• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Engagement with First Nations, Inuit and Métis Communities: Formalizing Relationship Building and Cancer Control Planning

 
Measure Desired DirectionAs of this Report
Relationship Protocols signed with Cancer Care Ontario Black Arrow UpGrey Arrow Null
Number of Regional Cancer Programs with Regional Aboriginal Cancer Plans and engagement processes underway Black Arrow UpYellow Arrow up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

The Aboriginal Cancer Control Unit at Cancer Care Ontario has been working to develop Relationship Protocols and a Memorandum of Understanding between Cancer Care Ontario and First Nations, Inuit and Métis leadership. These documents formalize relationships with Aboriginal partners through mutual respect, recognition and understanding, and they highlight Cancer Care Ontario’s commitment to establishing strong foundational engagement structures necessary to achieve common goals and objectives.

The Aboriginal Cancer Control Unit has also been working closely with the Regional Cancer Programs to build regional capacity to lead direct engagement with local First Nations, Inuit and Métis communities in order to inform and implement initiatives that will address region-specific cancer control issues and needs. Currently, Regional Aboriginal Cancer Plans are being developed in partnership with First Nations, Inuit, and Métis peoples within 10 of the province’s 13 Regional Cancer Programs. These regional partnerships continue to be strengthened as most regions with Regional Aboriginal Cancer Plans have initiated direct engagement with the core First Nations, Inuit and Métis Health Tables in their respective regions to develop and implement this work together.

Who are the Aboriginal peoples of Ontario?

Three groups are recognized by Canada’s Constitution Act of 1982 as “the Aboriginal peoples of Canada,” who are explicitly defined as “the Indian [now referred to as “First Nations”], Inuit, and Métis peoples.” Together, the First Nations, Inuit and Métis people experience significantly poorer health outcomes than their non-Aboriginal peers including lower life expectancy1 and a higher burden of chronic conditions2. The lack of First Nations, Inuit and Métis-specific health data continues to hamper our collective ability to accurately determine and effectively address chronic disease prevention priorities in these at-risk populations.

First Nations

Prior to contact with Europeans, First Nations in Ontario represented diverse and stable communities whose economy and governance were sound and thriving. The arrival of Europeans and the resulting relocations, reserves, residential schools, environmental degradation, the Indian Act, rupture of families, denigration of culture, loss of self-worth and cultural identity dramatically impacted the First Nations way of life and all aspects of their health. There are approximately 202,960 First Nations in Ontario who are registered under the Indian Act, of whom 94,312 live on- reserve or on Crown lands (46%)3. Over one quarter of those living on-reserve live in special access communities with no year-round road access (28%)4. Additionally, Ontario is home to an estimated 75,540 First Nations without registered Indian status5. The First Nations in Ontario are young, with a median age of 30 years, compared to a median age of 40 for non-Aboriginal Ontarians6.

Métis

The genesis of Métis culture and nation dates back to the 1600s, when early European settlers first came into contact with local Indigenous communities. Early unions between these predominantly male fur trading European settlers and local Indigenous women led to the emergence of a new and highly distinctive Aboriginal people with a unique identity and consciousness. The majority (85%) of Métis people live in either the western provinces or in Ontario. Ontario has the second largest number of Métis, with 86,015 people (or 19% of all Métis living in Canada)5. In 2006, about two thirds (nearly 70%) of the Métis population in Canada lived in urban areas, slightly less than the non-Aboriginal population (81%). It is important to note, however, that Métis people living in urban areas are twice as likely as their urban non-Aboriginal counterparts to reside in smaller urban centres with populations of fewer than 100,000 residents (41% vs. 20%)7.

Inuit

Inuit in Ontario constitute a small but fast-growing population. There were 3360 Inuit living in Ontario in 20115. Compared to the Canadian population, the age structure of the Inuit population also is quite young, with more than half (58%) of the Inuit population under 25 years of age. Rapid Inuit population growth and the corresponding young age structure are demographic trends that are expected well into the future. The urban Inuit population continues to grow through high fertility rates and migration away from the Inuit traditional homeland, which stretches across Canada’s Arctic, from the Northwest Territories to Newfoundland. In 2011, 16,000 Inuit (26.9% of all Inuit in Canada) lived outside their homeland5. There are many reasons Inuit come to southern cities such as Ottawa. Some come for work, post-secondary education or housing, and many Inuit are living in Ontario due to long-term medical treatment— treatment that is not available in Inuit Nunangat (Inuit homeland).

Aboriginal cancer control

The Aboriginal Cancer Control Unit at Cancer Care Ontario works to improve the cancer system and journey for Ontario’s First Nations, Inuit and Métis people. It also strives to ensure that First Nations, Inuit and Métis people in Ontario have access to high-quality cancer prevention, screening and treatment services that are culturally appropriate and that incorporate the Aboriginal holistic approach to health and well-being.

Following a culture-based belief in the interconnection between the physical, mental, emotional and spiritual aspects of life, the Aboriginal Cancer Strategy III (ACS III) promotes a holistic approach to cancer education, prevention, screening and research. The ACS III builds on the success of previous cancer strategies by continuing on the path towards health equity and well-being for First Nations, Inuit and Métis peoples. As we move forward on this path, Cancer Care Ontario remains committed to improving upon the achievements made through the Aboriginal Cancer Strategy II (ACS II) in the past 3 years, including:

  • establishing Relationship Protocols with First Nations, Inuit and Métis groups across Ontario;
  • developing Regional Aboriginal Cancer Plans in concert with hiring 5 Aboriginal Project Coordinators and 10 Regional Aboriginal Cancer Leads and Aboriginal Navigators, gaining new knowledge of cancer in First Nations, Inuit and Métis communities; and
  • creating Aboriginal Relationship and Cultural Competency courses to increase understanding of history and knowledge in order to improve health outcomes and person-centred care.

Aboriginal Relationship and Cultural Competency courses

Cancer Care Ontario has launched its first Aboriginal Relationship and Cultural Competency courses online, to promote greater awareness of First Nation, Inuit and Métis history, culture and the health landscape, to help improve health outcomes and person-centred care.

The ARCC courses are a series of 9 courses that are geared to healthcare providers, professionals, administrators and others working with First Nations, Inuit and Métis people and communities. Each course takes about 60 minutes to complete and is accredited for 1.0 Mainpro-M1 credits, with the exception of 1 course, which takes about 30 minutes to complete and is accredited for 0.5 Mainpro-M1 credits.

Designed by the Aboriginal Cancer Control Unit, the ARCC courses help address the great need to understand the underlying history and challenges experienced by First Nation, Inuit and Métis populations. This, in turn, informs the healthcare system on key issues related to addressing health equity for these populations. Cancer Care Ontario is committed to developing a cancer system that ensures health equity for all Ontarians and the ARCC courses address a key recommendation from the Truth and Reconciliation Commission of Canada report: to provide skills-based training in intercultural competency, conflict resolution, human rights and anti-racism8.

Relationship Protocols

Cancer Care Ontario’s Aboriginal Cancer Control Unit has engaged in the development of Relationship Protocols with Ontario’s First Nations leadership (Political Territorial Organizations and Independent First Nations), the Métis Nation of Ontario, the Ontario Federation of Indigenous Friendship Centres and Inuit health service providers in Ontario. These Relationship Protocols formalize working relationships based on trust and mutual respect, create accountability for the delivery of the Aboriginal Cancer Strategies, and enable a culturally appropriate approach towards addressing cancer control for First Nations, Inuit and Métis communities in the province.

The use of a Protocol to formalize relations with First Nation, Inuit and Métis groups was adopted from the Ministry of Aboriginal Affairs, which recognizes protocol agreements as:

  • an agreement that recognizes the unique history and ways of life of Aboriginal communities in Ontario;
  • an agreement that sets a new course for a collaborative relationship between the Ontario government and Aboriginal people;
  • an agreement that is intended to improve the well-being of Aboriginal children, families and communities while protecting and promoting the distinct culture, identity and heritage of Aboriginal peoples; and
  • an agreement that encourages partnership opportunities that recognize and respect Aboriginal traditions.
Table 1. Relationship Protocols signed with First Nations, Inuit and Métis Leadership as of March 31, 2016
Organization/First NationDate of signing
Grand Council Treaty #3May 2013
Anishinabek Nation (Union of Ontario Indians)June 2013
Ontario Federation of Indigenous Friendship CentresJuly 2014
Nishnawbe Aski NationAugust 2014
Kitchenuhmaykoosib Inninuwug (Big Trout Lake) First NationOctober 2014
Métis Nation of Ontario (the agreement signed is a known as a Memorandum of Understanding) February 2015

Relationship Protocols have also been drafted with the Association of Iroquois and Allied Indians, Tungasuvvingat Inuit and other Independent First Nations. Cancer Care Ontario is awaiting guidance and direction from these groups regarding next steps.

Regional Aboriginal engagement

Regional Aboriginal Cancer Plans are blueprints for the implementation of Cancer Care Ontario’s ACS II and ACS III, and have been developed through close partnerships with First Nation, Inuit and Métis Health Tables and Regional Cancer Program leadership. The goal of the Regional Aboriginal Cancer Plans is to ensure that First Nations, Inuit and Métis people have a voice in the delivery of cancer services and that each plan reflects the unique needs of communities in each region of Ontario. Regional Aboriginal Cancer Plans have been developed in the 10 regions in Ontario with the highest First Nations, Inuit and Métis populations, including Champlain, Central East, Erie St. Clair, Hamilton Niagara Haldimand Brant, North Simcoe Muskoka, North West, North East, South East, South West and Toronto Central (North and South). The Aboriginal Cancer Control Unit is starting to work closely with the remaining 3 Regional Cancer Programs to address cancer control for the First Nations, Inuit and Métis populations in their regions.

The Aboriginal Cancer Control Unit has followed a 3 pillar approach towards building regional capacity to address cancer control issues/needs:

    • Meet with Regional Cancer Programs.
      An initial meeting was held to discuss Aboriginal Cancer Strategy priorities and targets, establish primary contacts and develop a working group within each Regional Cancer Program. The Aboriginal Cancer Control Unit, in close partnership with the Regional Cancer Program working group, developed a draft Regional Aboriginal Cancer Plan to outline steps to make the cancer system more effective and accessible for First Nations, Inuit and Métis people.
    • Work with established Aboriginal Health Tables.
      The Aboriginal Cancer Control Unit identified core Aboriginal (First Nations, Inuit, Métis, Friendship Centres, Aboriginal Health Access Centres and other Aboriginal groups) Health Tables (boards, committees and advisory groups) to provide guidance and feedback on the Regional Aboriginal Cancer Plans before finalization. This ensures that Aboriginal people in each region have a voice in the delivery of cancer services, and it allows the Regional Cancer Programs to engage directly, respectfully and sustainably with First Nations, Inuit, Métis and other Aboriginal groups.
    • Build Regional Cancer Programs capacity.
      Dedicated resources were established in the Regional Cancer Programs to address First Nations, Inuit and Métis cancer control issues effectively. Aboriginal Navigators provide support for First Nations, Inuit and Métis people and their families along every step of the cancer journey. Regional Aboriginal Cancer Leads champion the ACS III strategic vision by engaging and collaborating with healthcare providers across the matrix of primary care. Aboriginal Project Coordinators are being recruited in 5 Regional Cancer Programs to support the work of the Regional Aboriginal Cancer Leads in those regions. The Aboriginal Cancer Control Unit also employs 3 Partnership Liaison Officers to support the work of the Regional Cancer Programs and to ensure sustained engagement between Regional Cancer Programs, the Aboriginal Cancer Control Unit, First Nations, Inuit and Métis leadership, Health Tables and communities across Ontario.
  • The Aboriginal Cancer Control Unit has established regular reporting procedures to ensure that First Nations, Inuit and Métis leadership, provincial-level Health Tables and local First Nations, Inuit and Métis partners are engaged and informed regarding the Aboriginal Cancer Strategy progress. This also provides an opportunity to ensure that the partners are able to guide and provide feedback on the implementation of deliverables that impact their communities. As such, the Aboriginal Cancer Control Unit meets with Political Territorial Organization leadership (Grand Chiefs and Chiefs), First Nations Tribal Councils, local-level Health Tables and communities, the Métis Nation of Ontario Healing and Wellness Branch, Ontario Federation of Indigenous Friendship Centres, Inuit service providers and Aboriginal Health Access Centres.
  • A key component of developing Regional Aboriginal Cancer Plans is to ensure that engagement between the Regional Cancer Programs and the core Aboriginal Health Tables is sustained. Structures to sustain the engagement may take the form of new advisory committees or involve meeting with local groups that are already established (such as Aboriginal Health Circles). Regular meetings ensure that progress reports on the implementation of each Regional Aboriginal Cancer Plan are provided to First Nations, Inuit, Métis and other Aboriginal partners, and that these partners have the opportunity to provide feedback and guidance on all work undertaken to address cancer control within their communities. Work undertaken in ACS III will involve working closely with Regional Cancer Programs and core Aboriginal Health Tables to develop sustainable engagement structures in every region of the province, while continuing to engage closely with those already established.
Figure 1. Southern Ontario: Aboriginal communities—development of a Regional Aboriginal Cancer Plan, 2013–2015

Figure 2. Northern Ontario: Aboriginal communities—development of a Regional Aboriginal Cancer Plan, 2013–2015
click to close graph
Close Graph

What do the results show?

  • Table 1 provides an overview of Relationship Protocols and the Memorandum of Understanding, between Cancer Care Ontario and First Nations, Inuit and Métis leadership. These documents formalize relationships with Aboriginal partners through mutual respect, recognition and understanding, and they highlight Cancer Care Ontario’s accountability and commitment to establishing the strong foundational engagement structures necessary to achieve common goals and objectives.
  • The strength of the partnerships developed through the Relationship Protocol process has ensured a sustained, ongoing dialogue that has been instrumental to the implementation of Regional Aboriginal Cancer Plans that are resulting in improved access to services and person-centred care. These Protocols set a new course for the way Cancer Care Ontario will engage and collaborate with First Nations, Inuit, Métis and other Aboriginal groups to address increasing cancer incidence and mortality rates among Ontario’s Aboriginal populations.

Currently, Regional Aboriginal Cancer Plans are being developed in partnership with First Nations, Inuit, and Métis peoples within 10 of the province’s 13 Regional Cancer Programs.

  • Figures 1 and 2 provides an overview of the development of Regional Aboriginal Cancer Plans across Ontario.
  • Figure 3 shows the status of relationship building with regions of Ontario as measured by development of a Regional Aboriginal Cancer Plan, by time period (2013 to 2015 and 2015 to 2019). The Regional Cancer Programs responsible for serving the 10 regions in Ontario with the highest First Nations, Inuit and Métis populations each developed Regional Aboriginal Cancer Plans during the period of 2013 to 2015. For the period of 2015 to 2019, the Aboriginal Cancer Control Unit is working closely with each of the 13 Regional Cancer Programs in Ontario to develop updated Regional Aboriginal Cancer Plans based on ACS III that reflect provincial and regional First Nations, Inuit and Métis cancer control priorities.
  • Regional Aboriginal Cancer Plans are blueprints for making the cancer system work better for First Nations, Inuit, Métis and other Aboriginal groups in each region. Each plan is the result of close partnerships and dialogue among the Aboriginal Cancer Control Unit, Regional Cancer Programs and core First Nations, Inuit and Métis Health Tables. The collaborative and respectful engagement process employed to develop the Regional Aboriginal Cancer Plans ensures that each Plan represents the unique needs of (and belongs to) First Nations, Inuit, Métis and other Aboriginal groups in each region.

Regional partnerships continue to be strengthened as most of the regions with Regional Aboriginal Cancer Plans have engaged with all of the core First Nations, Inuit and Métis Health Tables in their respective regions to develop and implement this work together (Figure 4).

  • Figure 4 provides the percentage of core First Nations, Inuit and Métis Health Tables engaged by Regional Cancer Programs in Ontario during the period 2013 to 2015. This engagement process between the Regional Cancer Programs and core First Nations, Inuit and Métis Health Tables will continue throughout the lifetime of the third Aboriginal Cancer Strategy, and it will be supported by the Aboriginal Cancer Control Unit’s Partnership Liaison Officers.
  • Throughout the lifetime of ACS II (2013 to 2015), the Aboriginal Cancer Control Unit worked closely with the 10 regions in Ontario with highest First Nations, Inuit and Métis populations, as well as the Central region. With expanded capacity as a result of hiring an additional Partnership Liaison Officer in 2016, the Aboriginal Cancer Control Unit will be working closely with the remaining Regional Cancer Programs to provide direct support for relationship building and enhanced Aboriginal cancer control in every region in the province.

Why is this important to Ontarians?

A foundation of trust and mutual respect between Cancer Care Ontario and Ontario’s First Nations, Inuit and Métis leadership, Health Tables and communities is essential if we are to work together to improve cancer control for Aboriginal peoples in the province. For this reason, “Building Productive Relationships” is the First Strategic Priority of both ACS II and ACS III, and it is the foundational component of all work undertaken. In order to build, develop and maintain relationships with its First Nations, Inuit and Métis partners, Cancer Care Ontario recognizes First Nations, Inuit and Métis traditions and practices, and honours the unique histories, cultures and diversity of Aboriginal peoples in Ontario.

The mechanisms put in place by Cancer Care Ontario and the Regional Cancer Programs that have been outlined above set a course for a new relationship with First Nations, Inuit and Métis peoples and emphasize Cancer Care Ontario’s ongoing commitment to working appropriately, effectively and sustainably with First Nations, Inuit and Métis in Ontario. This approach is vital to ensuring that Ontario’s cancer system recognizes the first peoples of this province, understands their unique needs and works together in true partnership to address cancer control.

Find out more

View Notes

  1. Tjepkema M, Wilkens R, Senécal S, Guimond É, Penney C. Mortality of Métis and Registered Indian adults in Canada: an 11-year follow-up study. Health Rep. 2009; 20(4):31–51.
  2. Gionet L, Roshanafshar S. Study: select health indicators of First Nations people living off-reserve, Métis and Inuit 2007 to 2010. Ottawa: Stats Can; 2013.
  3. Indigenous and Northern Affairs Canada [Internet]. Ottawa: Government of Canada. Registered Indian population by sex and residence 2014—Statistics and Measurement Directorate; 2015 May 21 [cited 2015 Sep 4]. Available from: http://www.aadnc-aandc.gc.ca/eng/1429798605785/1429798785836#tbc1303.
  4. Chiefs of Ontario and Cancer Care Ontario. Cancer in First Nations in Ontario: risk factors and screening. Toronto: 2015.
  5. Statistics Canada. Aboriginal Peoples in Canada: First Nations people, Métis and Inuit: National Household
  6. Survey, 2011. Ottawa: Statistics Canada; 2013. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm.
  7. Statistics Canada. Aboriginal Peoples and language. Catalogue no. 99-011-X2011003 [Internet].
  8. Ottawa: Statistics Canada; [cited 2015 Sep 4]. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm#a4.
  9. Statistics Canada. Aboriginal Peoples in Canada in 2006. Inuit, Métis and First Nations, 2006 Census: Métis.
  10. Ottawa: Statistics Canada; 2008.
  11. Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada [Internet]. 2015. Available from: http://www.myrobust.com/websites/trcinstitution/File/Reports/Executive_Summary_English_Web.pdf.