Health care inequities behind shorter life spans for Inuit from Nunavik, Quebec, with lung cancer

People living in the Inuit region of Nunavik in northern Quebec die earlier after a diagnosis of lung cancer than Montreal residents receiving treatment at the same cancer center, according to new research published in theCanadian Medical Association Journal.

All inhabitants of Nunavik are investigated and treated for cancer at the McGill University Health Center (MUHC) in Montreal, more than 1,400 km away from Nunavik hospitals, due to limited resources in the region.

Researchers compared lung cancer survival between 95 Nunavik and 185 Montreal residents being treated at MUHC. They found that Nunavik residents with similar stages of lung cancer had shorter survival than Montreal residents, even after accounting for other differences between the groups.

Analyzing results with community representatives pointed to chronic health care under-resourcing as a possible root cause of these survival differences.

"We underscore that our results should not be interpreted to conclude that Inuit have a genetic predisposition to worse lung cancer outcomes. Rather, our study observations contextualized with other knowledge about health services and access in Nunavik point to chronic underfunding and under-resourcing of Nunavik's health care services, as well as the lack of Inuit representation in health care provision, as likely upstream determinants of the disparity observed in our study," writes Dr. Faiz Ahmad Khan, a respirologist and associate professor, MUHC, Montreal, Quebec, with co-authors.

The authors recommend several actions to improve lung cancer survival for Nunavik Inuit, including:

• Deploying Inuit-specific smoking cessation and prevention services
• Making lung cancer screening available immediately, in an accessible, acceptable and culturally safe format, to facilitate earlier detection of lung cancer
• Improving lung health services by, for example, creating X-ray capacity in villages
• Supporting a Nunavik Inuit-specific lung cancer care plan
• Providing training and employment for Inuit health navigators to support patients and families in Montreal
• Increasing funding and human resourcing to strengthen Nunavik health care services

"In the bigger picture, observations such as ours should support Nunavik Inuit efforts toward greater self-governance, as increased Inuit decision-making over health care policy and funding will help ensure health services are aligned with the population's needs."