Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review

Abstract

Background Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. Methods A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. Results Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. Conclusion Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.

Assessing Access to And Outcomes of Medical Oncology and Radiation Oncology Consultation in Non-Small Cell Lung Cancer Patients: A Population-Based Study Using Administrative Data

“…Health equity needs to be at the forefront of these initiatives with strategies to measure and evaluate progress toward achieving equity goals or the impact of actions undertaken. 37 Limitations Due to the confines of an administration dataset, information regarding race/ethnicity, first language, immigration or refugee status could not be obtained. Many characteristics such as marginalization, income and distance were based on the neighbourhood and not specifically on the individual household.…”

Income differences in time to colon cancer diagnosis

“…Barriers to navigating the healthcare system for a cancer diagnosis exist at the patient, provider and health system levels. 8 These barriers are prevalent for all patients, but they disproportionately effect individuals facing structural inequities, such as poverty, leading to inequalities in cancer outcomes. 9 Cancer patients experiencing low income are more likely to have worse stage at diagnosis, and lower rates of survival and screening, however, little is known about income inequalities in the diagnostic interval specifically.…”

Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high‐resolution population‐level analysis

“…However, survival improvements in socioeconomically, sociodemographically, or geographically disadvantaged subpopulations may not necessarily occur at the same pace as in advantaged subpopulations. Despite a universal healthcare system providing free health services at the point of care for medically necessary treatments in all provinces, there is growing evidence of social inequalities in outcomes along the cancer control continuum in Canada 7 …”

“…Despite a universal healthcare system providing free health services at the point of care for medically necessary treatments in all provinces, there is growing evidence of social inequalities in outcomes along the cancer control continuum in Canada. 7 Due to suboptimal care, survival from different cancers, including lung cancer, may be shorter in socioeconomically, sociodemographically, or geographically disadvantaged groups. [8][9][10][11] For example, cancer patients with low socioeconomic status (SES), immigrant status, or living in specific regions in Canada are less likely to receive oncology consultations, surgery, radiotherapy, chemotherapy, and supportive care near death.…”

“…Despite a universal healthcare system providing free health services at the point of care for medically necessary treatments in all provinces, there is growing evidence of social inequalities in outcomes along the cancer control continuum in Canada. 7 …”