The stigma that patients face when diagnosed with lung cancer may be associated with poorer psychosocial outcomes, including distress and isolation, delayed help-seeking, and concerns about the quality of care, according to findings presented by Harrison et al at the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer (Abstract P2.27-02).
Background
Stigma linked to smoking-related respiratory diseases often leads to externalized devaluation, such as discrimination or judgmental comments as well as internalized self-blame or shame. As denormalization strategies have been central to population-level tobacco control responses that discourage smoking, evidence has suggested that stigmas around lung cancer and respiratory diseases may be on the rise. To address this issue, developing stigma-reducing interventions for affected individuals has been identified as a priority.
In 2021, the IASLC published a language guide detailing preferred language and phrasing for all oral and written communications, including presentations at IASLC conferences. A separate study—presented by Lockstadt et al at the IASLC 2023 World Conference on Lung Cancer (Abstract OA10.06)—demonstrated that a significant percentage of lung cancer researchers have embraced the IASLC Language Guide.
The lung cancer community recognized that some common words and phrases used in medicine may be contributing to stigmas associated with lung cancer. As a result, advocates have worked collaboratively with physicians and researchers to change the language used when discussing topics regarding smoking, tobacco use, and similar topics.
In the analysis, investigators included 519 presentations at the IASLC 2022 World Conference on Lung Cancer. They found that 177 of the presentations discussed smoking status, and 77 presenters used nonstigmatizing language; however, 100 of the presenters used the stigmatizing term "smoker." Thus, in 1 year of implementation of the preferred language, a significant number of presenters had already adopted the recommended changes, which may play an important role in creating a patient- and advocate-friendly environment at future IASLC meetings and activities.
Study Methods
In the recent study, investigators sought to identify and synthesize existing interventions to combat stigmas associated with lung cancer and smoking-related respiratory diseases such as chronic obstructive pulmonary disease. They conducted a systematic review and identified 10 studies that aimed to reduce these stigmas, 9 describing distinct interventions from 427 records. Most of the interventions focused on guiding behavioral changes through group programs; providing formal psychotherapeutic interventions; or offering information, instructions, and reference materials to individuals. These interventions primarily targeted symptomatic individuals or higher-risk groups in high-income countries.
The investigators then searched lung cancer, chronic obstructive pulmonary disease, and stigma-related terms in four electronic databases (PsycINFO, CINAHL, PubMed, and Scopus) to identify relevant records up to December 2022. They reported that the eligible studies described an intervention designed to reduce externalized or internalized stigmas that correlated with smoking-related respiratory disease; these studies were assessed using Joanna Briggs Institute critical appraisal tools as appropriate for the varied study designs—including case report, qualitative, quasi-experimental, and randomized controlled trials.
Of note, the investigators found that most of the identified interventions reported achieving reductions in stigma. Both remote and digital intervention delivery showed similar effects as traditional in-person modes, indicating the potential of increasing accessibility for patients with comorbidities or respiratory disease–related functional impairments.
Conclusions
“We need to further develop and evaluate stigma-reducing interventions with larger samples in diverse sociocultural contexts,” stressed co–study author Nathan Harrison, BPsych (Hons), a behavioral scientist and a PhD student from Flinders University in Australia. “Additionally, including validated stigma assessments in a wider variety of interventional studies could help identify more effective techniques for targeted stigma reduction,” he concluded.
