Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions

Abstract

A high cancer burden exists among indigenous populations worldwide. Providing equitable delivery of cancer services can be challenging in Canada and Greenland given their geography. We sought to describe geographic access to radiotherapy for indigenous populations in Canada and Greenland. We used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. In Canada, we calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We also calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). This took into consideration several assumptions, including that the new radiotherapy centers here would be similarly utilized and could offer all the same types of treatments available as in the current referral tertiary centers. We also assumed that patients would choose to receive radiotherapy within their own respective regions. Median one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 hours by plane or road), and 4,111 km (6 hours by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4,000 hours of travel could be saved for 1,000 patients with newly diagnosed cancers over a 10-year period in Canada, and 7 million km and 10,000 hours for 1,020 patients in Greenland, if radiotherapy was available in Yellowknife, Iqaluit, and Nuuk. Disparities in geographic access to radiotherapy exist between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight inequities in access to inform radiotherapy service planning, such as in Canada and Greenland where geography is an important potential barrier. Future work should involve a detailed economic evaluation involving the current costs associated with travelling, versus the implementation of local radiotherapy units.