According to a new study, In Canada, residents of an Inuit territory have worse survival following a diagnosis of lung cancer than similar patients living in Montreal.
The investigators conducted a retrospective matched cohort study comparing lung cancer survival for two populations treated at the McGill University Health Center: Residents of Montreal and of Nunavik, the Inuit homeland in Quebec where about a quarter of Canada’s Inuit population lives. The study found a significant difference, with Nunavik residents at a roughly 70% higher risk for death following a lung cancer diagnosis.
If we can lessen the proportion of lung cancers that are diagnosed at inoperable later stages by detecting lung cancer earlier, that could rapidly start lessening the disparity that we see, says study author Faiz Ahmad Khan, MD, MPH, a pulmonologist and associate professor of medicine at McGill University in Montreal, Quebec, Canada.
Rates of Survival
According to the authors, Canadian Inuit are stated to have the highest occurrence of lung cancer in the world. Despite it having been recognized for several years that Canadian Inuit experience high occurrence of lung cancer, there was no evidence on whether Canadian health services were realizing the same results among Inuit as we do among non-Inuit Canadian residents, said Khan. It’s a certainly significant lack of evidence.
The researchers related 95 inhabitants of Nunavik and 185 inhabitants of Montreal, whom they divided into subdivisions for non–small cell lung cancer and small cell lung cancer diagnoses. All patients were admitted at the McGill University Health Center between 2005 and 2017. Median survival times among patients with non–small cell lung cancer were 321 days for Nunavik populations and 720 days for Montreal populations. Likewise, among patients with small cell lung cancer, median survival times were 190 days for Nunavik populations and 270 days for Montreal populations.
Small cell lung cancer and squamous cell carcinoma were more widespread among Nunavik residents. These more aggressive forms were strongly connected with smoking tobacco, which was more common among Nunavik residents. However, the difference in survival continued when adjusting for factors including age, sex, cancer stage, and comorbidity. With these changes, Nunavik residents had a higher risk of death.
Healthcare Structures
According to Khan, it’s important to focus on healthcare services and structures, rather than perpetuating an image of poor health.
When considering the study results, a question all Canadians should ask is whether the healthcare services that are provided to Inuit are reasonable and acceptable for their specific context, says Khan.
As part of the study’s analysis, the investigators worked with a Nunavik lung health research steering committee to understand the findings — an important part of the study, Khan said. Because of the small sample sizes, they were not able to recognize treatment-related reasons for the shorter survival from the data. The authors noted, however, that fewer Nunavik residents received violent treatment. They suggested this may be due to a lack of prevention and detection resources in Nunavik, the burden of time away from the community during chemotherapy treatment, and a lack of support for shared decision-making.
Improving Outcomes
Stephen Lam, MD, a professor of medicine at the University of British Columbia in Vancouver, British Columbia, Canada, said that several factors may account for shorter survival among Nunavik residents. These aspects could include higher rates of small cell lung cancer and less violent treatment for both early and advanced-stage lung cancer, as outlined in the study.
Lam, who was not involved in the research, also realized that screening may fail to notice squamous cell carcinoma, which is difficult to detect until later stages, and small cell lung cancer, which can emerge rapidly. A Nunavik Inuit–specific lung cancer plan that includes funding and resources for diagnostic workup, treatment, and supportive care is a great idea to improve outcomes.
Overall, the study outlines the lack of sufficient healthcare resources in Nunavik, such as a steady workforce and more hospitals, which makes prevention or detection that much harder, says Natasha MacDonald, Ph.D., an assistant professor of education at McGill University who was not involved in the study. Inuit are not sicker or weaker or less than other human beings.
MacDonald, who is from Nunavik, said that the study took a culturally responsible method by consulting with Inuit involved in healthcare in Nunavik, which she says should be standard practice. In the future, differences may be improved by lessening structural barriers to care and redesigning screening programs to meet Inuit needs, she added.
