Strength, Culture and Survival: Resilience in Indigenous Cancer Journeys, a Scoping Review

Cancer is a universal human challenge, but for Indigenous Peoples around the world, the journey through diagnosis and treatment is often shaped by a unique set of historical and social forces. For generations, these communities have faced barriers to healthcare, including distance from treatment centers, the lingering effects of colonization, and systems that often fail to respect their cultural ways of knowing. While much medical research has focused on the statistics of who gets sick and who survives, a different question has begun to emerge: how do Indigenous people not only endure cancer but find strength and meaning while navigating it? This inquiry moves beyond looking at patients as victims of circumstance. Instead, it seeks to understand resilience—not as a personal trait that some people have and others lack, but as a complex web of support that grows from family, culture, spirituality, and connection to the land.

A team of researchers from Australia, Canada, and the United States set out to map this landscape of strength. They conducted a broad review of existing scientific literature, gathering thirty-three studies that involved more than 1,200 Indigenous adults who had experienced cancer. These studies came from four nations: the United States, Canada, Australia, and New Zealand. The researchers did not look for a single definition of resilience. Instead, they looked for the specific resources, relationships, and practices that helped people cope, hope, and live with dignity during their cancer journeys. By bringing these diverse stories together, the team aimed to see the full picture of how Indigenous communities navigate the illness, moving away from a view that focuses only on vulnerability and toward a clearer understanding of the power that already exists within these cultures.

The review revealed that resilience is not something an individual carries inside their head like a shield. Rather, it is a dynamic process that flows through relationships and cultural connections. The researchers identified five main areas where this strength appears. The most prominent source of resilience was social and relational support. In nearly every study reviewed, family, friends, elders, and community members were described as the foundation of the patient's ability to cope. This support was not just about emotional comfort; it was practical and essential. Family members provided transportation to appointments, helped with cooking and cleaning, offered financial assistance, and acted as advocates when patients faced confusing medical systems. For many Indigenous patients, the cancer journey was not a solitary experience but a collective one, shared with a network of people who helped interpret the illness and sustain hope.

Spirituality emerged as another profound pillar of strength. For many participants, faith was not limited to organized religion but included a deep connection to a higher power, ancestors, and the natural world. Prayer, meditation, and participation in spiritual gatherings provided a framework for understanding suffering and finding peace. Some patients drew strength from Christian practices, while others relied on traditional Indigenous ceremonies, or a blend of both. This spiritual dimension offered a sense of purpose and a way to connect with something larger than the illness itself. It helped patients make sense of uncertainty and provided a source of comfort that medical treatments alone could not offer.

Cultural continuity and traditional practices formed a third critical domain of resilience. The research showed that engaging with culture was a powerful way to maintain identity and strength during a time when cancer often disrupts daily life. Patients found solace in traditional healing methods, bush medicines, storytelling, and connection to the land. For some, tending to a garden or spending time in nature was a way to feel grounded and alive. For others, participating in ceremonies or speaking their native language helped preserve a sense of self that cancer could not take away. These practices were not merely nostalgic; they were active sources of healing that reinforced a patient's connection to their community, their ancestors, and the earth.

The fourth area of strength was individual agency and self-efficacy, but this was deeply intertwined with the other factors. Patients described having hope, optimism, and a determination to survive. They spoke of adapting to stress, reordering their priorities, and taking an active role in their care by asking questions and making decisions. However, the researchers noted that this individual strength rarely existed in isolation. It was often cultivated and sustained by the support of family, the guidance of elders, and the encouragement of the community. The ability to be strong was often a result of being supported, rather than a solitary act of will.

Finally, the relationship with healthcare professionals played a decisive role in whether these sources of strength could flourish. The review found that when doctors, nurses, and other staff treated patients with respect, listened to their cultural needs, and acknowledged their spiritual beliefs, it strengthened the patient's resilience. Conversely, when patients encountered racism, poor communication, or a lack of cultural understanding, it eroded trust and added to the burden of the illness. The researchers emphasized that the healthcare system itself is part of the social ecology of resilience; it can either support the patient's existing strengths or undermine them.

The findings of this review challenge the idea that resilience is simply a personal quality that Indigenous people must develop to survive a broken system. Instead, the evidence suggests that resilience is already present in the relationships, culture, and spiritual practices of these communities. The researchers argue that cancer services should not ask Indigenous people to become more resilient to inequitable systems. Instead, health systems need to change to recognize, respect, and strengthen the sources of resilience that already exist. This means creating space for family involvement, supporting cultural continuity, integrating spiritual care, and ensuring that healthcare providers build respectful, culturally safe relationships with their patients. By shifting the focus from fixing the individual to supporting the community and the culture, healthcare can better serve Indigenous peoples on their cancer journeys.