Abstract
Cancer is a health concern in Inuit populations. Unique cultural, dietary, and genetic factors and geographic isolation influence cancer epidemiology in this group. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking. A retrospective chart review of Inuit patients referred to The Ottawa Hospital Cancer Centre (tohcc) from the Baffin region of Nunavut between 2000 and 2010 was conducted. Nunavut cancer registry data were used to establish the percentage of cancer cases referred and their survival outcomes. Of 307 cancer patients registered among Baffin-region Inuit, 216 [70% (63 men, 153 women)] were referred to tohcc for chemotherapy (ct) and radiation therapy (rt). Mean age in the referred group was 59.3 years (range: 25-89 years), and current smokers constituted half the group (52%). The cancers most commonly leading to referral in men were lung (55%), colorectal (19%), and nasopharyngeal (11%) cancers; in women, they were lung (46%), colorectal (24%), breast (10%), nasopharyngeal (6%), and cervical (5%) cancers. Of the 216 referred patients, 82 (38%) had already undergone surgery, and 18 (8%) received chemoradiation or rt only, all given with curative intent. Among the surgical patients referred, 33 (40%) and 23 (28%) went on to receive adjuvant ct and adjuvant rt respectively. Among 116 patients referred for palliative care, 64 (55%) received ct, 76 (66%) received rt, 43 (37%) received both ct and rt, and 19 (16%) received neither treatment. Median all-stage overall survival was 10 months for patients with lung cancer [95% confidence interval: 6.1 to 13.9 months] and 37 months for patients with colorectal cancer [95% confidence interval: 14.8 to 59.2 months]. High uptake of palliative and adjuvant ct and rt was observed in the Inuit patients referred to tohcc. Lung cancer was the most common cancer in referred Inuit men and women. The survival rates for Inuit lung cancer patients referred to tohcc were comparable to those in the rest of Canada. Further research is required to understand reasons for non-referral of Canadian Inuit to tohcc.
Highlights
The seasonal lifestyle and healthy “country” diet high in vitamin A, protein, and omega-3-fatty acids has protected the circumpolar Inuit from many chronic Western diseases[1]
Of 307 cancer patients registered among Baffin-region Inuit, 216 [70% (63 men, 153 women)] were referred to tohcc for chemotherapy and radiation therapy
High uptake of palliative and adjuvant ct and rt was observed in the Inuit patients referred to tohcc
Summary
The seasonal lifestyle and healthy “country” diet high in vitamin A, protein, and omega-3-fatty acids has protected the circumpolar Inuit from many chronic Western diseases[1]. Despite the relative youthfulness of the Canadian Inuit population (median age: 22 years)[7], cancer is a leading cause of death, with half this population’s 10-year reduction in life expectancy being attributable to premature death from cancer[8]. This recent increase in cancer has not been uniformly distributed across all cancer sites. The high smoking rate in this population—which is higher by a factor of 4 than elsewhere in Canada9—cannot be ignored, given its influence on the increasing risk of lung, colon, and other cancers, and it is the focus of many ongoing public health promotion and cancer prevention strategies. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking
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