Dr. Ambreen Sayani presented on social inequalities and cancer. The presentation discussed definitions of social class and models of how social class influences health inequities. Bartley's models of health inequities including behavioral, psychosocial, material, and life-course models were used to understand how social class affects cancer risk and mortality, using lung cancer as an example. Data showed significant differences in health outcomes and mortality rates based on social class and neighborhood income.

1. Social Inequalities and Cancer
Dr. Ambreen Sayani, MD PhD
6th April 2023

2. Session objectives
• Discuss theories and definitions of social class
• Describe the link between social class and
health inequities
• Use Bartley’s models of health inequities to
understand how social class influences cancer
risk and mortality using lung cancer as an
example.

3. Agenda
Terms

4. Agenda
Terms
Concepts and
models

5. Agenda
Terms
Call to
action
Concepts and
models

6. WHAT DO WE MEAN BY SOCIAL
CLASS?

7. Social class is a term used to describe a group of people
who occupy a similar rank in terms of economic
(wealth), social (personal networks) or cultural
(knowledge) capital. This is determined by the
distribution of power, privilege and prestige across a
society.
Social class
7
Source: Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer Screening.
https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

8. Social inequity is a term which is used to describe the
unequal distribution of power, privilege and prestige
across a society. Inherently, individuals who occupy
positions of social advantage by virtue of their personal
wealth and credentials are more able to access
resources and services thereby creating further
differentiation between social groups.
Social inequity
8
Source: Sayani, A. (2019) Health equity in national cancer control plans: An analysis of the Ontario Cancer Plan. International Journal of Health Policy and
Management 8(9), 550–556

9. When social inequality becomes systematically
entrenched in a society such that it is institutionalised
into policies and procedures that continue to
differentiate between social groups, it is called social
structural inequality or social stratification.
Social structural inequity
9
Source: Sayani, A. (2019) Health equity in national cancer control plans: An analysis of the Ontario Cancer Plan. International Journal of Health Policy and
Management 8(9), 550–556

10. HOW IS SOCIAL CLASS MEASURED?

11. Measures of social class
• Occupation
• Education
• Income
Source: Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and
Healthcare, 3rd edition. Toronto: Canadian Scholars Press Inc.

12. WHAT IS THE RELATIONSHIP BETWEEN
SOCIAL CLASS AND HEALTH?

13. Life expectancy at
birth by
neighbourhood
income and sex, urban
Canada, 1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health
Inequalities

14. Infant mortality rate
by neighbourhood
income, urban
Canada, 1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities

15. Age-standardized
mortality rates for
ischemic heart disease
by neighbourhood
income, male,
urban Canada, 1971-
2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities

16. Age-standardized
mortality rates for
lung cancer by
neighbourhood
income, female, urban
Canada, 1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities

17. HOW SIGNIFICANT ARE THE
DIFFERENCES IN HEALTH OUTCOMES?

18. Income and mortality
Canadians were divided into five
quintiles of approximately equal
numbers from poorest to
wealthiest.
Source: Tjepkema, M., Wilkins, R., & Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health
Reports, 24(7), 14–22.

19. Income and mortality
Over a 16 year period, the number
of deaths of the wealthiest 20% of
Canadians was compared to the
other 80% of Canadians.
Source: Tjepkema, M., Wilkins, R., & Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health
Reports, 24(7), 14–22.

20. Income and mortality
If all Canadians were as healthy as
the top 20% of income earners,
there would be approximately
40,000fewer deaths each
year, every year.
Source: Tjepkema, M., Wilkins, R., & Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health
Reports, 24(7), 14–22.

21. Income and mortality
If all Canadians were as healthy as
the top 20% of income earners,
there would be approximately
40,000fewer deaths each
year, every year.
THAT IS
EQUIVALENT TO
110DEATHS
EACH AND
EVERY DAY
Source: Tjepkema, M., Wilkins, R., & Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health
Reports, 24(7), 14–22.

22. THAT IS EQUIVALENT TO
110DEATHS EACH AND
EVERY DAY
Source: Tjepkema, M., Wilkins, R., & Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health
Reports, 24(7), 14–22.

23. HOW DO SOCIAL MODELS HELP US
UNDERSTAND HEALTH INEQUITIES?

24. Bartley’s models of health inequities
• Behavioural
• Psychosocial
• Material
• Life-course
Source: Bartley, M. (2014; 2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons.

25. Behavioural model of health inequities

26. Sociopolitical forces shape social
structure
Social stratification determines
possibilities of choice
Individual health choices and
behaviours determined by social class
Clustering of risky lifestyle behaviours
based on social class
Behavioural model of health inequities
Source: Bartley, M. (2014; 2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons; Sayani A.(2019), Social Class and
Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc; Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer
Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

27. Psychosocial model of health
inequities
27

28. Sociopolitical forces shape distribution of societal
power, privilege and prestige
Social stratification determines hierarchy on ladder of
social privilege
Chronic feelings of subordination and oppression and
activation of stress response depends on social
position
Higher predisposition to disease based on social class
Psychosocial model of health
inequities
Source: Bartley, M. (2014; 2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons; Sayani A.(2019), Social Class and
Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc; Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer
Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

29. Material model of health inequities
29

30. Sociopolitical forces shape distribution of
the social determinants of health (SDH)
Social stratification determines access to
the SDH (income, education etc)
Access to the SDH enables individuals to
avoid risk, seek care
Lower access to quality care based on
social class
Material model of health inequities
Source: Bartley, M. (2014; 2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons; Sayani A.(2019), Social Class and
Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc; Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer
Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

31. Life-course model of health inequities
31

32. Sociopolitical forces influence health
risk over the life-course
Social stratification determines
degree/ duration of risk exposure
Cumulation and embodiment of risk
over time leads to poor health
Vulnerability to disease and health
outcomes determined by social class
Life-course model of health inequities
Source: Bartley, M. (2014; 2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons; Sayani A.(2019), Social Class and
Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc; Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung Cancer
Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

33. USING SOCIAL MODELS TO
UNDERSTAND INEQUITIES IN CANCER
CARE
33

34. The Cancer Care Continuum
Prevention
Early
detection
Diagnosis Treatment
Survivorship
End-of-life
care

35. The Cancer Care Continuum
Prevention
Early
detection
Diagnosis Treatment
Survivorship
End-of-life
care
Source: Sayani, A., et al. (2021). “My Cancer Is Worth Only Fifteen Weeks?” A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in Canada.
International Journal of Health Policy and Management. Sayani, A. (2017). Socially based inequities in breast cancer care: intersections of the social determinants
of health and the cancer care continuum. Women’s Health & Urban Life: An International and Interdisciplinary Journal, 13(1)
.

36. The Cancer Care Continuum
• Breast cancer Sayani, A. (2017). Socially based inequities in breast cancer care:
intersections of the social determinants of health and the cancer care continuum.
Women’s Health & Urban Life: An International and Interdisciplinary Journal, 13(1)
• Hereditary breast cancer Sayani, A. (2018). Inequities in genetic testing for
hereditary breast cancer: Implications for public health practice. Journal of Community
Genetics, 1–5.
• Lung cancer Sayani, A et al (2023). Interventions Designed to Increase the Uptake
of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clinical and
Research Reports, 4(3); Sayani, A et al (2021). Advancing health equity in cancer care:
The lived experiences of poverty and access to lung cancer screening, Plos One, 16(5),;
Sayani, A et al (2021). Perspectives of family physicians towards access to lung cancer
screening for individuals living with low income – a qualitative study. BMC Family
Practice, 22(1), 10.
• Social class and health inequalities Sayani A. (2019), Social Class and
Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive:
Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto: Canadian
Scholars Press Inc.
• Income and health Wankah, P.; Awil, F Sayani A. (forthcoming), Income and
Health, Raphael, D, In Social Determinants of Health: Canadian Perspectives, 4th
edition. Toronto: Canadian Scholars Press Inc

37. DEEP DIVE: LUNG CANCER CARE
CONTINUUM
37

38. Social gradient in lung cancer survival
38
Source: Dabbikeh, A., Peng, Y., Mackillop, W. J., Booth, C. M., & Zhang-Salomons, J. (2017). Temporal trends in the association between socioeconomic
status and cancer survival in Ontario: A population-based retrospective study. Canadian Medical Association Open Access Journal, 5(3), E682–E689

39. Behavioural model of cancer inequities
Sociopolitical forces shape social
structure
Social stratification determines
possibilities of choice
Individual health choices and
behaviours determined by social
class
Clustering of risky lifestyle behaviours
based on social class
Source: Sayani, A et al (2023). Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clinical and
Research Reports, 4(3); Sayani, A et al (2021). Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening, Plos
One, 16(5),; Sayani, A et al (2021). Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative
study. BMC Family Practice, 22(1), 10.Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung
Cancer Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

40. Sociopolitical forces shape distribution of
societal power, privilege and prestige
Social stratification determines hierarchy on
ladder of social privilege
Chronic feelings of subordination and
oppression and activation of stress response
depends on social position
Higher predisposition to disease based on
social class
Psychosocial model of cancer inequities
Source: Sayani, A et al (2023). Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clinical and
Research Reports, 4(3); Sayani, A et al (2021). Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening, Plos
One, 16(5),; Sayani, A et al (2021). Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative
study. BMC Family Practice, 22(1), 10.Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung
Cancer Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

41. Sociopolitical forces shape distribution of
the social determinants of health (SDH)
Social stratification determines access to
the SDH (income, education etc)
Access to the SDH enables individuals to
avoid risk, seek care
Lower access to quality care based on
social class
Material model of cancer inequities
Source: Sayani, A et al (2023). Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clinical and
Research Reports, 4(3); Sayani, A et al (2021). Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening, Plos
One, 16(5),; Sayani, A et al (2021). Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative
study. BMC Family Practice, 22(1), 10.Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung
Cancer Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

42. Sociopolitical forces influence health risk over
the life-course
Social stratification determines degree/
duration of risk exposure
Cumulation and embodiment of risk over
time leads to poor health
Vulnerability to disease and health outcomes
determined by social class
Life-course model of cancer inequities
Source: Sayani, A et al (2023). Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clinical and
Research Reports, 4(3); Sayani, A et al (2021). Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening, Plos
One, 16(5),; Sayani, A et al (2021). Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative
study. BMC Family Practice, 22(1), 10.Sayani, A. (2020). Patient Perspectives on Health Seeking Behavior: Understanding Lived Experiences of Poverty and Lung
Cancer Screening. https://yorkspace.library.yorku.ca/xmlui/handle/10315/37705

43. SOCIOLOGICAL PERSPECTIVES HELP
US UNDERSTAND LOCI OF ACTION

44. Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.
Improving health outcomes:
Thinking about a river stream
UPSTREAM
MIDSTREAM
DOWNSTREAM
➢ Strategies to improve health fall into one of these
three categories.

45. Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.
Improving health outcomes:
Thinking about a river stream
• To act upstream means to act at a community level.
• This means focusing on policies which shape the distribution
of the social determinants of health.
• An example would be providing all citizens with a living wage.
UPSTREAM

46. Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.
Improving health outcomes:
Thinking about a river stream
MIDSTREAM
➢ To act midstream means to act at the individual level.
➢ This means focusing on ways to improve health
opportunities for individuals.
➢ An example would be promoting health lifestyle
behaviours for people to adopt.

47. DOWNSTREAM
➢ To act downstream means to
target disease treatment.
➢ This can mean focusing on
cellular mechanisms.
➢ An example would be drugs
that target biological pathways.
Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.
Improving health outcomes:
Thinking about a river stream

48. Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.
Improving health outcomes:
Thinking about a river stream
UPSTREAM
MIDSTREAM
DOWNSTREAM
➢ As we go further and further downstream health
benefits become more personalised.
➢ As such, the benefits are limited to those who can
adopt change, or get timely treatment.
➢ Strategies that are upstream however tend to benefit
everyone, and as such health benefits are of a larger
scale across the population.

49. Cancer inequities: Intervention levels
Downstream
Cellular
mechanisms
Biological and
physiological
pathways
Midstream
Individual’s
Health
behaviours and
preventative
health habits
Upstream
Society
Social
determinants of
health and
global economic
forces
Approach
Locus of
action
Processes
Sayani A. (2019), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.

50. Lifestyle drift
Source: Carey, G., Malbon, E., Crammond, B., Pescud, M., & Baker, P. (2017). Can the sociology of social problems help us to understand and manage “lifestyle drift”? Health Promotion
International, 32(4), 755–761..

51. Fundamental cause theory
Source: Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 80–94.

52. REDISTRIBUTING INCOME FOR A MORE
EQUAL AND HEALTHIER SOCIETY

53. Income inequality is the extent to which income is
distributed unevenly in a country.
Income inequality

54. $$$$$
49%
$$$$
22%
$$$
14%
$$
9%
$
6%
HOUSEHOLD WEALTH BY INCOME
QUINTILE
$$$$$ $$$$ $$$ $$ $
How is the Canadian income pie split?
Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census.

55. Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census.
$$$$$
49%
$$$$
22%
$$$
14%
$$
9%
$
6%
HOUSEHOLD WEALTH BY INCOME
QUINTILE
$$$$$ $$$$ $$$ $$ $
How is the Canadian income pie split?

56. Source: Conference board of Canada. (2011). Canadian Income Inequality, Is Canada becoming more unequal?
The Gini Index

57. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.
Who has more money?

58. Who has more money?
Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.

59. Who has more money?
Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.

60. What is driving the gap?
Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.

61. Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.
What is driving the gap?

62. What is driving the gap?
Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.

63. What is driving the gap?
Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.

64. What is the big deal?
Source: Sayani, A., et al. (2021). “My Cancer Is Worth Only Fifteen Weeks?” A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in
Canada. International Journal of Health Policy and Management.

65. Social health versus economic wealth
SHI
GDP
Social Health Index:
• Infant mortality
• Child abuse
• Child poverty
• Teen suicide
• Drug abuse
• School drop-out
• Unemployment
• Weekly earnings
• 65+yrs in poverty
• Out-of-pocket health
expense
• Homicides
• Alcohol-related fatalities
• Social assistance use
• Affordable housing
• Gap between rich and poor
Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–216.

66. What does it look like?

67. What does it look like?

68. What does it look like?

69. What does it look like?

70. Social gradient in lung cancer survival
70
Source: Dabbikeh, A., Peng, Y., Mackillop, W. J., Booth, C. M., & Zhang-Salomons, J. (2017). Temporal trends in the association between socioeconomic status and cancer
survival in Ontario: A population-based retrospective study. Canadian Medical Association Open Access Journal, 5(3), E682–E689

71. In summary
• Social, political and economic decisions shape how a
society is structured.
• Unequal distribution of resources (social capital/
material wealth) create hierarchical differences between
population groups – this has implications for health.
• Social class profoundly influences cancer risk,
prevention, early detection and access to quality care.
• Loci of action can be downstream, midstream and
upstream.
• Unless there is upstream action to evenly distribute
resources we will not make a significant impact on the
fundamental causes of inequities in cancer care.

72. Remember
• Income inequality is
NOT inevitable, it
occurs as result of
social and political
choices.
• This means that we
can make better
choices moving
forward.

73. Call to action
• Recognise the forces that create income inequality;
• Understand how income inequality runs through the
whole of society impacting everyone not just the most
deprived;
• Improve communication between different sectors
regarding the implications of income inequality;
• Use the media to educate Canadians about the
consequences of income inequality;
• Lobby governments to maintain community, health and
social services that positively affect health and well-
being;
• Advocate for a health-in-all policies approach.
Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–
216.

74. Thank you
• Contact: Ambreen.Sayani@Wchospital.ca
74

75. Canadian Cancer Survivor Network
Contact Info
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Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
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