Psychological distress and quality of life in lung cancer: the role of health‐related stigma, illness appraisals and social constraints

Abstract

ObjectiveHealth‐related stigma is associated with negative psychological and quality of life outcomes in lung cancer patients. This study describes the impact of stigma on lung cancer patients' psychological distress and quality of life and explores the role of social constraints and illness appraisal as mediators of effect.MethodsA self‐administered cross‐sectional survey examined psychological distress and quality of life in 151 people (59% response rate) diagnosed with lung cancer from Queensland and New South Wales. Health‐related stigma, social constraints and illness appraisals were assessed as predictors of adjustment outcomes.ResultsForty‐nine percent of patients reported elevated anxiety; 41% were depressed; and 51% had high global distress. Health‐related stigma was significantly related to global psychological distress and quality of life with greater stigma and shame related to poorer outcomes. These effects were mediated by illness appraisals and social constraints.ConclusionsHealth‐related stigma appears to contribute to poorer adjustment by constraining interpersonal discussions about cancer and heightening feelings of threat. There is a need for the development and evaluation of interventions to ameliorate the negative effects of health‐related stigma among lung cancer patients. © 2015 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers

“…2, 8–11 Greater distress and reduced QoL in lung cancer patients have been associated with lower self-efficacy or confidence in their ability to manage symptoms and greater social constraints (e.g., avoidance, criticism) on cancer-related disclosure. 12, 13 …”

Reliability and Validity of the Korean Version of the Cancer Stigma Scale

“…According to previous studies, the quality of life of cancer patients is closely linked to cancer stigma; that is, the worse the quality of life, the greater the cancer stigma the patient presents [8,12,14]. The QLQ-C30 seems to be an adequate instrument to verify the concurrent validity of the KCSS because the degree of perceived cancer stigma suffered by 124 www.jkan.or.kr role, emotional, cognitive, and social aspects), and symptom (13 items assessing fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial problems).…”

“…To evaluate the known-group validity of the KCSS, we used Korean version of the psychological symptom inventory (PSI) developed by the National Cancer Center [3] which measure psychological distress that was proposed as closely related variables to the cancer stigma in previous studies [4,5,8,11,14], and use of the instrument was confirmed through an e-mail. The PSI assessed the current distress levels of three symptoms and interference with daily activities (insomnia, anxiety, and depression).…”

“…There are increasing empirical studies on how stigma affects cancer survivors [12]. Although researchers found the fact that cancer stigma affects individuals with cancer, most of the studies focus on patients with lung cancer [8,11,13,14]. Van Brakel [9] reported that many instruments have been developed to assess the intensity and qualities of stigma, but these are often condition-specific including cancer type-specific.…”

Barriers to lung cancer care: health professionals’ perspectives

“…Research from North America has found stigma and shame about lung cancer, social isolation and smoking-related stigma to be associated with delay in seeking medical help by lung cancer patients [18, 19]. Other researchers have found that lung cancer patients who have more internalised shame about their cancer are more likely to conceal their diagnosis from their social network [20] and that the negative effects of stigma and shame on lung cancer patients distress and quality of life were mediated by cancer threat and social constraints [21]. Hence, stigma influences the patient experience of lung cancer and although objective studies of actual discrimination in cancer treatment are not evident, stigma seems likely to influence the care pathway.…”