By J. Lee Westmaas, PhD
Some of us, at some point in time, have felt judged negatively by others or discriminated against because of some personal characteristic or behavior. Researchers refer to this as feeling stigmatized, and lung cancer patients report feeling this way more than patients with other types of cancers.
Many individuals with lung cancer fear that others will react to their diagnosis with blame, exclusion, rejection and/or discrimination. Many actually experience this as well. A primary reason is that smoking is so strongly linked to lung cancer.
Blaming the victim
Lung cancer was one of the first diseases to be identified as caused by smoking. Smoking rates have decreased dramatically since the 1960s due to laws to restrict smoking, greater publicity on the many harms of smoking, and a change in public attitudes toward smoking.
A result of these changes may be a "blame-the-victim" attitude toward someone who gets lung cancer. In one study, individuals with lung cancer (92% of whom were smokers) more often agreed with the statement "my behavior contributed to my cancer" compared to people with breast and prostate cancer, which are less strongly linked with smoking. Lung cancer patients were also more likely to agree with the statements:
- "I am ashamed I got my type of cancer,"
- "My family feels ashamed of my type of cancer," and
- "I am embarrassed to tell people my type of cancer,"
when compared to breast and prostate cancer patients.
Even individuals with lung cancer who never smoked may feel stigmatized. One study found that non-smoking patients felt the same amount of stigma as those who had smoked at some point in their lives. Even though about 80% of lung cancers do occur in smokers or former smokers, many people diagnosed with lung cancer (about 45,638 in 2013 alone) never smoked.
Stigma linked to depression
Feeling stigmatized by friends or family, or even health-care workers, is a serious concern because those feelings can result in depression and lower quality of life. Lung cancer patients have some of the highest rates of depression among cancer patients. The question of whether feeling stigmatized can cause their depression has become an important topic for research.
Clinical depression causes great distress, impairs functioning, and could make cancer patients less able to follow their treatment plan.
The research on stigma and its effects on individuals with lung cancer is limited, so we can't say whether feeling stigmatized causes depression or vice-versa. Regardless, taking actions to address these beliefs and feelings in cancer patients is important.
One approach is to educate others that many factors can lead to lung cancer and that blaming people for their disease may actually make it harder for them to cope. Another is to use counseling to help lung cancer patients deal with depression and self-blame. Counseling might include talking to patients who did smoke about the addictiveness of tobacco and the deception of the tobacco industry.
More research on this important topic is needed. Hopefully we can identify better ways to help individuals with lung cancer, and those diagnosed with any smoking-related cancer, overcome feelings of being stigmatized.
Dr. Westmaas is director of tobacco control research for the Behavorial Research Center at the American Cancer Society.