Delays in the Pathway to Cancer Diagnosis in Samoa: A Qualitative Study of Patients’ Experiences

Abstract

Cancer is a leading cause of death in Samoa, with cancer patients presenting late and experiencing poor outcomes. Barriers to early diagnosis are complex, and cultural factors play an important part. This qualitative study explored the barriers to cancer diagnosis in Samoa through semistructured interviews conducted with 19 Samoan patients. Thematic data analysis was informed by socioecological theory and yielded 4 themes: knowledge and beliefs about cancer; pain as a trigger for health care–seeking behavior; follow-up issues; and communication and trust. Cancer knowledge and attitudes toward pain were strongly influenced by culture and community beliefs. Lack of follow-up resulted in significant delays, and ineffective patient-doctor communication triggered feelings of uncertainty and mistrust in the health care system. Efforts to address knowledge gaps will not be effective unless they are accompanied by broader strategies addressing local health care capacity issues. Adopting a socioecological framework lens within a regional collaborative approach provides a way forward.

The Vave campaign: impact evaluation of a cancer awareness raising multi-media campaign in Samoa

“…The improved cancer awareness achieved through the community outreach education sessions resonates with the acknowledged importance of taking a grassroots approach to reaching underserved and/or geographically remote communities ( Northington et al , 2011 ). The lack of improvement reported around understanding the risk factors and cancer symptoms is consistent with previous research that has suggested cultural norms and beliefs that cancer is a western illness are acting as barriers to raising community awareness ( Cuesta-Briand et al, 2021a , b ). This suggests the need to draw in community partners such as traditional healers, chiefs and church leaders to support multiple strategies that address these misconceptions to increase depth of community knowledge.…”

“…In addition, data from a WHO pilot study conducted with Samoan cancer patients found that many had relied on traditional medicine pre-diagnosis and that lack of trust in the healthcare system resulted in delays to seeking diagnosis and treatment (WHO, 2016, Insight into the experiences of patients seeking healthcare in Samoa, unpublished data). A more recent study with Samoan cancer patients corroborates these findings highlighting the importance of cultural barriers to early detection ( Cuesta-Briand et al , 2021a ). Churches in Samoa play a central role in Samoan culture and village life making churches an appropriate place for health promotion ( Holmgaard, 2019 ).…”

“…Early detection and early intervention increase the likelihood of successful cancer treatment ( Allgar and Neal, 2005 ). Data collected by the Samoa Cancer Society (SCS) suggest that many patients present late, and due to the absence of chemotherapy and radiation treatment services locally, treatment options for these patients are limited ( Cuesta-Briand et al , 2021a ). Chemotherapy and radiation treatment are available through Samoa’s Overseas Treatment Scheme, which covers the cost of cancer treatment in New Zealand or India (SCS, 2018, Cancer patient registry, unpublished data).…”

“…International evidence shows that the reasons for delayed presentations among cancer sufferers are complex and multifactorial, and include demographic, clinical, financial, psychosocial and cultural factors ( Macleod et al , 2009 ; Cuesta-Briand et al 2021a ). Research conducted with Samoan populations living in the USA showed that there is a belief that cancer is not a Samoan illness but, rather, an illness brought by Westerners ( Hubbell et al , 2005 ), and that cancer cannot be cured and means death ( Ishida et al, 2001 ).…”