1
|
O’Grady JR, Ferdus J, Leylachian S, Bolarinwa Y, Wagamese J, Ellison LK, Siedule C, Batista R, Sheppard AJ. Lung cancer in First Nations, Inuit, and Métis peoples in Canada - a scoping review. Int J Circumpolar Health 2024; 83:2381879. [PMID: 39074244 PMCID: PMC11288199 DOI: 10.1080/22423982.2024.2381879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.
Collapse
Affiliation(s)
| | - Jannatul Ferdus
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Sayna Leylachian
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Yinka Bolarinwa
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Joshua Wagamese
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Lisa K Ellison
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Connie Siedule
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Ricardo Batista
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Amanda J Sheppard
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
Collapse
Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Chen Y, MacIsaac S, Young M, Ahodakin M, Jeagal LW, Boucher M, Agulnik J, Boulanger N, Camilleri-Broët S, Ezer N, Gonzalez AV, Owen S, Pepe C, Spicer J, Wang H, White-Dupuis S, Watt L, Grey M, Benedetti A, Khan FA. Nunavimmi puvakkut kaggutimik aanniaqarniq: Qanuilirqitaa? Lung cancer in Nunavik: How are we doing? A retrospective matched cohort study. CMAJ 2024; 196:E177-E186. [PMID: 38378218 PMCID: PMC10890229 DOI: 10.1503/cmaj.230682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Whether Inuit in Canada experience disparities in lung cancer survival remains unknown. When requiring investigation and treatment for lung cancer, all residents of Nunavik, the Inuit homeland in Quebec, are sent to the McGill University Health Centre (MUHC), in Montréal. We sought to compare survival among patients with lung cancer at the MUHC, who were residents of Nunavik and Montréal, Quebec, respectively. METHODS We conducted a retrospective cohort study. Using lung cancer registry data, we identified Nunavik residents with histologically confirmed lung cancer diagnosed between 2005 and 2017. We aimed to match 2 Montréal residents to each Nunavik resident on sex, age, calendar year of diagnosis, and histology (non-small cell lung cancer v. small cell lung cancer). We reviewed medical records for data on additional patient characteristics and treatment, and obtained vital status from a provincial registry. We compared survival using Kaplan-Meier analysis and Cox proportional hazards regression. RESULTS We included 95 residents of Nunavik and 185 residents of Montréal. For non-small cell lung cancer, median survival times were 321 (95% confidence interval [CI] 184-626) days for Nunavik (n = 71) and 720 (95% CI 536-1208) days for Montréal residents (n = 141). For small cell lung cancer, median survival times were 190 (95% CI 159-308) days for Nunavik (n = 24) and 270 (95% CI 194-766) days for Montréal residents (n = 44). Adjusting for matching variables, stage, performance status, and comorbidity, Nunavik residents had a higher hazard of death (hazard ratio 1.68, 95% CI 1.17-2.41). INTERPRETATION Nunavik residents experience disparities in survival after lung cancer diagnosis. Although studies in other Inuit Nunangat regions are needed, our findings point to an urgent need to ensure that interventions aimed at improving lung cancer survival, including lung cancer screening, are accessible to Inuit Nunangat residents.
Collapse
Affiliation(s)
- Yue Chen
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Sarah MacIsaac
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Matthew Young
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Marlene Ahodakin
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Luke Wan Jeagal
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Maryse Boucher
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Jason Agulnik
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Nathalie Boulanger
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Sophie Camilleri-Broët
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Nicole Ezer
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Anne V Gonzalez
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Scott Owen
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Carmela Pepe
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Jonathan Spicer
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Hangjun Wang
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Shirley White-Dupuis
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Larry Watt
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Minnie Grey
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que.
| |
Collapse
|
4
|
Belaid L, Budgell R, Sauvé C, Andersson N. Shifting paradigm from biomedical to decolonised methods in Inuit public health research in Canada: a scoping review. BMJ Glob Health 2022; 7:e008311. [PMID: 36323455 PMCID: PMC9639062 DOI: 10.1136/bmjgh-2021-008311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods. METHODS This scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis. RESULTS 356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods. CONCLUSIONS The last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.
Collapse
Affiliation(s)
- Loubna Belaid
- Direction de la Recherche et de l'Enseignement, École Nationale d'Administration Publique, Montréal, Québec, Canada
- Family Medicine (CIET/PRAM), McGill University, Montréal, Québec, Canada
| | - Richard Budgell
- Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Sauvé
- Direction de l'Enseignement et de l'Académie, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| |
Collapse
|
5
|
Histologic and Genotypic Characterization of Lung Cancer in the Inuit Population of the Eastern Canadian Arctic. Curr Oncol 2022; 29:3171-3186. [PMID: 35621648 PMCID: PMC9139845 DOI: 10.3390/curroncol29050258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Inuit are the Indigenous Arctic peoples and residents of the Canadian territory of Nunavut who have the highest global rate of lung cancer. Given lung cancer’s mortality, histological and genomic characterization was undertaken to better understand the disease biology. We retrospectively studied all Inuit cases from Nunavut’s Qikiqtani (Baffin) region, referred to the Ottawa Hospital Cancer Center between 2001 and 2011. Demographics were compiled from medical records and tumor samples underwent pathologic/histologic confirmation. Tumors were analyzed by next generation sequencing (NGS) with a cancer hotspot mutation panel. Of 98 patients, the median age was 66 years and 61% were male. Tobacco use was reported in 87%, and 69% had a history of lung disease (tuberculosis or other). Histological types were: non-small cell lung carcinoma (NSCLC), 81%; small cell lung carcinoma, 16%. Squamous cell carcinoma (SCC) represented 65% of NSCLC. NGS on 55 samples demonstrated mutation rates similar to public lung cancer datasets. In SCC, the STK11 F354L mutation was observed at higher frequency than previously reported. This is the first study to characterize the histologic/genomic profiles of lung cancer in this population. A high incidence of SCC, and an elevated rate of STK11 mutations distinguishes this group from the North American population.
Collapse
|
6
|
McVicar JA, Hoang-Nguyen J, O'Shea J, Champion C, Sheffield C, Allen J, Kimmaliardjuk DM, Poon A, Bould MD, Nickerson JW, Caron NR, McIsaac DI. Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study. CMAJ Open 2022; 10:E304-E312. [PMID: 35504694 PMCID: PMC9259461 DOI: 10.9778/cmajo.20210108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre. METHODS We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs. RESULTS A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03-1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03-2.58) and elective surgery (OR 1.58, 95% CI 1.20-2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit. INTERPRETATION Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.
Collapse
Affiliation(s)
- Jason A McVicar
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jenny Hoang-Nguyen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Justine O'Shea
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Caitlin Champion
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Chelsey Sheffield
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jean Allen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Donna May Kimmaliardjuk
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Alana Poon
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jason W Nickerson
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| |
Collapse
|
7
|
DECOLONIZING CANCER CARE IN CANADA. J Cancer Policy 2021; 30:100309. [DOI: 10.1016/j.jcpo.2021.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
|
8
|
Enuaraq S, Gifford W, Ashton S, Al Awar Z, Larocque C, Rolfe D. Understanding culturally safe cancer survivorship care with inuit in an urban community. Int J Circumpolar Health 2021; 80:1949843. [PMID: 34219604 PMCID: PMC8259824 DOI: 10.1080/22423982.2021.1949843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/03/2022] Open
Abstract
Cancer is a leading cause of death among Inuit. A legacy of colonialism, residential schools, and systemic racism has eroded trust among Inuit and many do not receive culturally safe care. This study aimed to explore the meaning of culturally safe cancer survivorship care for Inuit, and barriers and facilitators to receiving it in an urban setting in Ontario Canada. As Inuit and Western researchers, we conducted a descriptive qualitative study. We held two focus groups (n = 27) with cancer survivors and family members, and semi-structured interviews (n = 7) with health providers. Data were analysed using thematic content analysis.Three broad themes emerged as central to culturally safe care: access to traditional ways of life, communication, and family involvement. Family support, patient navigators, and designated spaces were facilitators; lack of support for traditional ways, like country food, was a barrier. Participants were clear what constituted culturally safe care, but major barriers exist. Lack of direction at institutional and governmental levels contributes to the complexity of issues that prevent Inuit from engaging in and receiving culturally safe cancer care. To understand how to transform healthcare to be culturally safe, studies underpinned by Inuit epistemology, values, and principles are required.
Collapse
Affiliation(s)
| | - Wendy Gifford
- School of Nursing, University of Ottawa, Ottawa, Canada
| | | | - Zeina Al Awar
- School of Nursing, University of Ottawa, Ottawa, Canada
| | | | | |
Collapse
|
9
|
Galloway T, Horlick S, Cherba M, Cole M, Woodgate RL, Healey Akearok G. Perspectives of Nunavut patients and families on their cancer and end of life care experiences. Int J Circumpolar Health 2021; 79:1766319. [PMID: 32449489 PMCID: PMC7448904 DOI: 10.1080/22423982.2020.1766319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.
Collapse
Affiliation(s)
- Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga , Mississauga, Ontario, Canada
| | | | - Maria Cherba
- Qaujigiartiit Health Research Centre , Iqaluit, Canada
| | | | - Roberta L Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba , Winnipeg, Canada
| | - Gwen Healey Akearok
- Qaujigiartiit Health Research Centre , Iqaluit, Canada.,Northern Ontario School of Medicine, Laurentian University , Sudbury, Canada
| |
Collapse
|
10
|
Jull J, Sheppard AJ, Hizaka A, Barton G, Doering P, Dorschner D, Edgecombe N, Ellis M, Graham ID, Habash M, Jodouin G, Kilabuk L, Koonoo T, Roberts C. Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making. BMC Health Serv Res 2021; 21:328. [PMID: 33845810 PMCID: PMC8042963 DOI: 10.1186/s12913-021-06303-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Inuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care. METHODS We are an interdisciplinary team of Steering Committee and researcher partners ("the team") from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis. RESULTS We mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) ("participant") interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care. CONCLUSIONS We describe the journey to receive cancer care as a "decision chain" which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.
Collapse
Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, 31 George Street, Louise D. Acton Building, Queen's University, Kingston, Ontario, Canada.
| | - Amanda J Sheppard
- Indigenous Cancer Care Unit, Ontario Health, 620 University Avenue, Toronto, Ontario, Canada
| | - Alex Hizaka
- Mamisarvik Healing Centre, Tungasuvvingat Inuit, 25 Rosemount Avenue, Ottawa, Ontario, Canada
| | - Gwen Barton
- The Ottawa Hospital, Indigenous Cancer Program, 501 Smyth Road, Ottawa, Ontario, Canada
| | - Paula Doering
- Bruyère Continuing Care, 60 Cambridge Street, North Ottawa, Ontario, Canada
| | - Danielle Dorschner
- Ottawa Health Services Network Inc., 1929 Russell Road, Ottawa, Ontario, Canada
| | | | - Megan Ellis
- The Ottawa Hospital, Indigenous Cancer Program, 501 Smyth Road, Ottawa, Ontario, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada
| | - Mara Habash
- Indigenous Cancer Care Unit, Ontario Health, 620 University Avenue, Toronto, Ontario, Canada
| | - Gabrielle Jodouin
- Ottawa Health Services Network Inc., 1929 Russell Road, Ottawa, Ontario, Canada
| | - Lynn Kilabuk
- Larga Baffin, 2716 Richmond Road, Ottawa, Ontario, Canada
| | - Theresa Koonoo
- Department of Health, Government of Nunavut, P.O. Box 1000, Iqaluit, Nunavut, Canada
| | - Carolyn Roberts
- The Ottawa Hospital, Indigenous Cancer Program, 501 Smyth Road, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Access to cancer care among Indigenous peoples in Canada: A scoping review. Soc Sci Med 2019; 238:112495. [DOI: 10.1016/j.socscimed.2019.112495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
|
12
|
Chan J, Friborg J, Chernov M, Cherkashin M, Grau C, Brundage M, Slotman B. Access to radiotherapy among circumpolar Inuit populations. Lancet Oncol 2019; 20:e590-e600. [PMID: 31579005 DOI: 10.1016/s1470-2045(19)30394-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023]
Abstract
Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.
Collapse
Affiliation(s)
- Jessica Chan
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, ON, Canada; Department of Radiation Oncology, Amsterdam UMC Vrije University Medical Center, Amsterdam, Netherlands.
| | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Mikhail Chernov
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam UMC Vrije University Medical Center, Amsterdam, Netherlands
| |
Collapse
|
13
|
Chan J, Linden K, McGrath C, Renaud J, Doering P, MacDonald S, Gaudet M, Pantarotto JR, Asmis T, Slotman B, Dennis K. Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada. Clin Oncol (R Coll Radiol) 2019; 32:60-67. [PMID: 31331816 DOI: 10.1016/j.clon.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
AIMS The cancer burden among Circumpolar Inuit is high. Palliative radiotherapy is a mainstay treatment for controlling symptoms of advanced cancers, but Inuit are required to travel far distances to access this service. Access to palliative radiotherapy and time away from home communities have not been explored among this population. We sought to describe the time intervals from symptom onset to the start of palliative radiotherapy among Canadian Inuit patients treated at The Ottawa Hospital (TOH). MATERIALS AND METHODS A retrospective review of Inuit patients from Nunavut treated with radiotherapy between 2005 and 2014 at TOH. RESULTS Of a total of 152 radiotherapy patients, 88 (58%) were treated palliatively. Of these, 61 (70%) had stage IV disease at diagnosis and 63 (72%) had lung cancer. The median time from referral for specialist care to the patient's first flight to Ottawa was 4 days (range 0-97). The median length of treatment was 7 days (range 0-27), but patients spent a median of 64.5 days (range 14-633) in Ottawa. The median survival from the date of pathological diagnosis was 5.2 months. CONCLUSIONS Most Inuit radiotherapy patients at TOH were treated palliatively. Patients were brought from Nunavut relatively quickly for specialist care, which is encouraging. However, patients spent over 2 months away from home, in the context of a median survival of less than 6 months. Opportunities for improvement include both provider and system-level changes, which may be applicable to other Circumpolar Inuit regions across Europe and North America.
Collapse
Affiliation(s)
- J Chan
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada; Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, Amsterdam, the Netherlands
| | - K Linden
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - C McGrath
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | - J Renaud
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P Doering
- Regional Cancer Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - S MacDonald
- Formerly with the Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
| | - M Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - J R Pantarotto
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - T Asmis
- Division of Medical Oncology, The Ottawa Hospital and the University of Ottawa, Ontario, Canada
| | - B Slotman
- Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, Amsterdam, the Netherlands
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
14
|
Kovesi T. Respiratory medicine in Nunavut and Northern Canada. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2018.1483784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Thomas Kovesi
- Department of Pediatrics, Children’s Hospital of Eastern Ontrio, Ottawa, Ontario, Canada
| |
Collapse
|
15
|
Rodin D, Longo J, Sherertz T, Shah MM, Balagun O, Wendling N, Van Dyk J, Coleman CN, Xu MJ, Grover S. Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care. Clin Oncol (R Coll Radiol) 2016; 29:135-140. [PMID: 27955997 DOI: 10.1016/j.clon.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.
Collapse
Affiliation(s)
- D Rodin
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - J Longo
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Sherertz
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - M M Shah
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - O Balagun
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Cornell University Medical School, New York, New York, USA
| | - N Wendling
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - J Van Dyk
- International Cancer Expert Corps (ICEC), New York, New York, USA; Departments of Oncology and Medical Biophysics, Western University, London, Ontario, Canada; Medical Physics for World Benefit (MPWB), Canada
| | - C N Coleman
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - M J Xu
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - S Grover
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
16
|
Wang JZ, Zhang YH, Guo XH, Zhang HY, Zhang Y. The double-edge role of B cells in mediating antitumor T-cell immunity: Pharmacological strategies for cancer immunotherapy. Int Immunopharmacol 2016; 36:73-85. [PMID: 27111515 DOI: 10.1016/j.intimp.2016.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/10/2016] [Accepted: 04/13/2016] [Indexed: 12/22/2022]
Abstract
Emerging evidence reveals the controversial role of B cells in antitumor immunity, but the underlying mechanisms have to be explored. Three latest articles published in the issue 521 of Nature in 2015 reconfirmed the puzzling topic and put forward some explanations of how B cells regulate antitumor T-cell responses both positively and negatively. This paper attempts to demonstrate that different B-cell subpopulations have distinct immunological properties and that they are involved in either antitumor responses or immunosuppression. Recent studies supporting the positive and negative roles of B cells in tumor development were summarized comprehensively. Several specific B-cell subpopulations, such as IgG(+), IgA(+), IL-10(+), and regulatory B cells, were described in detail. The mechanisms underlying the controversial B-cell effects were mainly attributed to different B-cell subpopulations, different B-cell-derived cytokines, direct B cell-T cell interaction, different cancer categories, and different malignant stages, and the immunological interaction between B cells and T cells is mediated by dendritic cells. Promising B-cell-based antitumor strategies were proposed and novel B-cell regulators were summarized to present interesting therapeutic targets. Future investigations are needed to make sure that B-cell-based pharmacological strategies benefit cancer immunotherapy substantially.
Collapse
Affiliation(s)
- Jing-Zhang Wang
- Department of Medical Technology, College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China.
| | - Yu-Hua Zhang
- Department of Library, Hebei University of Engineering, Handan 056038, PR China
| | - Xin-Hua Guo
- Department of Medicine, College of Medicine, Hebei University of Engineering, Handan 056002, PR China
| | - Hong-Yan Zhang
- Department of Medical Technology, College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China
| | - Yuan Zhang
- Department of Medical Technology, College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China
| |
Collapse
|
17
|
Abstract
Of Canada’s Inuit, 49% reside in Nunavut [...]
Collapse
Affiliation(s)
- P Doering
- Champlain Regional Cancer Program, The Ottawa Hospital, Ottawa, ON
| | - C DeGrasse
- Champlain Regional Cancer Program, The Ottawa Hospital, Ottawa, ON
| |
Collapse
|