Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country

Research progress on the psychological burden and intervention measures in cancer patients

In the past 40 years, the gradually increasing incidence and mortality rates of malignant tumors have severely impacted the quality of life of patients, bringing significant physical and psychological burdens and becoming an increasingly serious social issue. With the development of medical standards, new methods for cancer detection and treatment have been continuously proposed. Although it has been proven that cancer is related to increased psychological burden and suicidal behaviors in patients, current research on the psychological burden caused by cancer is insufficient. Clinicians often overlook the psychological health issues of patients while treating their physical diseases. Considering the high incidence of cancer, this review will outline the psychological burdens of cancer patients worldwide in recent years and its high-risk factors. Moreover, this review will summarize the common methods for evaluating psychological burdens, present current predictive models and treatment methods for the psychological burden of cancer patients, aiming to provide a research basis and future direction for the timely and accurate assessment of the psychological burden in cancer patients.

Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman

BACKGROUND

Cancer is widely considered as one of the most stigmatized diseases globally, despite scientific advances in the medicine. While most existing literatures focuses on cancer stigma as perceived by patients, there has been limited research on  stigma towards cancer among the non-cancer population. In 2014, Marlow et al developed and validated the "Cancer Stigma Scale" (CASS) specifically for the non-Cancer population. This study aims to quantitatively evaluate cancer stigma within the non-patient population in Oman.

METHODS

This is a cross-sectional study conducted in Oman. The Cancer Stigma Scale (CASS) has been used to evaluate the cancer-related stigma among the non-cancer patient population in Oman.

RESULTS

A total of 510 participants completed the survey of whom 57.6% were male. The personal responsibility section had the highest mean score, followed by the avoidance and financial discrimination. The lowest mean scores were observed in the danger and policy opposition sections. Female participants showed ore disagreement  with cancer stigma statements compared to males. Participants who knew someone with cancer expressed more disagreement with stigma statements than those  who did not know anyone with cancer.

CONCLUSION

This study provides a baseline measurement of  cancer-related stigma among non-cancer patients in Oman, tilizing the CASS in a representative sample of the population. The results indicate generally low levels of stigma, though certain aspects are more pronounced, varying according to the participants' gender, age, and personal connections to someone with cancer.

Multiple myeloma in people of working age in Czechia, Germany, and Poland: findings from a qualitative interview study

PURPOSE

The study sought to understand the experiences of working age adults with myeloma and their partner/family members, living in Czechia, Germany, and Poland.

METHODS

Qualitative interviews were conducted with 36 working age adults living with myeloma, and three family members. Data were collected from May to October 2022. Thematic analysis was applied to the data.

RESULTS

Healthcare and state support within each country are described. The degree of work engagement was informed by patients' symptom burden, treatment needs, state financial aid, and family/financial obligations. Many did not conceptualise their status as involving 'return to work' as they had continued to be engaged with their jobs throughout. For some, remote working enabled them to manage treatments/side-effects and their job, while avoiding infection. In some cases, patients did not tell their employer or colleagues about their illness, for fear of discrimination.

CONCLUSION

While experiences varied between countries, common across accounts was a struggle to balance ongoing treatments with employment, at a time when participants were expected to finance their own households and maintain their income and roles. Implications for Cancer Survivors To improve quality of life, clinical discussions around treatment decision-making should take into account patients' attitudes/approach to work, type of work engaged in, and other activities considered important to them. European Union and national cancer plans should set out optimum standards for employers, to ensure an equitable benchmark for how employees are supported. Such approaches would improve legal protections and better enforcement of employer policies to accommodate patients' limitations in the workplace.

Cancer Stigma Among 800 Saudi Citizens: A Cross-Sectional Study and Literature Review

INTRODUCTION

Cancer-related stigmatization is a noteworthy phenomenon, yet it has not received sufficient attention in public health studies. Despite recent advancements in treatment and improvements in survival, the burden of stigma remains a challenging concern for individuals diagnosed with cancer.

AIM

This study aims to assess the presence of cancer stigma in the Saudi Arabian population by using the Cancer Stigma Scale (CASS).

METHODS

A cross-sectional study was conducted among the general population of Saudi Arabia. Data collection was facilitated through a self-administered online questionnaire, incorporating socio-demographic variables such as age, gender, and regional residence and employing the CASS instrument to gauge the prevalent attitudes and stigmas related to cancer.

RESULTS

Out of the 874 participants, a majority of 87.1% were female, with 60.2% aged between 20 and 39 years. Notably, 59% reported having a close friend or family member diagnosed with cancer. The average CASS score stood at 1.59 (SD 0.39) on a 5-point scale, with an overwhelming 97.1% registering scores under 2.5, suggesting a generally low stigma perception. In dissecting the CASS components, 'severity' recorded the highest mean score (mean: 2.23), followed by 'awkwardness' (mean: 1.86) and 'financial discrimination' (mean: 1.71). 'avoidance' registered the lowest mean score at 1.11. Notably, a trend of increasing stigma was observed with advancing age, and male respondents indicated a marginally higher propensity towards stigmatizing attitudes.

CONCLUSION

In Saudi Arabia, cancer-related stigma is generally low. However, 'severity' is the most prominent stigma aspect, with 'avoidance' being the least. Older individuals and males exhibit slightly higher stigmatizing attitudes. These insights highlight the need for targeted public health efforts to address remaining stigmatization, especially based on age and gender.

Influence of dialysis-related stigma on health-related indicators in Japanese patients undergoing hemodialysis

INTRODUCTION

Focusing on impacts to health-related indicators in older Japanese patients, this study analyzed both the direct influence of dialysis-related stigma and influences of its intersectionality with other stigmatized characteristics.

METHODS

Data were collected through a cross-sectional survey of 7461 outpatients in dialysis facilities. Other stigmatized characteristics include lower income, lower education, disabled activities of daily living, and diabetic end-stage renal disease (ESRD) as a cause for starting dialysis treatment.

RESULTS

The average rate of an "agree" response on dialysis-related stigma items was 18.2%. Dialysis-related stigma significantly influenced all three health-related indicators, including suspected depression, informal networks, and compliance with dietary therapy. In addition, each interaction between dialysis-related stigma and educational attainment, gender, and diabetic ESRD significantly influence one health-related indicator.

CONCLUSION

These results suggest that dialysis-related stigma has both a significant direct and synergic influence with other stigmatized characteristics on health-related indicators.

Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis

OBJECTIVE

This study was conducted to examine the factors associated with stigma in breast cancer women.

METHODS

PubMed, Embase, the Cochrane Library, Web of Science, and two Chinese electronic databases were electronically searched to identify eligible studies that reported the correlates of stigma for patients with breast cancer from inception to July 2022. Two researchers independently performed literature screening, data extraction, and risk of bias assessment. R4.1.1 software was used for statistical analysis.

RESULTS

Twenty articles including 4161 patients were included in the systematic review and meta-analysis. Results showed that breast cancer stigma was positively correlated with working status, type of surgery, resignation coping, depression, ambivalence over emotional expression, and delayed help-seeking behavior and negatively correlated with age, education, income, quality of life, social support, confrontation coping, psychological adaptation, self-efficacy, and self-esteem. Descriptive analysis showed that breast cancer stigma was positively correlated with intrusive thoughts, body image, anxiety, and self-perceived burden but negatively correlated with a sense of coherence, personal acceptance of the disease, sleep quality, cancer screening attendance and doctor's empathy.

CONCLUSION

Many demographic, disease-related, and psychosocial variables are related to breast cancer stigma. Our view can serve as a basis for health care professionals to develop health promotion and prevention strategies for patients with breast cancer.

The association between comorbidities and stigma among breast cancer survivors

This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

Objectives

The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.

Methods

In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.

Results

An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.

Conclusion

While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.

Perceived Stigma and Its Correlates Among Asian Patients with Advanced Cancer: A Multi-Country APPROACH Study

OBJECTIVES

Perceived cancer-related stigma can affect mental health and potentially treatment choices for patients with cancer. Nevertheless, perceived stigma is not very well understood in Asia. This study investigated across six developing Asian countries: 1) the prevalence of perceived stigma among advanced cancer patients, 2) its risk factors, and 3) its association with patient treatment preferences.

METHODS

This cross-sectional study recruited patients receiving oncology care across major hospitals in Bangladesh, China, India, Philippines, Sri Lanka and Vietnam. Participants (N = 1358) were adults diagnosed with stage IV metastatic solid cancer who completed self-reported surveys. Multi-variable logistic regression and ordered logit models examined the associations with perceived stigma and variables of interest.

RESULTS

Across the countries, 35%, 95% CI [32%, 38%] of patients reported experiencing at least one facet of cancer-related stigma often or always, while 60% [57%, 63%] reported it occurring occasionally. Top-endorsed facets of perceived stigma across the Asian countries suggest a distinct pattern. Having knowingly engaged in health-risk behaviours (OR = 2.03-2.24, 95% CI [1.14-1.19, 3.43-4.41]), unemployment (2.64 [1.67, 4.19]) and body image change (1.57 [1.00, 2.45]) were associated with higher odds of perceived stigma, while time mitigated perceived stigma (0.49-0.65 [0.30-0.45, 0.76-0.92]). Perceived stigma was associated with lower odds of preference for life-extending treatments, although the associations did not hold up in the adjusted model.

CONCLUSIONS

Perceived stigma is unique among Asian advanced cancer patients. Stigma is important to assess and address, taking into consideration the various sociodemographic, clinical and psychological factors of cancer patients. This article is protected by copyright. All rights reserved.

Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients

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.

Experience of chronic noncommunicable disease in people living with HIV: a systematic review and meta-aggregation of qualitative studies

Background

An increasing number of people living with HIV (PLWH) have had chronic noncommunicable diseases (NCDs) over the last 5 years. However, robust evidence regarding the perception and challenges of having NCDs among PLWH is limited. Therefore, this study aimed to synthesize qualitative evidence regarding the experiences of PLWH with NCDs.

Methods

We used a meta-aggregation approach to synthesize qualitative studies. Peer-reviewed and gray literature published in English and Chinese from 1996 to November 2020 was searched using electronic databases. Two reviewers independently appraised the methodological quality and extracted data from the included studies. The Joanna Briggs Institute (JBI) meta-aggregation approach was used to synthesize the findings.

Results

In total, 10,594 studies were identified in the initial database search. Fourteen eligible studies were included in the meta-synthesis. Among these studies, nine synthesized findings regarding the following topics were identified: fragmented healthcare systems, care continuity, manifestations of multiple conditions, financial hardship, stigma and discrimination, polypharmacy burden and adherence, reciprocal relationships between HIV and NCDs, and coping strategies.

Conclusions

In recent years, attempts have been made to institutionalize NCD preventive and control services in HIV long-term care. However, considering the growing problem of HIV and NCD comorbidity globally, integrated primary health care systems are needed to address the problems of PLWH with NCDs. Healthcare professionals should help PLWH develop strategies to better monitor their polypharmacy burden and adherence, stigma and discrimination, financial hardship, and manifestations of multiple conditions to achieve high levels of care continuity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11698-5.

Stigmatization, discrimination and illness perception among oncology patients: A cross-sectional and correlational study

PURPOSE

Many individuals who get cancer may be exposed to stigmatization from their close relatives and their entourage. This cross-sectional and correlational study was conducted in order to determine stigmatization, discrimination and perception of illness among oncology patients in Northern Turkey.

METHOD

The sample of the study consisted of 367 inpatients who were hospitalized in the oncology and hematology clinics of a University Hospital in northern Turkey between 31.01.2019 and 30.07.2019. Data were collected using the demographics form, Cataldo Lung Cancer Stigma Scale and Illness Perception Questionnaire.

RESULTS

The mean total score of the patients according to Cataldo Lung Cancer Stigma Scale is 30.4 ± 8.8. In this study, no statistically significant relationship was determined between Cataldo Lung Cancer Stigma Scale total score and Illness Perception Questionnaire sub-dimension scores (p > .05). It can be said that the oncology patients were exposed to stigmatization and discrimination, and that certain socio demographic and clinical characteristics such as sex, marital status, education level, employment status, diagnosis, and the clinical phase of the disease are significant predictors of Cataldo Lung Cancer Stigma Scale scores.

CONCLUSIONS

In order to help them express their feelings in oncology patients, reduce their anxiety, increase their adaptation to their illness and treatment, help them cope with the multi-faceted crisis caused by the disease and improve their quality of life, cancer stigmatization should be evaluated objectively.

Effect of mind and body education on quality of life among young breast cancer patients: a randomized controlled trial

PURPOSE

This study aim was to evaluate efficacy of the combination with cosmetic and psychosocial education program on body image, sexual function, and emotional function among young-onset breast cancer (YBC).

METHODS

An unblended, randomized, controlled trial design was conducted in patients newly diagnosed with stage I-III breast cancer from 2014 to 2015. The intervention group received a structured education program including appearance management and mind control for 4 weeks. The outcome of this study shows effect on body image and sexual functioning and a distress due to altered appearance and anxiety after the intervention and 6 months after intervention.

RESULTS

Among 228 eligible patients, 109 (47.8%) agreed to participate in the present study and were randomized to intervention (n = 54) or control (n = 55) groups. After intervention, the intervention group reported significantly better body image compared to the control group (mean score of 75.0 vs. 59.3, respectively; P < 0.01). The intervention group also reported significantly lower levels of distress due to altered appearance and higher levels of sexual functioning compared to the control group after the intervention. The effects were maintained even 6 months after intervention.

CONCLUSION(S)

Body image intervention for YBC had effect on improving body image and sexual functioning and a reduction in distress due to altered appearance and anxiety. Trial registration number and date of registration: The study was registered at the Clinical Research Information Service (no. KCT0001191, https://cris.nih.go.kr/cris ) on 23 July 2014.

Young adults' stigmatizing perceptions about individuals with skin cancer: the influence of potential cancer cause, cancer metaphors, and gender

Objective: This study examined the influence of three potential predictors of stigmatising cancer perceptions: the controllability of the cancer cause, metaphors used to describe the cancer experience, and the target's gender.Method: 306 undergraduates (Mage = 20) were recruited via subject pool, balancing males and females. Participants read a fictitious post by a patient/blogger with skin cancer that described different potential causes for their cancer varying with respect to its controllability, used varying types of commonly invoked cancer metaphors, and indicated their gender with names.Main outcome measures: Potential stigmatisation of the blogger in the form of negative affective responses, perceptions of flawed character, desired social distance and expectations for post-traumatic growth were assessed using mixed methods. The perceived age of the blogger and expectations for their survival were also explored.Results: More blame, less sympathy, and less favourable perceptions of character were ascribed to the hypothetical blogger when their cancer was described as due to their lifestyle rather than genetics and thus potentially construed as more controllable. Females using a war metaphor resulted in more positive responses compared to a female using no metaphorical language.Conclusion: Stigmatisation of individuals with skin cancer may depend on the potential cause of cancer, and to some extent, metaphors and gender.

Correlates of stigma for patients with cancer: a systematic review and meta-analysis

OBJECTIVE

The systematic review and meta-analysis was performed to summarize the available evidence and identify the correlates of cancer stigma.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, and PsycINFO were electronically searched to identify eligible studies about correlates of stigma for patients with cancer. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies. A meta-analysis was performed using the statistical program R.

RESULTS

Thirty-one studies involving a total of 7114 patients were included in the systematic review and meta-analysis. The results of the meta-analysis showed that cancer stigma shared positive associations with male gender, symptoms, depression, anxiety, body image loss, self-blame, social constraint, intrusive thoughts, and ambivalence over emotional expression, and negative associations with income, NK cell subsets, QOL, self-esteem, self-efficacy, cancer screening attendance, doctor's empathy, and medical satisfaction. The results of the descriptive analysis indicated that cancer stigma was positively associated with self-perception of aging, anger, internal attributions, stressful life events, self-perceived burden, and sleep dysfunction, while negatively associated with patient-provider communication and sleep quality.

CONCLUSION

Healthcare staff should pay attention to the identified correlates of cancer stigma. The results of our research can inform the design of interventions to reduce stigma and to improve clinical outcomes in people with cancer.