Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making.

BACKGROUND: Inuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care. METHODS: We are an interdisciplinary team of Steering Committee and researcher partners ("the team") from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis. RESULTS: We mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) ("participant") interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care. CONCLUSIONS: We describe the journey to receive cancer care as a "decision chain" which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.

Understanding Characteristics, Treatment Patterns, and Clinical Outcomes for Individuals with Advanced or Recurrent Endometrial Cancer in Alberta, Canada: A Retrospective, Population-Based Cohort Study.

Endometrial cancer (EC) incidence has increased in recent decades. However, population-based outcomes data are limited. In this retrospective cohort study, we examined characteristics, treatment patterns, and clinical outcomes, including time to next treatment (TNNT) and overall survival (OS), among advanced/recurrent (A/R) EC patients between 2010 and 2018 in Alberta, Canada. Kaplan-Meier statistics evaluated TTNT and OS, stratified by patient (A/R) and treatment. A total of 1053 patients were included: 620 (58.9%) advanced and 433 (41.1%) recurrent. A total of 713 (67.7%) patients received first-line therapy: 466 (75.2%) advanced and 247 (57.0%) recurrent. Platinum-based chemotherapy (PBCT) was the most common first-line regimen (overall: 78.6%; advanced: 96.1%; recurrent: 45.3%). The median TTNT and OS from first-line therapy were 19.9 months (95% confidence interval [CI]: 17.5-23.5) and 35.9 months (95% CI: 31.5-53.5), respectively. Following first-line PBCT, the median OS from second-line chemotherapy (N = 187) was 10.4 months (95% CI: 8.9-13.3) and higher for those rechallenged with PBCT (N = 72; 38.5%) versus no rechallenge (N = 115; 61.5%) (13.3 months [95% CI: 11.2-20.9] vs. 6.4 months [95% CI: 4.6-10.4; p < 0.001]). The findings highlight poor outcomes in A/R EC, particularly following first-line therapy, and that additional tolerable therapeutic options are needed to improve patient outcomes.

Cost-effectiveness of tezepelumab in Canada for severe asthma.

AIMS: To assess the cost-effectiveness of tezepelumab as add-on maintenance therapy compared with standard of care (SoC) for the treatment of patients with severe asthma in Canada. MATERIAL AND METHODS: A cost utility analysis was conducted using a Markov cohort model with five health states ("controlled asthma", "uncontrolled asthma", "previously controlled asthma with exacerbation", "previously uncontrolled asthma with exacerbation", and "death"). Tezepelumab plus SoC was compared to SoC (high-dose inhaled corticosteroids plus long-acting beta agonist) using efficacy estimates derived from the NAVIGATOR (NCT03347279) and SOURCE (NCT03406078) trials. The model included the costs of therapy, administration, resource use for disease management, and adverse events. Utility estimates were calculated using a mixed-effects regression analysis of the NAVIGATOR and SOURCE trials. A Canadian public payer perspective was used with a 50-year time horizon, a 1.5% annual discount rate, and the base case analysis was conducted probabilistically. A key scenario analysis assessed the cost-effectiveness of tezepelumab compared with currently reimbursed biologics informed by an indirect treatment comparison. RESULTS: The base case analysis suggested that tezepelumab plus SoC was associated with a quality-adjusted life-year (QALY) gain of 1.077 compared with SoC alone at an incremental cost of $207,101 (2022 Canadian dollars), resulting in an incremental cost-utility ratio of $192,357/QALY. The key scenario analysis demonstrated that tezepelumab was dominant against all currently reimbursed biologics, with higher incremental QALYs (ranging from 0.062 to 0.407) and lower incremental costs (ranging from -$6,878 to -$1,974). Additionally, when compared against currently reimbursed biologics in Canada, tezepelumab had the highest probability of being cost-effective across all willingness-to-pay (WTP) thresholds. CONCLUSION: Tezepelumab provided additional life years and QALYs at additional cost compared with SoC in Canada. In addition, tezepelumab dominated (i.e. more effective, less costly) the other currently reimbursed biologics.

An evaluation of Indigenous Tobacco Program smoking prevention workshops with First Nations youth in Ontario, Canada.

SETTING: The Indigenous Tobacco Program (ITP) operated by the Indigenous Cancer Care Unit at Cancer Care Ontario provides customized tobacco prevention workshops to First Nations youth across Ontario, in partnership with First Nations communities and partner organizations. INTERVENTION: First Nations youth in Canada are more likely than non-Indigenous youth to be smokers. The ITP aims to address the negative health impacts of commercial tobacco, using culturally relevant approaches, tools and resources while remaining respectful to the significance of sacred tobacco. This paper aims to determine whether a culturally tailored tobacco prevention workshop increases tobacco-related knowledge among First Nations youth in Ontario. OUTCOMES: The workshops exhibited promise in impacting First Nations youth knowledge on the harms of commercial tobacco, as after the workshop intervention, all indicators showed improved knowledge. Building strong and ongoing relationships with communities and partner organizations is vital to the success of the program. IMPLICATIONS: Culturally tailored workshops grounded in traditional knowledge and values provide an opportunity to increase the knowledge of the harms of commercial tobacco among First Nations youth in Ontario. With commercial tobacco use and exposure having tremendous health consequences, such interventions are essential.

RéSUMé: CADRE: Le Programme pour la lutte contre le tabagisme chez les peuples autochtones (PLTPA) administré par l'Unité des soins de cancérologie chez les peuples autochtones à Cancer Care Ontario dispense des ateliers personnalisés de prévention du tabagisme aux jeunes Autochtones dans tout l'Ontario, en partenariat avec les communautés et organismes partenaires des Premières Nations. INTERVENTION: Les jeunes des Premières Nations canadiennes sont plus susceptibles de fumer que les jeunes non autochtones. Le PLTPA vise à remédier aux effets négatifs sur la santé du tabac commercial à l'aide d'approches, d'outils et de ressources pertinents sur le plan culturel, tout en demeurant respectueux de l'importance du tabac sacré. Cet article vise à déterminer si un atelier de prévention adapté sur le plan culturel permet d'accroître les connaissances relatives au tabac parmi les jeunes des Premières Nations de l'Ontario. RéSULTATS: Les ateliers ont eu des répercussions prometteuses sur les connaissances des jeunes des Premières Nations ayant trait aux effets néfastes du tabac commercial, puisqu'à la suite de l'atelier d'intervention, tous les indicateurs dénotaient une amélioration des connaissances à ce sujet. L'entretien de relations solides et continues avec les communautés et organismes partenaires est essentiel à la réussite du programme. IMPLICATIONS: Les ateliers culturellement adaptés et fondés sur des connaissances et des valeurs traditionnelles permettent d'accroître les connaissances des jeunes des Premières Nations ontariennes ayant trait aux effets néfastes du tabac commercial. Au vu des impacts énormes sur la santé, liés à la consommation de tabac commercial et à l'exposition à celui-ci, de telles interventions sont essentielles.

Scoping Review of the Potential Health Effects of Exposure to Extremely Low-Frequency Electric and Magnetic Fields.

Previous studies suggest that extremely low-frequency (ELF) electric and magnetic fields (EMFs) may impact human health. However, epidemiologic studies have provided inconsistent results on the association between exposure to ELF EMFs and various health outcomes. This scoping review reports on primary investigations that were published during the ten-year period of 2007-2017 on the association between ELF EMFs and cancer, cardiovascular disease (CVD), reproductive health effects, and neurodegenerative diseases. We identified a total of 361 articles from two bibliographic databases (PubMed and EMBASE). Of these, 39 articles (19 cancer studies, two CVD studies, nine reproductive health studies, and ten neurodegenerative disease studies [with one repeated for two outcomes]) met inclusion criteria. Articles identified in this study focus on three different types of exposure: occupational (22 studies), residential (15 studies), and electric blanket (two studies). This review suggests that ELF EMFs may be associated with neurodegenerative diseases, specifically Alzheimer's disease; however, limited evidence was found to suggest that ELF EMFs are associated with several types of cancer, CVD, and reproductive outcomes. Additional epidemiological studies in large study populations with improved exposure assessments are needed to clarify current inconclusive relationships.