Recent advancements in cancer treatment have lengthened and improved patients’ lives, but the increased complexity in care can be challenging to navigate – especially for marginalized communities. 

“It’s almost like cancer care becomes someone’s full-time job. They’re so busy going to appointments for scans, for tests, for treatments, that they don’t have time to do anything else,” says Dr. Lisa Hicks, malignant hematologist at St. Michael’s Hospital. “When you’re already struggling to manage your day-to-day, navigating care becomes almost insurmountable.”

To address this, an interdisciplinary team led by Hicks and medical oncologist Dr. Ronita Lee received $200,000 in funding from the Canadian Partnership Against Cancer for a new pilot project supported by Ontario Health – Care for All: An initiative to help marginalized patients engage with, and benefit from, cancer treatment.

The goal of the program is to provide a sustainable infrastructure that will enable oncology care teams to identify and address the unique, unmet needs of vulnerable patients with cancer.

“Often the patients with the highest needs are the people who don’t speak up,” says Hicks, adding that when people are dealing with homelessness, mental illness and cultural and language barriers, they may not have the capacity to advocate for themselves. “That’s what this initiative is really about. It’s about, ‘How can we get the services and assistance to those who need it most?’”

“Cancer can be challenging for patients physically, emotionally, mentally,” adds Lee. “We want to help patients navigate their cancer care and offload some of that burden, as cancer therapy itself is only part of the treatment.”

To start, the team, which will include oncologists, nurses, social workers, administrative champions and patient representatives, will conduct a mixed methods study to better understand the needs of marginalized people with cancer.

That information will help guide the development of interventions. The team isn’t certain exactly what it will look like – it could be a guide to connect people to existing resources, it could lead to new resources being created, it could be a reorganization of existing processes (likely, it will be all of those things) – but they do know some of the key issues that will need to be addressed.

“Cancer has a financial impact on our patients, so I expect there will be a financial piece,” says Hicks, citing the cost of drugs, child care and transportation, as well as the loss of income from being off work, as some of the reasons. “When we’re talking about patients who are already living in poverty, that can be crushing.”

Hicks says there will likely also be aspects to assist with transportation; support cancer-related dietary needs, especially for those dealing with food insecurity; coordinate appointments so that patients don’t have to go to the hospital so frequently; and help patients with various cultural and language needs.

Some care providers and services are already addressing these barriers, but Hicks and Lee say there’s opportunity for them to be done better and in a more coordinated way.

“Locally, the goal is to create an infrastructure that provides lasting benefits to patients,” says Hicks. The hope is that infrastructure will be adaptable for other centres that are caring for patients with intersectional
vulnerabilities.

“We see people falling through the cracks,” says Hicks of cancer care. “We’re seeing a ton of advances, but if we don’t act, not everyone is going to benefit.” 

By Kaitlin Jingco
Kaitlin Jingco is a Communications Advisor at Unity Health.