Affected by the same type of lung cancer, patients from Nunavik have a mortality rate 60% higher than those living in southern Quebec, reveals a new study published Tuesday in the Journal of the Canadian Medical Association.
A “disparity which cannot be explained by genetic, social or cultural issues”, but rather by the chronic lack of resources and financing of health services in the Far North of Quebec, explains one of the co-authors of the study, the Dr Faiz Ahmad Khan, pulmonologist at the McGill University Health Center (MUHC).
A team bringing together MUHC researchers, doctors working in Nunavik and Inuit stakeholders analyzed a cohort of 185 Montreal patients and 95 Nunavik patients who suffered from lung cancer between 2005 and 2017 and were treated at the MUHC.
Because the health services offered in the 14 villages of Quebec’s Far North are limited, Inuit patients treated for lung cancer must travel thousands of kilometers to receive all of their treatment, including their diagnosis, in Montreal.
PHOTO OLIVIER JEAN, LA PRESSE ARCHIVES
“Waiting time may be longer due to a lack of nurses,” read this poster at the Inuulitsivik Health Center in Puvirnituq, Nunavik, in 2022.
The Dr Khan explains that there are two broad categories of lung cancers: small cell and “non-small cell.” In both cases, Montreal residents have a median survival time much higher than that of Nunavik residents.
In order to be able to fairly compare the two cohorts of patients, the data were adjusted to take into account different factors, including comorbidities. The study notes that the results “should not be interpreted to conclude that Inuit have a genetic predisposition to develop more serious outcomes from lung cancer.”
It is noted that chest x-rays, for example, “are only available in two villages” and that government smoking cessation services “are not available in Inuktitut.”
Pulmonologist responsible for the lung cancer screening program at the MUHC and co-author of the study, Dr.D Nicole Ezer believes that the results show “the importance of acting to ensure equitable access” to screening in Nunavik communities. “It’s also important that the solutions come from the communities themselves,” she says.
Refusing care to stay close to family
The authors emphasize that the reason why the lifespan of Nunavik lung cancer patients is shorter “is not clear.” They note, however, that these patients “are less likely to undergo aggressive treatments.”
“Our clinical experience shows us that some Inuit with advanced lung cancer refuse chemotherapy because they believe its benefits are outweighed by the heavy burden of all the time spent away from their family and community,” he said. writing.
A situation “which does not arise from cultural preferences, but from structural inequity”, underlines the study.
While smoking rates are particularly high among Inuit and they have “one of the highest rates of lung cancer in the world,” it is “unacceptable that all stages of the cancer diagnosis and management process lung disease require residents of Inuit Nunangat [territoire ancestral inuit] to travel thousands of kilometers,” write the authors of the study.
The Dr Khan points out that the data on which the study is based is from 2017. “We believe that since the pandemic, the situation has gotten worse,” he says.