Cancer-related Stigma Research Articles

The psychosocial impact of stigma in people with head and neck or lung cancer

Lung and head and neck cancers are widely believed to produce psychologically destructive stigma because they are linked to avoidable risk-producing behaviors and are highly visible, but little research has tested these ideas. We examined cancer-related stigma, its determinants, and its psychosocial impact in lung (n = 107) and head and neck cancer survivors (n = 99) ≤ 3 years post-diagnosis. We investigated cancer site, self-blame, disfigurement, and sex as determinants, benefit finding as a moderator, and illness intrusiveness as a mediator of the relation between stigma and its psychosocial impact. Prospective participants received questionnaire packages 2 weeks before scheduled follow-up appointments. They self-administered widely used measures of subjective well-being, distress, stigma, self-blame, disfigurement, illness intrusiveness, and post-traumatic growth. As hypothesized, stigma correlated significantly and uniquely with negative psychosocial impact, but contrary to common beliefs, reported stigma was comparatively low. Reported stigma was higher in (i) men than women, (ii) lung as compared with head and neck cancer, and (iii) people who were highly disfigured by cancer and/or its treatment. Benefit finding buffered stigma's deleterious effects, and illness intrusiveness was a partial mediator of its psychosocial impact. Stigma exerts a powerful, deleterious psychosocial impact in lung and head and neck cancers, but is less common than believed. Patients should be encouraged to remain involved in valued activities and roles and to use benefit finding to limit its negative effects.

Stigma in Cancer Patients Whose Behavior may Have Contributed to Their Disease

The purpose of the present review is to examine stigma and its consequences among people with cancer, with an emphasis on the situation in which one's behavior may have contributed to the disease. We examine whether voluntarily engaging in behavior that adds to cancer risk leads to increased stigma after cancer onset, as compared with when one's behavior is not considered (by the affected individual or by others) to have contributed to the onset of cancer. We conducted literature searches in PsychInfo and Medline and identified 38 published papers that empirically addressed cancer-related stigma. We found evidence of increased negative attitudes and more severe consequences of stigma among people that have engaged in a behavior that is perceived to have contributed to their cancer, compared with those who are not perceived to have contributed to their disease.

An Attributional Analysis of Gender and Cancer-Related Stigma

This experiment examined the impact of gender on cancer-related stigma from Weiner’s (An attributional theory of motivation and emotion. Springer, New York, 1986) attributional perspective. Undergraduates (n = 204; 59% female; 71% White) and community members (n = 85; 62% female; 64% White) in the northeastern U.S. were assigned randomly to listen to an audiotaped interview of a target person with lung cancer in which gender and smoking status (nonsmoker, smoker, or unspecified) were manipulated. Participant and target gender predicted participants’ perceptions of disease controllability and anger toward the target person. The target person’s smoking status also predicted participants’ perceptions of disease controllability and emotional responses to the target person. Findings partially support Weiner’s (An attributional theory of motivation and emotion. Springer, New York, 1986) theory and suggest that the relationship between gender and cancer-related stigma deserves further investigation.

Assessment of Guilt and Shame in Patients with Non–Small-Cell Lung Cancer Compared with Patients with Breast and Prostate Cancer

PURPOSEPatients with lung cancer might feel more guilt and shame resulting from previous smoking. This study was designed to determine the levels of guilt and shame among patients with non–small-cell lung cancer (NSCLC) compared with breast and prostate cancer. PATIENTS AND METHODSSurveys were sent to participants 3 times (at enrollment, 2 months, and 6 months). Patients were eligible if they had stage IV NSCLC, breast cancer, or prostate cancer. The survey included tests of generalized guilt, shame, depression, and anxiety as well as guilt, shame, and embarrassment related to one's cancer. RESULTSOne hundred seventy-two participants completed ≥ 1 questionnaire: 96 patients with NSCLC, 30 patients with breast cancer, and 46 patients with prostate cancer. Of the patients with NSCLC, 91.7% were current or former smokers versus 67.1% of the comparison patients. A composite score of embarrassment related to one's cancer (perceived cancer-related stigma; PCRS) was higher in patients with NSCLC (P < .01). Mean baseline generalized guilt and shame scores were not different among groups and did not change over time. A history of smoking correlated with increased levels of guilt and shame, regardless of tumor type. A personal identification of past behaviors as contributing to cancer correlated with higher levels of guilt, shame, anxiety, and depression. Of the patients with NSCLC, 29.5% felt that their behaviors contributed to their cancer compared with 10.5% of the comparison patients. CONCLUSIONPatients with NSCLC had higher levels of PCRS than patients with prostate cancer or breast cancer but not higher baseline levels of shame and guilt. Smoking is correlated with higher levels of guilt and shame. A belief that one caused one's own cancer is correlated with higher levels of guilt, shame, anxiety, and depression. These findings could be translated into an increased need for open communication among patients and their providers surrounding issues of cancer causation, guilt, shame, depression, and anxiety.

Death Anxiety and Cancer-Related Stigma: A Terror Management Analysis

In a study designed to examine correlates of cancer-related stigma, 405 college students were assigned randomly to listen to an audiotaped interview in which the target's cancer type and smoking status were manipulated. In the lung cancer conditions, target gender also was manipulated. Social distance and emotional responses differed according to participant gender, death anxiety, and target cancer type. Participant gender and target characteristics also were associated with perceptions of the target's character. Findings partially support terror management theory and suggest that death attitudes, gender norms, and diagnostic status influence social distancing from individuals with cancer.