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Halms T, Strasser M, Hasan A, Rüther T, Trepel M, Raab S, Gertzen M. Smoking and quality of life in lung cancer patients: systematic review. BMJ Support Palliat Care 2024; 13:e686-e694. [PMID: 37607808 DOI: 10.1136/spcare-2023-004256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC. METHODS A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies. RESULTS A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive. CONCLUSIONS The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Marcus Gertzen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
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Knettel B, Minja L, Msoka E, Tarimo C, Katiti V, Pan W, Mwobobia J, Juhlin E, Knippler E, Watt M, Suneja G, Kimani S, Abouelella D, Mmbaga B, Osazuwa-Peters N. Culturally-informed adaptation and psychometric properties of the Cataldo Cancer Stigma Scale in Northern Tanzania. J Psychosoc Oncol 2023; 42:286-298. [PMID: 37534869 PMCID: PMC10837313 DOI: 10.1080/07347332.2023.2241458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Cancer-related stigma impacts patients' emotional health, care engagement, and cancer outcomes, but few measures of cancer stigma exist. We culturally adapted and assessed psychometric properties of the Cataldo Cancer Stigma Scale (CCSS) in Tanzania. METHODS We administered the CCSS short version (21 items), plus 12 locally-derived items, to 146 adult cancer patients. We conducted exploratory factor analysis, examined internal consistency/reliability, and assessed convergent validity with relevant measures. RESULTS We identified a 17-item cancer stigma scale with strong psychometric properties and four subscales: enacted stigma, shame and blame, internalized stigma, and disclosure concerns. Stigma was rare except for disclosure concerns. Stigma was positively associated with depression and anxiety and negatively associated with social support, quality of life, and illness acceptance. CONCLUSIONS The scale provides valid, culturally-informed measurement of cancer stigma in Tanzania. Future studies should assess associations with care engagement, which will inform interventions to reduce stigma and improve outcomes.
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Affiliation(s)
- Brandon Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Elizabeth Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre Cancer Care Centre, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Judith Mwobobia
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Erika Juhlin
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Melissa Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Dina Abouelella
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nosayaba Osazuwa-Peters
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
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Sætre LMS, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. A population-based study on social inequality and barriers to healthcare-seeking with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:48. [PMID: 36335123 PMCID: PMC9637082 DOI: 10.1038/s41533-022-00314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.
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Affiliation(s)
- Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Tian X, Tang L, Yi LJ, Qin XP, Chen GH, Jiménez-Herrera MF. Mindfulness Affects the Level of Psychological Distress in Patients With Lung Cancer via Illness Perception and Perceived Stress: A Cross-Sectional Survey Study. Front Psychol 2022; 13:857659. [PMID: 35465528 PMCID: PMC9022206 DOI: 10.3389/fpsyg.2022.857659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aims of the study were first to investigate the association between illness perception and psychological distress and second to determine whether mindfulness affects psychological distress via illness perception and perceived stress in patients with lung cancer. Methods Among 300 patients with lung cancer who participated in this cross-sectional study, 295 patients made valid responses to distress thermometer (DT), the Five Facet Mindfulness Questionnaire (FFMQ), the Brief Illness Perception Questionnaire (B-IPQ), and the Perceived Stress Scale (PSS) between January and July 2021. The possible pathways of mindfulness affecting psychological distress were analyzed based on the structural equation modeling analysis. Results A total of 24.4% patients with lung cancer had DT > 4. Illness perception (β = 0.17, p = 0.002) and perceived stress (β = 0.23, p < 0.001) had a direct effect on psychological distress. Mindfulness had a direct effect on illness perception (β = -0.16, p = 0.006) and mindfulness indirectly influenced psychological distress (β = -0.04, p = 0.009) through affecting illness perception alone or simultaneously affecting both the illness perception and perceived stress in patients with lung cancer. Conclusion Lung cancer suffered from varying levels of psychological distress. Mindfulness may alleviate psychological distress by reducing the level of illness perception and perceived stress. We suggest developing a comprehensive factor model to clarify potential mechanisms of mindfulness on psychological distress due to the very low effect of mindfulness on psychological distress via illness perception and perceived stress.
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Affiliation(s)
- Xu Tian
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Ling Tang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Li-Juan Yi
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Xiao-Pei Qin
- Department of Rehabilitation Medicine, Jiaozuo People’s Hospital, Jiaozuo, China
| | - Gui-Hua Chen
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Akin-Odanye EO, Husman AJ. Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients. Ecancermedicalscience 2021; 15:1308. [PMID: 34824631 PMCID: PMC8580722 DOI: 10.3332/ecancer.2021.1308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 12/11/2022] Open
Abstract
Background Stigma is known to negatively influence cancer patients’ psychosocial behaviour and treatment outcomes. The aim of this study was to systematically review the current data on cancer-related stigma across different populations and identify effective interventions used to address it. Methodology The protocol, search, appraisal, synthesis, analysis and reporting framework was used for conducting this systematic literature review. CINAHL, PubMed, PsycINFO and Google Scholar databases were searched using the different combination of keywords that include ‘cancer stigma’. Articles publication period was set for 2010–2020. A total of 54 articles (31 quantitative, 19 qualitative, 2 mixed methods and 2 scoping reviews) that met inclusion criteria were reviewed out of the 958 articles initially identified. Quality assessment of included studies revealed the studies had varying levels of methodological quality. Extracted data were organised and narratively analysed. Results Cancer stigma was expressed across different segments of the society including amongst the elites and healthcare providers. Developing countries had higher rates of stigma reported and experience of stigma varied by cancer type. Cancer was consistently associated with imminent death in all studies reviewed. Cancer patients experiencing stigma were more inclined to conceal their diagnosis and to seek medical help later. Whilst cancer stigma majorly resulted in negative psychosocial outcomes in patients, there were also instances of posttraumatic growth emanating from the stigma experienced. Literature on cancer-related stigma interventions was scant. Conclusion Cancer related stigma remains high in both clinical settings and amongst the general public. There is need for more interventions to combat cancer stigma and its effect in both patient and non-patient population. Anti-cancer public enlightenment campaigns should be sensitively designed to not further fuel stigma against patients with certain types of cancers.
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Affiliation(s)
- Elizabeth O Akin-Odanye
- Department of Clinical Psychology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, 200212, Nigeria
| | - Anisah J Husman
- College of Health Professions and Sciences, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA
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McLaughlin-Barrett S, Brunelli VN. Did you smoke? Addressing stigma in lung cancer. Respirology 2021; 26:1018-1020. [PMID: 34595781 DOI: 10.1111/resp.14161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sara McLaughlin-Barrett
- Lung Clinical Nurse Consultant, Lung Sleep Allergy Immunology Department, Monash Health, Clayton, Victoria, Australia
| | - Vanessa N Brunelli
- Research Fellow in Lung Cancer, Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Rose S, Boyes A, Kelly B, Cox M, Palazzi K, Paul C. Lung cancer stigma is a predictor for psychological distress: A longitudinal study. Lung cancer stigma is a predictor for psychological distress. Psychooncology 2021; 30:1137-1144. [PMID: 33624377 DOI: 10.1002/pon.5665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To examine if baseline stigma predicts psychological distress at 3 and 6 months follow-up among patients newly diagnosed with lung cancer. METHODS This longitudinal study was nested within a larger randomised controlled trial. Eligible participants were recruited via respiratory and oncology out-patient clinics in Australia (n = 194). Consenting participants were asked to complete surveys at baseline, 3 and 6 months post-recruitment. Measures included lung cancer stigma (Cataldo Lung Cancer Stigma Scale) and psychological distress (General Health Questionnaire-12 [GHQ-12]). RESULTS One-hundred and ninety-four participants were included for analysis. Most were male (57.7%) with a mean age of 68 years (SD = 8.8). A significant relationship between baseline lung cancer stigma and psychological distress at 6 months was found, where a one unit increase in lung cancer stigma increases psychological distress by 0.044 when adjusting for age, gender, smoking status, baseline GHQ-12 scores and intervention allocation (as part of the larger trial; p = 0.001; β = 0.044, 95% CI = 0.010, 0.079). CONCLUSION Temporal links between lung cancer stigma and psychological distress was found at 6 months, suggesting stigma-related experiences may have a delayed impact. Development of routine lung cancer stigma assessments is recommended to identify those at risk of psychological distress.
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Affiliation(s)
- Shiho Rose
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison Boyes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Brian Kelly
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martine Cox
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kerrin Palazzi
- Clinical Research, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Hunter Cancer Research Alliance, University of Newcastle, Callaghan, New South Wales, Australia
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Tian X, Jin Y, Chen H, Tang L, Jiménez-Herrera MF. Relationships among Social Support, Coping Style, Perceived Stress, and Psychological Distress in Chinese Lung Cancer Patients. Asia Pac J Oncol Nurs 2021; 8:172-179. [PMID: 33688566 PMCID: PMC7934593 DOI: 10.4103/apjon.apjon_59_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Social support is associated with improved psychological distress in cancer patients. This study investigates the impact of social support on Chinese lung cancer patients' psychological distress and further clarifies the mediating role of perceived stress and coping style. Methods: A cross-sectional survey study examined social support and psychological distress in 441 patients diagnosed with lung cancer from seven hospitals in Chongqing, China, between September 2018 and August 2019. Coping style and perceived stress were considered to be potential mediators of adjustment outcomes. Results: We found a detection rate of 17.7% for psychological distress among Chinese lung cancer patients. Social support was in significantly negative association with psychological distress, which was partially mediated by confrontation coping and perceived stress. Conclusions: Social support appears to contribute to ameliorate psychological distress by enhancing confrontation coping with cancer and enhancing perceived stress. There is a need for the development and evaluation of psychological intervention program to enhance the buffering effects of social support in lung cancer patients.
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Affiliation(s)
- Xu Tian
- Department of Nursing, Faculty of Nursing, Rovira I Virgili University, Tarragona, Spain.,Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
| | - Yanfei Jin
- Department of Nursing, Faculty of Nursing, Rovira I Virgili University, Tarragona, Spain
| | - Hui Chen
- Department of Gastroenterology, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
| | - Ling Tang
- Department of Nursing, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China
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Maguire R, Lewis L, Kotronoulas G, McPhelim J, Milroy R, Cataldo J. Lung cancer stigma: A concept with consequences for patients. Cancer Rep (Hoboken) 2019; 2:e1201. [PMID: 32721137 DOI: 10.1002/cnr2.1201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared with 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 < .001), greater social deprivation (P < .05), being unemployed (P < .001), depression (P < .001), symptom burden (P < .001), and HR-QoL deficits (P < .001). Symptom burden explained 18% of variance in LCS (P < .001). LCS explained 8.5% and 14.3% of the variance in depression (P < .001) and HR-QoL (P < .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 psychosocial well-being of patients with perceived LCS.
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Affiliation(s)
- Roma Maguire
- Department of Computing and Information Science, University of Strathclyde, Glasgow, UK
| | - Liane Lewis
- Department of Computing and Information Science, University of Strathclyde, Glasgow, UK
| | | | | | | | - Janine Cataldo
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California
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