Perceptions and Use of Complementary and Alternative Medicine in American Samoa: A Survey of Health Care Providers Sara L. Krosch Abstract
Purpose: American Samoa health care providers’ use and perceptions of common complementary and alternative treatments, with a focus on traditional Samoan healing for women diagnosed with breast cancer or cervical cancer, was investigated to inform the development of the first locally produced women’s cancer prevention radio drama and the first cancer patient navigator program in the US Territory. Methods: A 10-item self-administered survey was completed by a total of 47 health care providers employed at the Lyndon B. Johnson Tropical Medical Center and the American Samoa Department of Health Breast and Cervical Cancer Early Detection Program. Findings: Comprehensive health care is limited in American Samoa, especially cancer treatment. Dissatisfaction or disconnection with Western medicine leads some patients to seek complementary or alternative health care from traditional Samoan healers who provide massage and herbal remedies. Health care providers in American Samoa use and recommend many complementary and alternative medicines (CAM) popular in the United States. The most common CAM recommended to patients is exercise (81%), diet modification (81%), prayer (36%), massage (36%), support group participation (26%), and relaxation techniques (19%). Traditional Samoan healing methods are unique CAM that 19% of mainstream health care providers have used, and 17% have recommended these techniques to patients. Most survey respondents believe traditional Samoan healing methods have a harmful effect on patient quality of life and 72% have advised a patient to discontinue using this type of CAM. While most providers feel that the majority of American Samoan patients use traditional healing methods to complement Western healthcare, 55% are aware of a breast cancer or cervical cancer patient utilizing these techniques as an alternative to hospital treatment. A provider’s ethnicity, gender, age and years of professional experience appear to be indicators of different CAM method endorsement and patient consultations concerning CAM use. Conclusions: CAM use is likely to continue in American Samoa as long as health care deficiencies exist. Most American Samoa health care professionals accept common CAM in the United States, but local providers are more likely to endorse traditional healing methods than their mainland counterparts. Little is known of the impact different CAM have on quality of life, especially amongst cancer patients. The majority of American Samoa health care providers request more information about traditional healing which would facilitate more comprehensive medical documentation and patient care.
Introduction Cancer treatment is limited to surgery in the United States Territory of American Samoa. Patients who can afford mainstream treatment are referred off-island to Hawai‘i for chemotherapy or radiation. Those who cannot afford off-island care remain in American Samoa. In both cases, patients may visit a traditional Samoan healer, a Fofo or Taulasea, for complementary or alternative therapy. The use of Samoan healers is believed to be motivated by lack of affordable treatment or a distrust or dissatisfaction with hospital care. This results in a competition between the two medical systems with some cancer patients foregoing mainstream medical treatment and utilizing only traditional methods.
In 2009, the American Samoa Community Cancer Coalition investigated local health care providers’ use and perceptions of common complementary and alternative treatments with a focus on traditional Samoan healing for women diagnosed with breast cancer or cervical cancer. In particular, the study aimed to determine which common complementary and alternative therapies health care providers endorse; their awareness of cancer patients utilizing traditional Samoan healing methods as complementary or alternative treatment; and their opinions of the safety of indigenous medicine. These and other research findings informed the development of the first locally produced cancer prevention radio drama, Tasi le Ola (One Life) and the first cancer patient navigator program in American Samoa. Complementary and Alternative Medicines Complementary or alternative medicine (CAM) for cancer is any practice or product that is not thought of as standard medical care based on scientific evidence such as surgery, chemotherapy or radiation therapy. Complementary medicines are used along with standard medical treatments whereas alternative therapies are scientifically unproven remedies and techniques used in place of standard medical treatments.1-4 Most patients use complementary therapies along with standard medical therapy, while a minority utilizes only alternative treatments.3,4 Complementary therapies have been found to improve patient quality of life,1,3,4 patient satisfaction,1,4 and the physicianpatient relationship,4,5 whereas alternative therapies may conflict with mainstream treatments1,3 and be potentially harmful.1,3-6 The use of CAM and CAM practitioners is rising in the United States.7 Robinson and McGrail8 report that over half of all patients requiring health care use some type of complementary or alternative therapy. Cancer patients are more likely than the general population to use CAM,9 especially those diagnosed with breast cancer.10,11 The prevalence of CAM use amongst breast cancer patients in the US is as high 80%.12 The most common reasons US cancer patients utilize CAM therapies are to reduce psychological distress;1,3,4,9,11,13 improve quality of life;3,4, 11-13 gain more control over personal health;1,4,7,11,13 manage symptoms and side-effects of treatment;1,4,9,11 prevent cancer recurrence;3,9,11,13 and to boost the immune system.11,13 Traditional Samoan Healing as CAM Samoan healers can be classified as CAM practitioners who practice traditional massage (Fofo) or who prescribe herbal remedies and have some training in diagnosis and treatment of illnesses of natural or supernatural origins (Taulasea). Many traditional Samoan healers are women who treat specific illnesses commonly afflicting women and children.14,15 Traditional Samoan herbal remedies have been documented but the medicinal value of most catalogued plants has not been scientifically proven, and dosages are dependent on the illness and the particular healer.14 Some herbal remedies have been found to cause harmful reactions in cancer patients receiving anesthesia for surgery or undergoing chemotherapy.4 Conversely, the benefits of massage therapy are well documented4 and include
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