Disparities in Cancer Care for Indigenous Peoples
Disparities in Cancer Care for Indigenous Peoples
Several factors contribute to the inequities in cancer care for Indigenous peoples in Canada. Cancer rates are higher among the Indigenous population, with increased morbidity and mortality observed in Ontario (Jumah et al., 2023; Ahmed & Shahid, 2012). This disparity is shaped by multiple factors, including intergenerational trauma and barriers to accessing care (Jumah et al., 2023; Horrill et al., 2019).
Individual-level factors include lower rates of participation in cancer screening programs (Jumah et al., 2023; Horrill et al., 2019). Many Indigenous communities are located in remote areas, often without the necessary equipment or staffing to provide adequate care (Jumah et al., 2023). Additionally, treatment and screening locations are frequently far from home, creating financial burdens due to the cost of travel, which deters many from seeking care (Jumah et al., 2023; Horrill et al., 2019). The legacy of colonialism has also eroded trust in the established healthcare system, leading to anxiety and mistrust of healthcare providers, provincial guidelines, and care requirements (Jumah et al., 2023; Horrill et al., 2019). This mistrust is particularly significant in the context of cervical cancer screening and seeking cancer care among women. Fear and lack of awareness further complicate the situation. Limited access to the internet, a shortage of health education materials, and the absence of Indigenous navigators exacerbate these challenges (Horrill et al., 2019). Moreover, inequities such as inadequate access to stable housing, food, and clean water continue to affect many communities (Horrill et al., 2019).
Cancer Care Ontario aims to address these barriers by fostering relationships to improve health outcomes for Indigenous peoples. This includes identifying inequities and creating policies and standards focused on improving care. The integration of Indigenous navigators into regional and national cancer care working groups is one such initiative. This ensures representation, support, and the integration of Indigenous beliefs and practices into healthcare systems. Relationship-building and resource allocation are key to improving cancer care outcomes, from screening through to survivorship. Meeting the needs for diagnostic tools, care staff, financial support, transportation, and funding remains critical. There is much work to be done to achieve these goals, and both provincial and federal governments have a significant responsibility to address the inequities Indigenous peoples face.
Professional Observations
In Ontario, Indigenous communities do not have equal access to cancer care, a challenge that mirrors the situation across Canada. Throughout my career, I have witnessed efforts within various regional organizations to address the unique needs of the Indigenous community. These efforts include patient navigators, Indigenous care rooms, cancer care navigators, inclusive artwork, and policy development. For example, the Hamilton Niagara Brant Halton regional cancer care working group recently hired an Indigenous patient care navigator to provide “culturally sensitive support and advocacy” (Hamilton Health Sciences [HHS], n.d.). Despite these efforts, much work remains to improve care and sustain these programs. It has been disheartening to see motivated Indigenous staff initiate projects, become frustrated with slow progress, and eventually leave their roles, resulting in limited long-term outcomes. Given that residential schools continued until 1996, there is still a significant level of mistrust that must be addressed. Even small details, such as artwork on the walls that reflects colonialism, can create an environment that feels exclusionary.
Fortunately, both provincial and federal governments have acknowledged the issue. Indigenous care is highlighted in the Ontario Cancer Care Plan 6, which sets the standard of care for the next five years. However, given the time and resources required to address these complex issues, I am concerned that financial resources will not align with the pressing needs. The shortage of staff and funding is palpable, despite the well-intentioned policies. For instance, there is currently only one Indigenous Navigator for our entire region, which includes five cancer centers. As a manager overseeing 11 clinics, including cancer care, there simply isn’t enough time for leaders to collaborate and drive meaningful change. While I remain cautiously optimistic, I hope that the national and provincial cancer strategies will go beyond political gestures and truly drive the much-needed transformation in cancer care for Indigenous peoples.
Ahmed, S., Shahid, R.K. (2012). Disparity in cancer care: A Canadian perspective. Current Oncology, 19(6), e376-382. http://dx.Wdoi.org/10.3747/co.19.1177
Canadian Medical Association. (2024, July 25). Advancing Indigenous health.indigenous people can cancer care in ontario
Cancer Care Ontario. (n.d.) Cancer care strategy.
Cancer Care Ontario. (n.d.). Indigenous cancer care unit. indigenous-cancer-care-unit
Cancer Care Ontario. (n.d.) Indigenous navigators. https://www.cancercareontario.ca/en/find- cancerservices/aboriginal-navigators
Cancer Care Ontario. (n.d.) Horrill, T.C., Linton, J., Lavoie, J. G., Martin, D., Wiens, A. (2019). Access to cancer care among Indigenous people in Canada: A scoping review. Social scienceand Medicine, 238(2019), 1-15. http://doi.org/10.1016/j.socscimed.2019.112495
Jumah, N.A., Kewayosh, A., Downey, B., Sense, L. C., Tinmouth, J. (2023). Developing a health equity impact assessment ‘Indigenous lends tool’ to address challenges in providing equitable cancer screening for indigenous peoples. BMC Public Health 23(2250), 1-7. https://doi.org/10.1186/s12889- 023-16919-7
Ashley. (2024). Rethink Cancer Care. https://www.instagram.com/rethinkbreastcancer/reel/DA1bPRNJRlG/
Cancer Care Ontario (n.d.) Cancer care unit. https://www.cancercareontario.ca/en/findcancerservices/aboriginal-navigators
Cancer Care Ontario (n.d.) Cancer care unit. indigenous-cancer-care-unit
Cancer Care Ontario. (n.d.) Horrill, T.C., Linton, J., Lavoie, J. G., Martin, D., Wiens, A. (2019). Access to cancer care among Indigenous people in Canada: A scoping review. Social science and Medicine, 238(2019), 1-15. http://doi.org/10.1016/j.socscimed.2019.112495
Hamilton Health Sciences (n.d.). Indigenous care and services.indigenous-care-services
Jumah, N.A., Kewayosh, A., Downey, B., Sense, L. C., Tinmouth, J. (2023). Developing a health equity impact assessment ‘Indigenous lends tool’ to address challenges in providing equitable cancer screening for indigenous peoples. BMC Public Health 23(2250), 1-7.
https://doi.org/10.1186/s12889- 023-16919-7
Ashley. (2024). Rethink Cancer Care https://www.instagram.com/rethinkbreastcancer/reel/DA1bPRNJRlG/
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