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Garth Nicholas



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    EP1.11 - Screening and Early Detection (ID 201)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.11-01 - Lung Cancer Screening and Canada’s Inuit: A Missed Opportunity (Now Available) (ID 447)

      08:00 - 18:00  |  Author(s): Garth Nicholas

      • Abstract
      • Slides

      Background

      Inuit peoples account for 0.2% of Canada’s population. Lung cancer rates in this population are disproportionately high for both genders with Canada’s Inuit having the highest incidence of lung cancer in the world. Outcomes are also poor with median survival for all stages combined in Nunavut being approximately 10 months.

      Lung cancer screening with low dose CT scan is being implemented in many countries, and a pilot program exists in Ontario, Canada. However, the screening model may not be appropriate for the Inuit.

      Method

      A literature review was performed regarding lung cancer screening, specifically with reference to the Inuit.

      Result

      Several challenges must be considered for implementation of lung cancer screening with the Inuit population.

      The Prostate, Lung, Colorectal and Ovarian Screening Trial model (PLCO[M2012]) is the risk prediction model used in the Ontario Lung Cancer Screening Pilot for People at High Risk. This requires individuals to be between ages 55-74 and to have smoked daily for at least 20 years during their life. The average life expectancy among Inuit is 72 years, compared to 82 years for Canadians overall. Using this model where the average life expectancy is lower than the upper limit of eligibility restricts its applicability.

      Smoking rates among this indigenous group are approximately 3 times higher than the rest of Canada, which indicates a clear need for screening where a higher proportion of the population would be eligible.

      Nunavut is a vast land area of around 2 million square kilometres, with a population of approximately 35,000. The logistics of providing screening in remote communities only connected by air travel is therefore daunting.

      Other dominant health issues among the Inuit of Nunavut are high rates of tuberculosis, therefore screening CT scans may be further complicated by higher false positive scans requiring established algorithms for management of all abnormal scans.

      With the Inuit population growing faster than the rest of Canada, yet experiencing a reduced lifespan as compared to other Canadians, there is an opportunity to address the inequity that may be created with the current eligibility model used for screening in Ontario. Furthermore, current recruitment strategies and eligibility assessments are not well suited to this group’s unique background.

      Conclusion

      The current PLCO risk prediction model used in Ontario may not offer the best benefit for screening in this population while careful thought about how this group is recruited is also required to minimize barriers experienced by this vulnerable population.

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    MA22 - Partnering with Patients to Understand Stigma, Disparities and Values Leading to Improved Lung Cancer Care (ID 154)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Advocacy
    • Presentations: 1
    • Now Available
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      MA22.07 - A Culturally Safe Advocacy Model of Care for Inuit Cancer Patients and Their Families (Now Available) (ID 448)

      15:45 - 17:15  |  Author(s): Garth Nicholas

      • Abstract
      • Presentation
      • Slides

      Background

      The Ottawa Hospital is the tertiary care center for Inuit living in the Baffin Island region of Nunavut, in Canada’s far North. Inuit – once relatively cancer free – now have among the highest lung cancer rates in the world (Young et al., 2016). Approximately 30% of Inuit diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016), for which they must travel thousands of kilometers where they are displaced from family, community and culture.

      Colonization has had a detrimental impact on the social determinants of health for Inuit in Nunavut and has created a lack of trust in government institutions. This context creates an advocacy need at the individual and systems level to address access and equity issues, with the goal of advancing positive health outcomes.

      Method

      The Champlain Indigenous Cancer Program (CICP) team has developed a patient-centered, culturally appropriate, land-based approach to support Inuit patients using the principles of the “Supportive Care Framework” (Fitch, 1994) as a guiding ideology. Recognizing the social and economic inequities (Inuit Tapiriit Kanatami, 2019), the Nurse Navigator developed an unconventional approach to connect with Inuit patients. She prioritizes developing therapeutic, trusting relationships with patients and families based on the observation that Inuit patients often feel most comfortable outside the confines of a hospital office. Developing these relationships on the land has become a cornerstone of her work.

      Result

      The approach that the CICP has implemented has achieved far-reaching success. Between the first six months and latest six months of tracking (through 2017-2018) there has been a 400%+ increase in patient encounters with the Nurse Navigator role. Clinicians report an increased awareness and understanding of the unique context of Inuit patients and families, resulting in increased numbers of referrals to CICP. Within the Inuit community, there is a recognition and appreciation of the Inuit-specific approach, leading to an increase in self-referrals.

      Conclusion

      The CICP is continuing to actively pursue tracking and reporting initiatives to demonstrate a shift in access to cancer care and the long-term outcomes for Inuit patients and families. The program is also continuing to increase access to cultural awareness education for staff to combat misunderstandings about Inuit. By sharing experiences and stories garnered through this work, the Nurse Navigator will help attendees to question and redefine the perception of the traditional role of a cancer nurse.

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      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-40 - Acknowledging Social and Economic Inequities Experienced by Canada's Inuit: Implications for Diagnosis and Treatment of Lung Cancer (Now Available) (ID 664)

      10:15 - 18:15  |  Author(s): Garth Nicholas

      • Abstract
      • Slides

      Background

      The Inuit living in Canada’s north have the highest rates of lung cancer in the world. Barriers to care are numerous and exist at all phases of the lung cancer journey. Beginning with difficulty in accessing the diagnostic phase of care through to treatment at a tertiary cancer centre located over 2000 km away and little to no palliative care available locally, this population experiences obstacles at each step of their lung cancer journey.

      The Inuit in Canada’s arctic experience dramatically higher rates of social and economic inequity than the rest of Canada with only one hospital serving a land mass similar to the size of Mexico, access to or from many communities is by air only. This means that diagnosis and treatment for lung cancer is provided thousands of kilometres away from family, community and culture, often for months at a time.

      Along with geographic barriers to care, Inuit peoples also have a historical mistrust of government and mainstream health care services owing to past encounters with colonization and marginalization. A lack of awareness of Inuit specific culture from health care providers (i.e. discrimination) further compounds this lack of trust. These end result of these traumas contribute to the significant health disparities experienced by the Inuit as compared to other Canadians and may in part explain why approximately 30% of Inuit diagnosed with lung cancer between 2000-2010 did not access cancer care.

      To better meet the needs of this population, TOHCC hired an Indigenous Nurse Navigator in 2016 with a goal to provide culturally safe care for Inuit patients and their families. Collaborative relationships have been built with key stakeholders in Inuit communities through consistent efforts which in turn have garnered awareness of Inuit specific issues within TOHCC and the surrounding city.

      Method

      In depth semi-structured interviews with Inuit patients, caregivers and community leaders. The Indigenous nurse navigator will interview participants either in person or by video during April and May 2019.

      Result

      The results of these interviews will be presented at the 2019 World Lung Cancer Conference in Barcelona.

      Conclusion

      There is still much work to do in breaking down barriers to accessing care at all phases of the lung cancer journey for the Inuit of Canada’s North. This presentation offers the opportunity to hear directly from a marginalized community who potentially have the greatest lung cancer needs of any population in the world.

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