Navigating Cancer Care: How to Advocate for First Nations' Health
"Understanding the unique barriers and cultural considerations in cancer treatment for Indigenous communities in Canada."
For First Nations people living in rural and remote communities in Canada, accessing cancer treatment often means making a difficult choice: commuting long distances or relocating to an urban center. These decisions are further complicated by historical and systemic issues that affect healthcare experiences and create jurisdictional confusion. As cancer rates rise within First Nations populations, it's more important than ever to address these challenges and ensure equitable access to care.
The Ojibway word for cancer, 'Matajoosh,' translates to 'worm eating at your insides,' reflecting the devastating impact of the disease. Cancer has become a leading cause of death among First Nation males and the second leading cause among First Nation females in Canada. Disparities in cancer mortality rates highlight the urgent need for improved healthcare access and culturally sensitive support.
This article will explore the experiences of First Nations individuals navigating cancer care in Manitoba, Canada. By understanding the barriers they face and the perspectives of healthcare providers, we can work toward a whole-systems approach that addresses these limitations and promotes better health outcomes for First Nations communities.
Cancer Outcomes and Data
In 2025, First Nations cancer age-standardised mortality in Australia was estimated at 105 deaths per 100,000 people, compared with 58 deaths per 100,000 among non-Indigenous people. The Australian Institute of Health and Welfare also reported that First Nations pancreatic cancer 5-year relative survival was 8.8% in 2017–2021, compared with 19% for non-Indigenous people. The First Nations Data Centre provides access to published, unpublished, and record-level data from national survey work, supporting more informed understanding of these outcomes.
From Tradition to Self-Determination
The First Nations Health Authority describes the lands now known as British Columbia as having been populated by First Nations ancestors since time immemorial, with oral traditions conveying multiple Origin stories. A 2024 Canadian perspective on cancer care emphasizes that Indigenous self-determination, data governance, access to care, and research contribute to improved outcomes and wellness across the cancer journey. The Canadian Partnership Against Cancer's 2023–24 work included strengthening relationships with Indigenous partners and organizations while advancing First Nations, Inuit and Métis cancer priorities.
Understanding the Barriers: A Closer Look at the Challenges
Research reveals that healthcare providers, including social workers, physicians, nurses, patient navigators, and administrators, are often committed to assisting patients and families. However, their focus tends to remain on the clinical aspects of care, sometimes overlooking the broader context that significantly impacts access to cancer services. This includes factors such as jurisdictional issues, policy limitations, and the unique socio-historical experiences of First Nations peoples.
- Delayed Diagnosis: Challenges in accessing timely screenings and diagnostic services in rural and remote communities often lead to delayed diagnoses.
- Poor Care Coordination: Jurisdictional complexities and lack of communication between healthcare providers can result in fragmented care and logistical difficulties.
- Logistical Complexities: The burden of coordinating transportation, accommodation, and other essential needs can lead to fatigue and undermine adherence to treatment plans.
- Systemic Limitations: Providers and decision-makers, even when aware of the broader context, often lack the authority or resources to address the systemic issues contributing to these barriers.
Research on Cancer Care Decisions
Lavoie, Kaufert, Browne and O’Neil's 2016 study, “Managing Matajoosh: determinants of first Nations’ cancer care decisions,” examined factors shaping First Nations cancer care decisions. A qualitative study on preventive care among First Nations people at risk of lower extremity amputation used a community participatory research design and engaged representatives from two communities. Other reviews describe how jurisdictional confusion, previous negative healthcare experiences, and a lack of culturally relevant support can complicate cancer care and contribute to some First Nations people deciding against treatment.
Limits of the Evidence
The study “Managing Matajoosh: determinants of first Nations’ cancer care decisions” identifies a key limitation: its findings are based on interview data. Interview-based findings can provide insight into participants’ experiences and decisions, but the source does not establish that they represent all First Nations cancer care decisions. This limitation should be considered when interpreting the study's conclusions.
Disparities and Data Gaps
A 2025 analysis found that Indigenous peoples received marginally less cancer surgery than non-Indigenous peoples, with the lowest surgery prevalence among respiratory and hepatobiliary cancers and the highest among reproductive and urinary system cancers. Comparative evidence from Canada describes widening cancer-related disparities, although population-level evidence has limitations. Other research cautions that limited resources and inconsistent cancer data collection, together with Indigenous data sovereignty considerations, can prevent a complete picture of cancer burden worldwide.
Moving Forward: A Call for Systemic Change
Addressing the disparities in cancer care for First Nations individuals requires a fundamental shift toward a whole-systems approach. This includes enhancing access to early diagnostic pathways, implementing cross-jurisdictional case management, and addressing the broader social determinants of health. By working in partnership with First Nations communities, healthcare providers and policymakers can create a more equitable and culturally responsive cancer care system that improves outcomes and honors the unique needs of Indigenous peoples.
Systemic Barriers to Care
Cancer incidence and mortality among First Nations, Inuit and Métis peoples in Canada continue to rise in contrast to non-Indigenous Canadians, according to a 2021 review. The review also identifies jurisdictional and administrative challenges as barriers to high-quality cancer care. In Ontario, First Nations peoples face increasing cancer rates and poorer survival, while lower participation in cancer screening presents an additional challenge.
Support Through the Cancer Journey
Indigenous cancer survivors have emphasized the importance of support systems when accessing cancer care. These supports include family and community resources, culture, and First Nations and Métis health support services. A Canadian study also reports limited access to culturally safe and individualized survivorship care and highlights the distinct challenges and strengths of Indigenous people living with cancer.