Thank you.
Good morning, Mr. Chairman, committee members and fellow witnesses. I am Dr. Ambreen Sayani. I am a scientist at Women's College Hospital and an assistant professor at the University of Toronto.
I lead a person-centred research program focused on promoting cancer prevention, early detection and access to high-quality care for all. I supervise our next generation of learners, including graduate and medical students. In my role as health equity expert adviser to the Canadian Partnership Against Cancer, I guide the partnership's efforts to achieve equitable access to quality cancer care for all people in Canada. In 2020, I co-founded a group called EMPaCT, which engages directly with members of the community from underserved populations to give them direct influence on health care decisions. I am also an international medical graduate. I practised surgical oncology before moving to Canada.
From my community-engaged work, I want to give you some insight into the lived experiences of three women with cancer in Canada.
The first is a 65-year-old woman with colon cancer. Let's call her Audrey for the purposes of today. She said, “You have no idea how time consuming it is to be poor. You spend so much time proving you are poor, by getting photocopies of things. Plus, I am dealing with the fact that I am dying. It is so terrible”.
The second is a young adult bone and lung cancer survivor. We will call her Fatima for today. She said, “As newcomers to Canada, my parents did not know anyone or the system. Our primary care doctor didn't take my symptoms seriously and we did not know how to advocate for ourselves”.
The third, Maria, is a 71-year-old woman who has since died of cervical cancer. She said, “I went into the hospital, and I got treated so badly. I don't want to go back. I don't want to go through that ever again.”
Mr. Chairman and committee members, in Canada we are supposed to have universal access to cancer care, yet cancer care is not universally accessible to all. One out of every five women diagnosed with cancer will die from the disease. Last year 40,200 women died of cancer in Canada. That is on average 110 women a day, but not all women have the same risk of dying from cancer. Such factors as racism, sexism, ableism, classism and ageism can be the difference between life and death from cancer.
For women, biological sex influences susceptibility to certain types of cancer, while socially and culturally constructed gender roles impact women's cancer outcomes by influencing their health literacy, their health care-seeking behaviours and access to health care. Issues related to financial hurdles, geographic challenges, lack of transportation and limited availability of culturally and linguistically appropriate services directly contribute to delays in cancer diagnosis, inadequate treatment and poor quality of care.
For indigenous peoples, racialized communities, people living with low income and gender-diverse individuals, issues of systemic racism and discrimination lead to poor care experiences, avoidance of care and missed diagnosis. This can occur in part because of a lack of competencies to deliver equity-oriented health care in the workforce and services that are not designed to respond to their needs.
As a country, we've made strides in cancer prevention, detection and survivorship. These efforts include the implementation and coordination of preventative measures, organized cancer screening and design of innovative models of care. However, as I have shared with you today, care gaps are evident. They will require concerted and multipronged efforts across all sectors to address the root causes of social inequalities so that we can improve health outcomes for all women by elevating their living and working conditions.
In conclusion, I want to recommend three areas for action based on the lived experiences that I have shared with you today.
For women like Audrey, who are experiencing financial toxicity, we need to reduce the administrative burden of accessing the resources required to support cancer care. More broadly, this implies that we must invest resources to understand and respond to the real-life experiences of patients, with a focus on engaging those who are marginalized and underserved.
Second, for women like Fatima, who experience multiple barriers to care, we need culturally and linguistically accessible care pathways. To achieve this more broadly, we must strengthen community-based care and focus on diversifying the health care workforce so that it is representative of the populations it serves.
Last, for women like Maria who experience discrimination, we need to train and raise awareness across the health and social sector on the historical and systemic factors that shape health. Responsive care can lead to better health outcomes.
Thank you for inviting me to share my perspective.