Whether Inuit in Canada experience disparities in lung cancer survival remains unknown. When requiring investigation and treatment for lung cancer, all residents of Nunavik, the Inuit homeland in ...Quebec, are sent to the McGill University Health Centre (MUHC), in Montréal. We sought to compare survival among patients with lung cancer at the MUHC, who were residents of Nunavik and Montréal, Quebec, respectively.
We conducted a retrospective cohort study. Using lung cancer registry data, we identified Nunavik residents with histologically confirmed lung cancer diagnosed between 2005 and 2017. We aimed to match 2 Montréal residents to each Nunavik resident on sex, age, calendar year of diagnosis, and histology (non-small cell lung cancer v. small cell lung cancer). We reviewed medical records for data on additional patient characteristics and treatment, and obtained vital status from a provincial registry. We compared survival using Kaplan-Meier analysis and Cox proportional hazards regression.
We included 95 residents of Nunavik and 185 residents of Montréal. For non-small cell lung cancer, median survival times were 321 (95% confidence interval CI 184-626) days for Nunavik (
= 71) and 720 (95% CI 536-1208) days for Montréal residents (
= 141). For small cell lung cancer, median survival times were 190 (95% CI 159-308) days for Nunavik (
= 24) and 270 (95% CI 194-766) days for Montréal residents (
= 44). Adjusting for matching variables, stage, performance status, and comorbidity, Nunavik residents had a higher hazard of death (hazard ratio 1.68, 95% CI 1.17-2.41).
Nunavik residents experience disparities in survival after lung cancer diagnosis. Although studies in other Inuit Nunangat regions are needed, our findings point to an urgent need to ensure that interventions aimed at improving lung cancer survival, including lung cancer screening, are accessible to Inuit Nunangat residents.
Trauma care in Nunavik, Quebec, is highly challenging. Geographic distances and delays in transport can translate into precarious patient transfers to tertiary trauma care centres. The objective of ...this study was to identify predictors of clinical deterioration during transport and eventual intensive care unit (ICU) admission for trauma patients transferred from Nunavik to a tertiary trauma care centre.
This is a retrospective cohort study using the Montreal General Hospital (MGH) trauma registry. All adult trauma patients transferred from Nunavik and admitted to the MGH from 2010 to 2019 were included. Main outcomes of interest were hemodynamic and neurologic deterioration during transport and ICU admission.
In total, 704 patients were transferred from Nunavik and admitted to the MGH during the study period. The median age was 33 (interquartile range IQR 23-47) years and the median Injury Severity Score was 10 (IQR 5-17). On multiple regression analysis, transport time from site of injury to the MGH (odds ratio OR 1.04, 95% confidence interval CI 1.01-1.06), thoracic injuries (OR 1.75, 95% CI 1.03-2.99), and head and neck injuries (OR 3.76, 95% CI 2.10-6.76) predicted clinical deterioration during transfer. Injury Severity Score (OR 1.04, 95% CI 1.01-1.08), abnormal local Glasgow Coma Scale score (OR 2.57, 95% CI 1.34-4.95), clinical deterioration during transfer (OR 4.22, 95% CI 1.99-8.93), traumatic brain injury (OR 2.44, 95% CI 1.05-5.68), and transfusion requirement at the MGH (OR 4.63, 95% CI 2.35-9.09) were independent predictors of ICU admission.
Our study identified several predictors of clinical deterioration during transfer and eventual ICU admission for trauma patients transferred from Nunavik. These factors could be used to refine triage criteria in Nunavik for more timely evacuation and higher level care during transport.
Delivering trauma and surgical care to Northern Quebec presents unique challenges owing to the region's remoteness, extreme weather and limited transport; the expansion of telehealth could help ...address these difficulties. We aimed to evaluate current surgical, trauma and telemedicine capacity in Nunavik, Quebec.
We used validated assessment tools, including the Personnel, Infrastructure, Procedures, Equipment and Supplies survey, the International Assessment of Capacity for Trauma index and the Maryland Health Care Commission Telemedicine Readiness tool to evaluate surgical, trauma and telemedicine capacity, respectively. We adapted these tools to the Northern Quebec context through discussions with local leadership. Data were collected in 2 regional hospitals - the Ungava Tulattavik Health Centre (UTHC) and the Inuulitsivik Health Centre (IHC) - and 12 Centres locaux de services communautaires (CLSCs; local community services centres) in 6 villages along the Hudson Bay coast and 6 villages along the Ungava Bay coast through iterative discussions with 4 chief nurses from each regional hospital and set of CLSCs; resources were confirmed through on-site evaluation by the respondents. We performed a descriptive analysis of the data.
Surgical capacity was highest in the IHC (6.76) and lowest in the Ungava Bay CLSCs (5.52). Personnel (0%-0%) and procedures (13%-33%) were the least available resources. Trauma capacity was highest in the IHC (7.25) and lowest in the Hudson Bay CLSCs (5.58). Although equipment (90%-100%) and supplies (100%-100%) were readily available, personnel (0%-0%) and procedures (25%-56%) were lacking. The UTHC was most prepared for telehealth (67.80%), and the Ungava Bay CLSCs achieved a lower score (51.13%). Underdeveloped telehealth criteria included funding, administrative support, quality improvement and physical spaces (all 33%-67%).
Acute care capacity in Nunavik appears heterogeneous, with readily available equipment and supplies, but a lack of personnel capable of performing lifesaving procedures. To address the need for telemedicine, future initiatives should focus on improving funding, administrative support, physical spaces and quality-improvement initiatives.
Background: We have previously reported that same day dosing (SDD) of pegfilgrastim (PG) did not result in an increased incidence of negative outcomes as compared to filgrastim (G) administered the ...next day. (Watt et al. Pharmacotherapy . 2003; 23:406. #105). Age (≥ 65 years) is known to be a risk factor for febrile neutropenia in patients undergoing myelosuppressive chemotherapy.
Purpose/Methods: This study aims to assess the efficacy and safety of SDD of PG among older cancer patients for severity of neutropenia (grade 4), infection/neutropenia- related hospitalization, incidence of delayed administration (or dose reduction) of chemotherapy or any unplanned MD visits due to leukopenia (table). G administered subsequent to chemotherapy served as the control group. Patients ≥ 65 years with solid tumors who received fractionated dose chemotherapy at our institution between January 2001 and March 2004 were reviewed retrospectively. Patients who received chemotherapy initially at substandard doses were excluded.
Results: Patient demographics indicated that the two groups were evenly matched, with similar mean baseline absolute neutropenic counts (ANC). Distribution of cancer diagnoses is as follows: PG: breast (7), lung (8), GI (18) and others (2); G: breast (5), lung (9), GI (7) and others (4). Twenty-six (87%) and 21 (84%) patients had stage IV cancer in the PG and G groups, respectively. The mean ANC nadirs for PG and G were 2790±2190 cells/mm³ and 1820±1930 cells/mm³, respectively (p=0.01). For the outcome endpoints, although certain trends seemed to favor SDD of PG, none of the odd ratios (OR) performed reached statistical significance. Doses of PG and G were generally well-tolerated by all patients.
Conclusion: Concurrent administration of PG showed safety and efficacy at least comparable to G in elderly patients receiving fractionated dose chemotherapy. Such administration schedule has the potential to further simplify the outpatient management of chemotherapy-induced neutropenia, providing the needed convenience for elderly patients as well as caregivers. However, further prospective study is warranted.
PGGp-value; OR (95% CI)No. patients3025No. cycles5954Age (range)68.8 (65–79)68.3 (65–72)Gender (female)18 (60%)15 (60%)ANC before chemo±SD(cells/mm³)4530±18504790±2600p=0.539ANC nadir±SD (cells/mm³)2790±21901820±1930p=0.01Severe Neutropenia (grade IV)9 (15%)15 (28%)OR=0.47; (0.19, 1.18)Unplanned MD visit7 (12%)3 (5.6%)OR=2.28; (0.56, 9.34)Chemo delayed/dose reduced9 (15%)11 (20%)OR=0.70; (0.27, 1.86)Hospitalization7 (12%)5 (9.3%)OR=1.32; (0.39, 4.44)data were analyzed based on cycles
