Facets of stigma, self-compassion, and health-related adjustment to lung cancer: A longitudinal study

Examining evidence of lung cancer stigma among health-care trainees

BACKGROUND

Innovations in lung cancer control and care have started to transform the landscape of lung cancer outcomes, but lung cancer stigma and biases have been implicated as a deterrent to realizing the promise of these innovations. Research has documented lung cancer stigma among the general public and lung cancer survivors (self-blame), as well as clinicians across many disciplines. However, studies have not explored lung cancer stigma in health-care trainees. These data seek to address that gap and inform efforts to prevent the emergence or mitigate the presence of lung cancer stigma among future clinicians.

METHODS

Using clinical vignettes and a 2x2 factorial design, this investigation evaluated the impact of a history of smoking (yes vs no) and cancer diagnosis (lung vs colorectal) on perceptions of the described patient among 2 groups of preclinical health-care trainees (medical = 94 and nursing = 138). A charitable giving paradigm also asked participants to donate provided funds to 1 of 2 cancer advocacy organizations: one serving the lung cancer community and one serving the colorectal cancer community.

RESULTS

In study 1, results revealed a consistent pattern of statistically significant and medium to large effect size differences regarding stigmatized perceptions (eg, higher stigmatizing behavior, increased pity, greater anger, and less helping) for individuals with a history of smoking but no reliable differences regarding cancer diagnosis. Analysis of data from nursing trainees in study 2 showed a similar pattern of statistically significant and medium to large effects pertaining to stigma behavior and perceptions of individuals who had a history of smoking depicted in the vignettes. The charitable giving paradigm did not identify any reliable difference between the groups in either study.

CONCLUSIONS

Findings revealed a consistent pattern of health-care trainee perceptions that varied by smoking status but much less evidence that the cancer diagnosis contributed to different perceptions. This suggests that efforts to integrate consideration of stigma and biases in health-care training needs to adopt an approach that seeks to mitigate or eliminate stigmatizing perceptions and behaviors toward individuals with a history of smoking.

Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden

OBJECTIVE

This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer.

METHODS

Lung cancer patients on active oncological treatment ( N = 108; 74.1% stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep.

RESULTS

Higher discrimination ( b = 5.52, 95% confidence interval [CI] = 2.10-8.94) and constrained disclosure ( b = 0.45, 95% CI = 0.05-0.85) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress ( b = 0.19, 95% CI = 0.09-0.29) and physical symptoms ( b = 0.28, 95% CI = 0.17-0.40) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI = 0.13-1.96) and physical symptoms (indirect effect = 1.58, 95% CI = 0.37-2.79) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI = < 0.01-0.17) and physical symptoms (indirect effect = 0.13, 95% CI = 0.01-0.25).

CONCLUSIONS

Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.

Modeling the relationship between depression in people with cancer and perceived stress, with the mediating role of eating problems, sexual satisfaction, emotion regulation and self-compassion

Aim

With the rising prevalence of cancer and the adverse physical and psychological experiences endured by affected individuals, this study aims to establish a model illustrating the relationship between depression in people with cancer and perceived stress. Additionally, it examines the mediating influence of eating problems, sexual satisfaction, emotional regulation, and self-compassion.

Method

This study employs a descriptive-correlational research method, utilizing structural equation analysis (modeling) to explore the role of mediators. The research sample comprised 200 individuals diagnosed with cancer, selected based on predetermined inclusion and exclusion criteria. Participants completed Beck's 13-item depression questionnaire, a 10-item perceived stress questionnaire, an 8-item appetite measurement questionnaire, a 25-item sexual satisfaction questionnaire, a 10-item emotion regulation questionnaire, and a 12-item compassion questionnaire. The data were subsequently analyzed using SPSS-24 and Lisrel 80/8 software.

Findings

The research findings indicate a significant positive relationship between perceived stress and depression in people with cancer. Furthermore, eating problems exhibited a mediating role in the relationship between perceived stress and depression, with a direct effect coefficient of (t = 0.28, ß = 0.02). However, the path from perceived stress to depression, mediated by sexual satisfaction, was found to be statistically insignificant, with a standard coefficient of 0.01 at the p < 0.05 level. Emotion regulation demonstrated a direct effect coefficient of (t = -3.52, ß = -0.33) on depression. Likewise, self-compassion exhibited a direct effect coefficient of (t = -3.08, ß = -0.28) on depression, while the path from perceived stress to depression was mediated by self-compassion, with a standard coefficient of 0.12 at the p < 0.05 level.

Conclusion

In conclusion, this study sheds light on the interplay between depression and perceived stress in individuals with cancer, revealing a significant positive association. Eating problems emerged as a mediating factor, directly influencing the manifestation of depressive symptoms. However, the mediation pathway through sexual satisfaction was found to be statistically insignificant. Emotion regulation and self-compassion were identified as influential factors, with direct effects on depression and self-compassion also serving as a mediator in the relationship between perceived stress and depression. The findings emphasize the importance of targeted interventions addressing eating problems, enhancing emotion regulation, and fostering self-compassion to alleviate the impact of depression and perceived stress in individuals facing cancer-related challenges. Further research is encouraged to refine and expand upon these insights, advancing holistic care for this population.

Real-world analysis of the relationships between smoking, lung cancer stigma, and emotional functioning

INTRODUCTION

People diagnosed with lung cancer experience high rates of distress, which can be compounded by the stigma of the disease. This study assessed a real-world population to understand patient-reported emotional functioning, types of stigma experienced, and relationship with smoking history.

METHODS

Questionnaires using validated survey tools assessing demographics, smoking history, stigma, and quality of life (EORTC QLQ-C30 Emotional Functioning Scale) were analyzed from 539 global participants in the Lung Cancer Registry between November 2019 and July 2022. The associations between smoking history and self-reported internalized and perceived stigma and constrained disclosure of lung cancer diagnosis, as well as the potential impact of stigma on emotional functioning, were examined using multivariable logistic regression models.

RESULTS

Among the broad geographic mix of study participants, all types of lung cancer stigma were associated with decreased emotional functioning due to a combination of factors including depression, anxiety, stress, and irritability. Participants who reported a history of current or former smoking experienced higher levels of internalized stigma and perceived stigma. Constrained disclosure about a diagnosis was common, associated with decreased emotional functioning, and not related to a history of smoking. Smoking status itself was not associated with reduced emotional functioning, implicating the role of stigma in distress.

CONCLUSIONS

In this study, all types of lung cancer stigma were associated with clinically important decreases in emotional functioning. This impact was not dependent on smoking history. Internalized and perceived stigma were associated with the presence of a smoking history. These findings have implications for proper psychosocial care of people diagnosed with lung cancer.

Development and validation of the thyroid cancer self-perceived discrimination scale to identify patients at high risk for psychological problems

Objective

To develop a Thyroid Cancer Self-Perceived Discrimination Scale (TCSPDS) to identify patients at high risk for psychological problems and to test its reliability, validity and acceptability.

Methods

Using classical test theory, a total of 176 thyroid cancer patients from November 2021 to October 2022 were recruited to develop the TCSPDS. Item analysis was used to improve the preliminary TCSPDS. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation model (SEM) were used to test the construct validity of the final TCSPDS. Pearson correlation coefficient was used to analyze the validity coefficient between TCSPDS and EORTC QLQ-C30 to test the criterion-related validity (CRV) of the final TCSPDS. The internal consistency coefficient (Cronbach's alpha coefficient), split half reliability (Spearman-Brown coefficient) and test-retest reliability were used to verify the reliability of the final TCSPDS. The questionnaire completion time and effective response rate were used to validate the acceptability of the final TCSPDS.

Results

The TCSPDS consisted of 20 items and was divided into 3 subscales: 8 items for stigma, 6 items for self-deprecation, and 6 items for social avoidance. The TCSPDS had good validity (χ2/df=1.971, RMSEA=0.074, GFI=0.921, CFI= 0.930, IFI=0.932, TLI=0.901, Validity coefficient=0.767), reliability (Cronbach's alpha=0.867, Spearman-Brown coefficient=0.828, test-retest reliability coefficient=0.981) and acceptability [average completion time (15.01 ± 1.348 minutes) and an effective response rate of 95.14%]. Patients with higher TCSPDS scores reported a lower quality of life (P<0.05).

Conclusion

The TCSPDS could be used for early identification and assessment of the level of self-perceived discrimination in patients with thyroid cancer, which may provide a scientific basis for health education, social support and psychosocial oncology services in the future, especially in Southwest China.