Nunavut first began offering oncology services in-territory in July 2022, when an Iqaluit doctor, a team of physicians from The Ottawa Hospital and the Indigenous Cancer Care Program came up with a plan.
“We have not, in the past, given any chemo[therapy] drugs in the territory,” Dr. Francois de Wet, territorial chief of staff of physician services said. “We had no oncology [physicians] on staff, or internal medicine [doctors].”
Before July 2022, Nunavut patients seeking treatment for cancer had to be flown south, usually to Ottawa. There were issues with this approach that affected treatment, as doctors noted that not only were patients reluctant to be fully open about their conditions in case it meant a longer stay, but they were also separated from their support systems, home environments and communities — all of which are critical in the recovery process.
Subsequently, Dr. Patty DeMaio of Iqaluit’s Qikitani Hospital came up with the idea of piloting a program in a clinic based in Nunavut’s capital. She pitched the idea to her colleagues at The Ottawa Hospital: Dr. Marc Gaudet, Tim Asmis and Perry Gaudet, who looked at the number of patients from Nunavut undergoing treatment in Ottawa, and felt there were enough to justify a clinic in Iqaluit.
The drug Herceptin was used, which has multiple applications but is generally to treat breast cancer. A form of the drug can be administered under the skin. The results of the experimental clinic were that patients were very happy to be treated in-territory, and the pilot program was a success.
A similar form of the drug — Cepgo, was then also tried — now that a protocol for mixing and administering the pharmaceuticals had already been adopted. Last fall, the program was expanded to add a third drug: Pembro. In addition to three drugs now being administered to patients, the program has expanded to a total of three communities, including Pangnirtung and Pond Inlet, based on need and “enough people to make the clinic a good thing.”
In May 2023, de Wet, other medical colleagues and deputy minister of Health Megan Hunt, whom de Wet describes as “extremely supportive of the program,” held a conference in Iqaluit to discuss “where we want to be over the next couple of years” in terms of expanding cancer treatment options in the territory. Although there has been exciting changes and growth in terms of treatment options, there are still several large infrastructure obstacles the program faces before expanding further.
“Part of the challenge is space,” de Wet acknowledges.
Qikiqtani Hospital recently added a gynecology and psychiatry department, however, there is currently no pharmacist available in territory to mix and administer the appropriate drugs. Additionally, a larger clinic or department would require equipment, staff and housing that currently do not exist, although strides are being made and discussions are being had to address these problems.
“Those things are currently being investigated,” says de Wet, who also mentioned doctors from Nunavut who are working towards attaining an oncology certificate that would allow them to practice and treat cancer patients.
“What we would like to see are satellite cancer-care clinics from Ottawa, spaces in the territory where [treatment] can be administered safely,” says de Wet. “We are still a long way at this point. The main drive is to make sure we can deliver [treatment] safely,” he emphasizes. “We’re looking years down the road, but the vision is to have a cancer-care centre similar to Ottawa available in Iqaluit.”
At the moment, however, de Wet believes it’s more important to focus on the administration of cancer-fighting drugs in Nunavut.
“It’s positive,” he says of the program. “We definitely want to move this [program forward], and we’ve got amazing support from Ottawa… as well as the minister for Health, John Main. He’s been a great support as well.”