Her mom’s lung cancer was caught too late. It’s part of a pattern in Nunavik

Nearly 17 years after her mother’s death, Natasha Ita MacDonald, from Kuujjuarapik in northern Quebec, still wonders if she could have survived.

Louisa Tuckatuck MacDonald, died at 57, just seven months after doctors discovered a grapefruit-sized mass in her lungs and diagnosed her with Stage 4 cancer.

“If she had been living in Calgary or Montreal or Vancouver would it have been screened before?” questions MacDonald. “Would she have had a better chance?”

MacDonald thinks so.

The assistant professor of Indigenous education at McGill University says her mother’s story highlights the failures in the health-care system in Nunavik.

MacDonald says her mom was only diagnosed after being sent to Montreal for a nagging cough. She had no idea it was cancer.

“As sad as it is, you know, if we can learn something from it, then that’s what is important,” said MacDonald. “It shouldn’t happen to anyone else.”

This month, a study published in the Canadian Medical Association Journal and authored by physicians from the McGill University Health Centre (MUHC) and Nunavik health workers found that Nunavik patients had a shorter survival rate after lung cancer diagnosis than Montreal residents, even if they received the same treatment at the same centre.

The study compared the outcomes of 95 Nunavik residents to 185 Montreal residents who had been diagnosed at around the same time, had the same type of lung cancer and were in the same age group.

The results suggested lung cancer patients from Nunavik were 68 per cent more likely to die compared to Montreal residents and pointed to the fact that health services aren’t well adapted to the needs of Inuit patients.

Dr. Faiz Ahmad Khan, a respirologist, associate professor at McGill and senior author of the study, says researchers analyzed the results with Nunavik community members.

“There was a complete lack of information on the outcome being achieved in this population,” said Ahmad Khan.

“The solutions to these things are very complex.”

Ahmad Khan says the motivation to conduct this study came from physicians’ observations and the absence of literature on cancer-treatment outcomes of people who live in Nunavik.

“It was striking,” said Ahmad Khan.

“They’re all Canadian citizens… In principle we should be able to achieve the same outcomes for them as we do for any other Canadian or Quebec citizen.”

He says these results point to the need to adapt lung cancer screening programs, which typically involve undergoing an annual CT scan.

Right now, he notes there are no CT scans in Nunavik. While it could take years to co-ordinate machines up north, Ahmad Khan says the waitlist for scans in Montreal is another hurdle.

“There is a very pressing, urgent need for the MUHC to figure out how to remove bottlenecks,” said Ahmad Khan.

“It’s particularly challenging because we need to co-ordinate the scans with air travel, lodging, things like that.”

Some patients choose to forgo care

Minnie Grey, the former executive director of the Nunavik regional health board, says because the region is under-resourced, some patients will opt to stay home with their loved ones and forgo care.

“When people get sick, they have to travel thousands of miles, leave their family and their community for long periods of time,” said Grey.

“It’s sad to say that they would rather choose to be home.”

Grey, who is Inuk, hopes this study brings communities closer to change.

“This is something that’s trying to shed light on our needs, but who’s to say that the government will respond in a timely fashion?” said Grey.

‘Inuit are not sicker or weaker’

MacDonald says screening programs also need to take language into consideration.

“Inuit are forced to navigate in French or English,” said MacDonald.

“They’re not prepared to engage in discussions around cancer without having an advocate there for them.”

She says the presence of cancer navigators — people trained to support in the health-care setting — could help bridge the gap.

“Screening programs, they need to be redesigned to meet the needs of Inuit rather than forcing Inuit to fit the program,” said MacDonald.

“Inuit are not sicker or weaker or less than anyone else. We don’t have more prevalence of cancer. What we have is insufficient health-care resources.”