A collaborative approach to tackling disparities
Warren Clarmont, director of Indigenous Cancer Control at BC Cancer - Provincial Health Services Authority, welcomes collaborative actions stemming from growing awareness about gaps in cancer care in Indigenous communities. ROB CAMPBELL
The discussion about cancer care in Indigenous communities has changed significantly in the 10+ years since Warren Clarmont, a member of the Gitanmaax Band of the Gitxsan First Nation, was diagnosed with testicular cancer.
“There are lots of opportunities to do things differently now,” says Clarmont, the provincial director of Indigenous Cancer Control at BC Cancer - Provincial Health Services Authority. He attributes this shift to “a societal awakening.”
Contributing to a growing awareness about gaps in access to care was a 2020 report titled In Plain Sight, which chronicled racism in the B.C. health-care system, and Clarmont believes bringing such issues to light served to galvanize much-needed action for addressing inequalities in the system.
BC Cancer, for example, is implementing an Indigenous Cancer Strategy that addresses all aspects of cancer – from prevention to survivorship – with a focus on delivering culturally safe cancer care. “People often ask, ‘Why do we need an Indigenous cancer strategy?” he says. “I think the biggest challenges beyond discrimination are geography and economics, since many Indigenous people experience poverty and live in rural and remote areas.”
Having to travel to receive care often comes with extra costs, such as transportation or accommodation. It can also mean being away from community and family circles, whose support Clarmont found crucial in his own cancer journey. “I found that while I got used to the pattern of chemotherapy, continuing for months on end requires an immense will,” he says. “That’s where culture and ceremony can help provide emotional support and mental grounding.”
When he was treated in 2009, things like traditional medicine, spiritual care and ceremonies were not only not offered but often actively discouraged since oncologists and care providers were unfamiliar with them, says Clarmont, who believes a tailored approach – where Western medical treatment is paired with spiritual care – better meets the needs of Indigenous communities.
However, for programs and interventions to be successful, they have to be designed with community input, and they need to be based on data, Clarmont explains. “Having solid information on cancer outcomes for Indigenous people in B.C. to guide us is absolutely essential because we have limited resources and need to know where we can make the biggest impact.”
Partnerships with governments, health authorities and Indigenous organizations can help to fill the gap, he says. “It’s about connecting the dots, strengthening networks and figuring out what’s needed in our community.”
Initial findings from a data linkage project show a lower rate of survival for Indigenous cancer patients. Clarmont suggests a focus on providing communities with the tools to make informed decisions about cancer care – and particularly about screening – can help to improve outcomes “and tackle some of the disparities and behavioural aspects.”
For example, many Indigenous people still equate a cancer diagnosis with a death sentence. Or they may avoid regular screenings because they feel uncomfortable in a health-care setting, he notes. “Many don’t seek help until their cancer is in a later stage. Like myself, I didn’t go in until I was on the floor, writhing in pain.”
Better training and hiring practices can ensure “care providers understand the history and circumstances experienced by Indigenous people, and this can help to increase relatability and lessen anxiety for Indigenous patients,” says Clarmont, who is building a team of Indigenous patient navigators who directly support patients as well as conduct outreach in Indigenous communities.
Facing his own mortality at age 30 in a brush with “one of the more treatable types of cancer, with a cure rate of about 95 per cent,” inspired Clarmont to reflect on “the other 5 per cent who are not so fortunate” – and this fuels his motivation to make a difference.
To view this report on The Globe's website, visit globeandmail.com
To view the full report as it appeared in The Globe's print edition: World Cancer Day