the United States.
Dr. Chan’s main findings highlighted that geography is an important barrier faced by patients living in Nunavut if they require specialized cancer services, and what that can mean for accessing palliative radiotherapy. There are no radiotherapy centres in the northern Canadian territory of Nunavut, meaning patients from the eastern region fly more than 2,000 km to the southern Canadian city of Ottawa for radiotherapy. Patients receiving palliative radiotherapy were found to spend a significant period of time in Ottawa, away from their home community, in the context of a poor median survival. She also touched on some lessons learned through conducting research with Arctic Indigenous communities, including the importance of collaborating with and engaging the local community and stakeholders throughout the research process.
A fruitful and thought-provoking discussion period followed the presentation. Tele-health as a potential solution was brought up on several occasions. While this is certainly a promising intervention that is currently used in other jurisdictions across Canada to deliver health care to rural/remote communities, it is not currently used between Nunavut and Ottawa for oncology. Several possible challenges that may underlie this were discussed, including cross-jurisdictional licensing, technical/network infrastructure (despite having the physical equipment installed in the territory), and establishing appropriate manpower to run all the telehealth stations in the north.
Other barriers that could impact access were also discussed, including cultural factors. There is an increasing effort across Canada to introduce Indigenous-specific resources for patients receiving cancer treatment in the referral centers. This includes cancer glossaries published in the different Inuit languages by national organizations (e.g. http://www.pauktuutit.ca). Many provinces also include an Indigenous-specific strategy within their provincial cancer strategy (e.g. Cancer Care Ontario’s Aboriginal Cancer Strategy). A need for further work was recognized to better understand the complex barriers that Inuit patients face in accessing radiotherapy, which could also help to inform outcomes used in future studies that are meaningful and relevant to Inuit and other Indigenous patients.
Dr. Jessica Chan is a medical resident in radiation oncology at the University of Ottawa, and is currently pursuing her PhD at the Vrije University medical center in Amsterdam. Her research focuses on access to radiotherapy particularly within high-income countries and for Indigenous populations. She has been a member of the Canadian Association of Radiation Oncology’s Global Oncology Committee since 2016, and is the current resident representative.