Samoa struggling to manage cancer

Samoa is struggling to keep up with rising incidences of cancer, a report on cancer control released by one of the world's oldest and most prestigious medical journals has found. 

With no national plan in place for either cancer and other non-communicable diseases (N.C.D’s), Samoa can expect a bigger healthcare burden in the future, according to the research, published in the Lancet. 

The report, published by Lancet Oncology on Tuesday, examined cancer control in small island nations, and was co-authored by medical professionals from across the region including three from Samoa. 

Its recommendations are going before the Pacific Health Ministers' Forum in Tahiti this week.

They include implementing a regional approach to cancer control to counter limited resources, strengthening palliative care within a decade, increasing HPV (Human Papilloma Virus) vaccines and cervical cancer screening, and collecting more data on the rates at which cancer is occurring and being survived by sufferers. 

Samoa does not have a national cancer plan or non-communicable diseases (N.C.D’s) plan, or vaccine or screening programs for cervical, breast and bowel cancers, like most Pacific Islands countries, the report found. 

In Samoa, the most common cancers found in men are reported to be: prostate, lung, colorectum, liver and non-Hodgkin lymphoma, while in women they are breast, lung, uterus, colorectum and thyroid.

There are 203.3 cases of cancer per 100,000 men in Samoa and 217.1 women, and the mortality rate (per the same) is 126.2 for men and 112.4 for women.

And that number is expected to rise, the report states.

“Assuming that no change in the overall cancer incidence occurs, demographic projections suggest that 84 per cent more cancer cases and 92 per cent more deaths will occur between 2018 and 2040," the authors conclude. 

Samoa, with its estimated population of 196,700 and a gross domestic product per capita of US$4360.80 (T$) spends just 5.6 percent of GDP on health.

The report states Samoa has just five physicians for every 10,000 people, and 15 nurses – approximately 100 doctors and nearly 300 nurses.

The country has just two publicly available pathology services (histology and cytology), and four radiology services (CT, MMG, USS, and x-ray). 

There is one pathologist and two radiologists, and there are publicly available chemotherapy services available to paediatric cases (children) only, and publicly available cancer surgery services.

But there are no public operational cancer units, no medical oncologists or publicly available radiotherapy services, or radiation oncologists.

Importantly, there are also no formal palliative care services, beyond the work of the Samoa Cancer Society.

The report found there is oral morphine available, but it is commonly out of stock in rural Samoa.

Some 16,2000 new cancer cases and 9800 cancer deaths are reported in Pacific Islands countries and territories annually, according to a report by the Global Cancer Observatory last year. 

“The cancer profile of the Pacific Island countries and territories tells a story of ongoing transition from cancers associated with infection to those associated with high-income lifestyles,” the report states.

“A double burden emerges in the Pacific, with a profile that includes cancers linked to poverty and infection coinciding with those cancers that are more associated with a changing diet, physical inactivity, obesity, and exposure to tobacco, such as lung, breast and uterine cancers.”

The Pacific Islands (excluding territories of the United States) have the added barrier of low quality and availability of both diagnostic information, and death certificates. 

So, the region’s cancer estimates may well be lower than is accurate.

To counter this, The Global Initiative for Cancer Registry Development is establishing a Pacific Cancer Registry Hub, to help those without develop better cancer surveillance and therefore have better policy and decision making data.

Pacific Islands Countries and Territories (P.I.C.T.s) stand out for their lack of cancer control plans and services. There are several barriers to a comprehensive cancer control plan, including poor access to information and laboratory systems.

The region is also struggling with diagnosis and treatment, with a lack of pathways to service and available diagnostic services.

“P.I.C.T.s face numerous challenges in enhancing these process and few, if any, examples of documented cancer-specific pathways for diagnosis and referral exist.

“Less than a third of the 22 P.I.C.T.s have a full-time pathologist or radiologist. The remainder of P.I.C.T.s send specimens and patients overseas for diagnostic tests, which is expensive and can result in considerable delays.”

Cancer, and the rising crisis of N.C.D.s are putting Pacific Islands in a no-win situation, the report finds. 

The region is struggling to maintain a strong health workforce, and trade, globalisation and climate change each have unique pressures on the food sources available to islanders.

Cheap, processed foods rich in carbohydrates, free sugars, trans fats and salt are contributing to the non-communicable disease epidemic and obesity related cancers, and the the National Kidney Foundation of Samoa estimates 11.5 per cent of adults have chronic kidney disease.    

Climate change is threatening locally grown food and access to clean water, and increasing dependence on imported foods.

These all adds to the obesity risk, the report states:

“In 2007, Samoa banned the importation of cheap high-fat turkey tails as part of its efforts to combat N.C.D.s; however, in 2011, the ban was reversed to meet conditions of international trade agreements.”

“The effects of climate change in combination with disruptions to health-care services and environmental infrastructure and population displacement increase both the drivers for and effects of N.C.D’s.”

Local authors to the Lancet report were: Dr. Alec Ekeroma and Dr. Malama Laura Tafuna’i from the National University of Samoa and Dr. Filipina Amosa-Lei Sam in the Pathology Department of the Tupua Tamasese Meaole Hospital.

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