Being diagnosed with lung cancer carries a certain stigma.
”How long did you smoke?” “I didn’t know you were a closet smoker.” “Too bad he didn’t quit smoking sooner.” Unlike the unconditional support given to those with other forms of cancer, people with lung cancer often feel singled out, like somehow they “deserve” to have cancer. Where does this stigma come from?
Public Perception of a Diagnosis of Lung CancerThere is a feeling among the general public, that lung cancer is a self-inflicted disease. Smoking is responsible for 80 to 90% of lung cancers, but let’s put this in perspective: Twice as many women die from lung cancer in the United States each year as die from breast cancer, and 20% of these women have never touched a cigarette. Even for those who smoke and develop lung cancer, why do we attach such a stigma to them? Many cancers, and other chronic diseases, are related to lifestyle choices. We don’t seem to judge as harshly those who overeat, are sedentary or sunbathe extensively.
Physicians’ Attitude Regarding Lung CancerPhysicians are people too, and the bias we see among the public is present in the doctor's office as well. Joan Schiller, MD, the President and Founder of National Lung Cancer Partnership, and a physician who has done a lot of research on the stigma of lung cancer, surveyed primary care physicians in Wisconsin with some saddening results. Though the physicians stated that the type of cancer was not a factor in their referral decisions, results showed that:
- When hypothetical patients were presented as having advanced cancer, physicians were less likely to refer lung cancer patients to an oncologist than they were to refer breast cancer patients.
- More physicians were aware that chemotherapy improves survival in advanced breast cancer than with advanced lung cancer.
- Breast cancer patients were more likely to be referred for further therapy, whereas lung cancer patients were often referred only for symptom control.
Lung Cancer Patient’s Perceived Stigma
Those who are diagnosed with lung cancer experience more embarrassment than those with prostate cancer or breast cancer, and individuals tend to feel stigmatized whether they smoked or not. Some people have even concealed their diagnosis leading to negative financial consequences and lack of social support. On the other side of the equation, some people with lung cancer have felt embarassed with their health care providers, and feared that their care may be negatively affected because of their history of smoking.
In a focus group of lung cancer patients, common emotions expressed relating to the stigma included guilt, self-blame, anger, regret, and alienation with regard to family and society interactions.
Funding for Lung Cancer Research vs Other CancersSadly, even though lung cancer kills more people than breast cancer, prostate cancer and colon cancer combined, federal funding lags behind. Funding from the private sector also pales in comparison to fund-raising efforts for some other cancers.
Clearly, lung cancer carries a stigma that extends from the government down to the individual. That said, we won’t move forward by pointing the finger and blaming ourselves, physicians, the public and the government. Each of us can make a difference by supporting those with lung cancer as we would support someone with any other form of cancer. Whether you are a lung cancer survivor, the loved one of someone living with lung cancer or a professional working with those with lung cancer, we need to raise awareness. Those living with lung cancer need and deserve our care, love, and support, not an evaluation of the possible causes of the disease.
Chapple A, Zieband S, McPherson A. Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. British Medical Journal. 2004. 328(7454).
Kehto, R. Patient views on smoking, lung cancer, and stigma: A focus group perspective. European Journal of Oncology Nursing. 2014. 18(3):316-322.
LeConte NK, Else-Quest NM, Eickhoff J, Hyde J, Shiller JH. Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer. 2008. 9(3):171-8.
Wassenarr TR, Eickhoff JC, Jarzemsky DR, Smith SS, Larson ML, Shiller JH. Differences in primary care clinicians’ approach to non-small cell lung cancer patients compared with breast cancer. Journal of Thoracic Oncology. 2007. 2(8):722-8.