Stigma in Early-Stage Lung Cancer

Abstract

Background The phenomenon of lung cancer stigma has been firmly established in the literature. However, studies have predominantly focused on patients with advanced disease, whose experiences may differ from patients with earlier stage, surgically resectable lung cancer and an improved prognosis. Purpose The objective of the study was to examine the stigma experienced in a Canadian population with early-stage, resectable lung cancer. Methods Patients with newly diagnosed lung cancer were enrolled at a tertiary thoracic surgery clinic. The 25-item Lung Cancer Stigma Inventory (LCSI) was self-administered by patients to quantitatively measure experiences of lung cancer stigma. LCSI results informed the development of a semi-structured focus group and individual interviews. Results Of the 53 participants completing the survey, 38 (72%) met established LCSI score threshold, indicating a clinically meaningful level of stigma. No significant relationship was found between total LCSI scores and any demographic variable. Analysis of qualitative data revealed multiple themes related to experiences of lung cancer stigma. The major themes were classified into four categories: impact of the association between lung cancer and smoking, societal attitudes and assumptions, personal choices in relation to diagnosis, and experiences related to care. Conclusions A surgical population of patients with predominantly early-stage lung cancer experienced lung cancer stigma at a high incidence and a level similar to previously studied populations with more advanced disease. The qualitative results support the quantitative findings that respondents experienced more internal stigma than either perceived stigma from others or constrained disclosure related to their diagnosis.

Quitting smoking after a cancer diagnosis is associated with reductions in stigma and anxiety: A longitudinal mediation analysis.

“…Patients who smoked at the time of their diagnosis report the highest levels of perceived and internalized stigma, followed by those who formerly smoked, and then by those who never smoked (Williamson, Kwon, et al, 2020; Williamson et al, 2018). Qualitative research illustrates that causal attributions for lung cancer are tied closely with smoking, evidenced by the omnipresent question that patients are often asked immediately after they share information about their diagnosis: “Did you smoke?,” which many patients experience as assumptive, judgmental, and blaming (Bédard et al, 2022; Chapple et al, 2004; Hamann et al, 2014; Occhipinti et al, 2018). This is consistent with attributional stigma theory, which posits that health conditions are more highly stigmatized and viewed as self-inflicted if they are believed to result from a behavior that is perceived as personally and volitionally controllable (Stump et al, 2016; Weiner et al, 1988).…”