Lung cancer stigma: a concept with consequences for patients

Background: Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared to other cancer populations. Lung cancer stigma (LCS) may in part explain these findings. 
Aim: We investigated the prevalence of patient-perceived lung cancer stigma (LCS) and its relationships to symptom burden/severity, depression, and deficits in health-related quality of life (HR-QoL). 
Methods: In this descriptive, observational and cross-sectional study, 201 participants were sent questionnaires. These included The Cataldo Lung Cancer Stigma Scale (CLCSS); the Lung Cancer Symptom Scale; the Centre for Epidemiologic Studies-Depression Scale; and the Quality of Life Inventory. 
Results: Participants were on average 69 years old, 52% women, 95% ever smokers, and 18.5% current smokers. The mean total CLCSS score was 53.1 (SD=14.1; range=31-94). LCS was significantly correlated with younger age (p<0.001), greater social deprivation (p<0.05), being unemployed (p<0.001), depression (p<0.001), symptom burden (p<0.001), and HR-QoL deficits (p<0.001). Symptom burden explained 18% of variance in LCS (p<0.001). LCS explained 8.5% and 14.3% of the variance in depression (p<0.001) and HR-QoL (p<0.001), respectively. 
Conclusion: Patients with lung cancer are vulnerable to LCS. Symptom burden can directly contribute to greater perceived LCS. Greater perceived LCS can be directly related to greater levels of depression and lower HR-QoL. A tailored approach is required to screen for LCS and implement interventions to enhance the psycho-social well-being of patients with perceived LCS.