Cancer and Stigma
Healthcare providers can help.
Posted Aug 01, 2017
When a person carries a mark or stigma that sets them apart, this can discredit them in the eyes of others and threaten their sense of identity.
In the past, cancer carried a stigma due to its association with death, and this manifested in ways that decreased people’s willingness to discuss cancer--even to the extent that patients’ diagnosis were not shared with them. Today, cancer is less stigmatized and more openly discussed, but stigma can still affect the well-being of cancer patients. Research shows that there is some likelihood that different characteristics of the disease, such as its perceived controllability and visibility, factor in to how much stigma is applied to individuals with cancer.1 In addition, individuals with cancer may vary in how they interpret or appraise potential threats to their identity that they may encounter in the workplace, social interactions, and the media as stigmatizing or not.2 Certain cancers have been found to carry more stigma, particularly lung cancer. This is due to its link to tobacco use and the perception that patients hold some responsibility for their disease, although not all lung cancer patients have a history of smoking. This negative perception is even reflected in the fact that lung cancer receives less research funding than other similarly common cancers, such as breast cancer, and that perceptions of its controllability are linked to the people’s willingness to support funding.3
Regrettably, lung cancer patients also perceive stigmatization from their health care providers. Such perceived stigmatization can cause patients to delay or underreport their symptoms or their levels of smoking. Similarly, when medical providers ask about smoking history, this can be interpreted as a suggestion that patients are responsible for their disease. A new study investigated the association between communication with providers and levels of perceived stigma among 231 lung cancer patients, 26% of whom were never smokers.4 Stigma, shame, social isolation, and discrimination were assessed in this group in terms of reports of instances of things like being told that one deserves cancer because of their smoking and feelings of guilt for having cancer. Medical providers’ communication as perceived by patients was assessed in terms of things like explaining things in a way that was easy to understand and being aware of important medical information in a patient’s history.
The results indicated that patients perceived less stigma when health care providers communicated with them positively, that is, explained things clearly and thoroughly, were good listeners, and showed respect. Smoking status was not associated with perceptions of stigma, indicating that lung cancer patients report experiencing some stigma (a score of 48 on a scale ranging from 31-124), regardless of their smoking status. The authors conclude that the study illuminates “a potentially fruitful area for intervention that could reduce patients’ perception of lung cancer stigma…good patient-provider communication” and “developing a communication intervention to improve physicians’ communication with lung cancer patients could improve patients’ psychological and clinical outcomes through a reduction in stigma.” 4, p. 6.
1 Knapp-Oliver, S., & Moyer, A. (2009). Visibility and the stigmatization of cancer: Context matters. Journal of Applied Social Psychology, 39, 2798-2808. doi:10.1111/j.1559-1816.2009.00550.x
2 Knapp, S., Marziliano, A., & Moyer, A. (2014). Identity threat and stigma in cancer patients. Health Psychology Open, July-September, 1-10 doi: 10.1177/2055102914552281. eCollection 2014 Jul.
3 Knapp‐Oliver, S., & Moyer, A. (2012). Causal attributions predict willingness to support the allocation of funding to lung cancer treatment programs. Journal of Applied Social Psychology, 42, 2368-2385. doi:10.1111/j.1559-1816.2012.00945.x
4 Shen M. J. Hamann, H. A., Thomas A. J., & Ostroff, J.S.(2016). Association between patient-provider communication and lung cancer stigma. Supportive Care in Cancer, 24, 2093-2099. doi: 10.1007/s00520-015-3014-0.