The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients

BACKGROUND

Cancer is the leading cause of death in Taiwan. Because the causes of cancer are often difficult to identify, a diagnosis of cancer is occasionally attributed to karma and the concept of stigma. These feelings lead to a life predicament, and stigma influences these perceptions.

OBJECTIVE

This study intended to understand how stigma is formed in the disease-related experiences of women with cancer.

METHODS

Ten participants were interviewed at the time of a confirmed diagnosis of advanced cancer and completed cancer treatment with regular follow-up after treatment, and all subjects underwent 2-3 interviews. The number of interviews conducted was determined by data saturation. A content analysis method was used.

RESULTS

The stigma of cancer includes the concepts of "cancer equals death", including the feeling of death approaching and an awareness of disease severity. "Cancer equals menace to social life" suggests that social life is affected and includes other individuals' uncomfortable attitudes toward cancer (shame, sympathy, pity, suffering, and over-cautiousness) and external physical changes. "Cancer equals cancer-ridden life" includes being sensitive to the topics of death and calculating the number of remaining survival days.

CONCLUSIONS

The process from early diagnosis to the decision to receive treatment is complicated for patients with cancer. After the diagnosis is confirmed, the stigma of diagnosis significantly affects patients. Regarding social stereotypes, educating the public to resolve individuals' negative responses to cancer and further convey social and public information to women in society is necessary.

Psychological consequences of cancer screening in HIV

PURPOSE OF REVIEW

There is a growing awareness of the increase in non-AIDS-defining cancers (NADC) in the HIV-infected population. Cancer screening is one means of reducing morbidity and mortality, but such screening may have psychological consequences across those with high and low-risk results, such as increased anxiety, worry and potential behavior change like increased self-examination or medical follow-up. This review examines the literature on psychological consequences of screening for NADC in HIV-infected populations.

RECENT FINDINGS

Anal cancer is the only cancer type in which the psychological consequence of screening has been investigated in HIV-infected populations. Screening increases worry about anal cancer, particularly in those who are younger, have higher baseline anxiety or more symptoms. Participants with low-risk results show unrealistic optimism; this is a potential concern as it may lead to unrealistic beliefs about future risk, the need for healthy behaviors or follow-up screening. The lack of standardized screening protocols and programs makes assessing psychological consequences difficult.

SUMMARY

More research is needed to determine if HIV populations differ from general population studies. Increased health promotion or symptom awareness is important for NADC with no standardized screening. Screening programs need to be aware of the potential for increased anxiety and worry and provide support as needed.

Motivations and experiences of women who accessed "see and treat" cervical cancer prevention services in Zambia

BACKGROUND

In Zambia, a country with a generalized HIV epidemic, age-adjusted cervical cancer incidence is among the highest worldwide. In 2006, the University of Alabama at Birmingham-Center for Infectious Disease Research in Zambia and the Zambian Ministry of Health launched a visual inspection with acetic acid (VIA) -based "see and treat" cervical cancer prevention program in Lusaka. All services were integrated within existing government-operated primary health care facilities.

OBJECTIVE

Study aims were to (i) identify women's motivations for cervical screening, (ii) document women's experiences with screening and (iii) describe the potentially reciprocal influences between women undergoing cervical screening and their social networks.

DESIGN AND METHODS

Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with women who accepted screening and with care providers. Low-level content analysis was performed to identify themes evoked by participants. Between September 2009 and July 2010, 60 women and 21 care providers participated in 8 FGD and 10 IDI.

RESULTS

Women presented for screening with varying needs and expectations. A majority discussed their screening decisions and experiences with members of their social networks. Key reinforcing factors and obstacles to VIA screening were identified.

CONCLUSIONS

Interventions are needed to gain support for the screening process from influential family members and peers.

'Worse than HIV' or 'not as serious as other diseases'? Conceptualization of cervical cancer among newly screened women in Zambia

Invasive cervical cancer is the second most common cancer among women worldwide, with approximately 85% of the disease burden occurring in developing countries. To date, there have been few systematic efforts to document African women's conceptualization of cervical cancer after participation in a visual inspection with acetic acid (VIA)-based "see and treat" cervical cancer prevention program. In this study, conducted between September, 2009-July, 2010, focus groups and in-depth interviews were conducted with 60 women who had recently undergone cervical cancer screening at a government-operated primary health care clinic in Lusaka, Zambia. Interviewers elicited participants' causal representations of cervical cancer, associated physical signs and symptoms, perceived physical and psychological effects, and social norms regarding the disease. The lay model of illness causation portrayed by participants after recent exposure to program promotion messages departed in several ways from causal models described in other parts of the world. However, causal conceptualizations included both lay and biomedical elements, suggesting a possible shift from a purely traditional causal model to one that incorporates both traditional concepts and recently promoted biomedical concepts. Most, but not all, women still equated cervical cancer with death, and perceived it to be a highly stigmatized disease in Zambia because of its anatomic location, dire natural course, connections to socially-condemned behaviors, and association with HIV/AIDS. No substantive differences of disease conceptualization existed according to HIV serostatus, though HIV positive women acknowledged that their immune status makes them more aware of their health and more likely to seek medical attention. Further attention should be dedicated to the processes by which women incorporate new knowledge into their representations of cervical cancer.

Psychosocial aspects of anal cancer screening: a review and recommendations

Cancer screening programs have the potential to decrease psychosocial wellbeing. This review investigates the evidence that anal cancer screening has an impact on psychosocial functioning and outlines considerations for supporting participants. The review suggested that screening has no significant effect on general mental health but may increase cancer-specific worry. Having worse anal or HIV symptoms, being younger, higher baseline distress or worse histology results were predictive of greater worry. The findings suggest the need to increase education campaigns, particularly targeting those with HIV infection and men who have sex with men. There is a need to develop a consensus on measuring the psychosocial impact of screening and stepped care approaches for responding to any resulting distress.