Access to cancer care among Indigenous peoples in Canada: A scoping review

The inequities in access to healthcare documented and experienced by Indigenous peoples in Canada are startling given Canada's publicly funded and 'equally accessible' healthcare system, however little is known about access to cancer care, and barriers to accessing cancer care in particular. We conducted a scoping review to identify what is known about barriers to accessing cancer care among Indigenous peoples in Canada (including barriers to accessing cancer services, and barriers to receiving optimal care once those services were accessed), and to identify where along the cancer continuum (screening, diagnosis, treatment, etc.) these barriers are located. We searched SCOPUS, EBSCOhost, Google Scholar, Ovid MEDLINE and Ovid EMBASE for studies published between 1996 and 2019 that examined access to cancer care for Indigenous peoples in Canada; 36 studies were included in our analysis. Our review indicates that Indigenous peoples face barriers to accessing care at the individual level (factors at the level of the individual patient or healthcare provider (HCP) that impede access to cancer care), at the systems level (factors stemming from the healthcare system and its structure), and at the structural level (factors that are embedded within and systematically produced political, historical, social or economic structures). While barriers to accessing cancer care were found throughout the trajectory, there remains a disproportionate focus on access to cancer screening. Moreover, some barriers to accessing cancer care, such as racism, discrimination and lack of culturally safe care, although rooted in structural factors, were inconsistently framed as individual and/or systems factors. This suggests that while there is growing awareness of the impact that racism and discrimination have on access to cancer care at the individual level for example, there remains a lack of understanding of how these issues are linked with systemic and structural issues.