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

Experiences of cancer-related stigma in Africa: A scoping review

Cancer is a major health issue, particularly in low- and middle-income countries where 70% of cancer deaths occur. Stigma and barriers to screening and treatment lead to poor outcomes. We conducted structured searches of PubMed, Embase, MEDLINE, CINAHL, and CABI Global Health databases according to PRISMA-ScR guidelines. Searches used keywords related to (1) Africa, (2) cancer, and (3) stigma. We then screened to finalize a list of research manuscripts, dissertations, theses, and conference abstracts using quantitative, qualitative, or mixed methods to explore cancer stigma in Africa. This review focused on non-cervical cancers. Breast and cervical cancers have distinct stigma-related experiences due to awareness, screening, and sociocultural perceptions. Including cervical cancer risks dilutes the specificity and depth of findings. The review included 53 studies that linked stigma and cancer in Africa to physical symptoms, appearance changes, misconceptions, and emotional challenges, hindering care and worsening treatment outcomes. Cancer-related stigma negatively impacts screening and treatment engagement in Africa. The lack of intervention studies underscores the need for evidence-based strategies to reduce stigma. Future efforts should reduce barriers to cancer care, enhance public awareness, and implement policy changes to improve outcomes.

Perceived stigmatization in cancer patients during the first year after diagnosis: the role of socioeconomic status

PURPOSE

Stigmatization in cancer patients leads to poorer health-related outcomes. The effect of socioeconomic status (SES) on stigmatization has not been investigated. We therefore aim to investigate, which differences in stigmatization in cancer patients regarding SES exist up to one year after diagnosis and which medical and demographic characteristics are associated with stigmatization.

METHODS

Patients with different solid cancer diagnoses were assessed within two months after diagnosis (t1) and at a 12-month follow-up (t2). Stigmatization was assessed using the Social Impact Scale (SIS), which comprises four dimensions: isolation, rejection, shame and financial insecurity. An SIS-total score can be computed. Bivariate and multiple regression analysis were performed.

RESULTS

Six hundred-eighty patients completed the assessments (mean age 60.4; 51.2% male; most prevalent cancers: prostate (21.0%), skin (17.1%), breast (16.2%)). Stigmatization at t1 was moderate in all dimensions, independent of SES. It decreased at t2, especially in patients with middle or high SES (p < 0.001). Low SES was identified as a risk factor for stigmatization at t2 (p = 0.036 - p < 0.001). Other predictors include stigmatization at t1 as well as distress, disease stage and cancer diagnosis, e.g. lung cancer. The predictors explained 27-43% of the variance in stigmatization in the four dimensions resp. in the SIS-total score.

CONCLUSION

Stigmatization after cancer diagnosis was dependent of SES. Reasons may be fewer social and economic resources, lower health literacy and insufficient consideration of the specific needs of this patient group in the healthcare system.

IMPLICATION FOR CANCER SURVIVORS

Patients with low SES should receive greater attention in the medical care system and in scientific research to identify and mitigate possible burdens and subsequent problems.

A Critical Discourse Analysis of the Language of Stigmatization of Breast Cancer Patients in Nigeria

Breast cancer is a significant health concern globally, including in Nigeria, where its incidence is rising. An essential component of breast cancer care is the psychosocial wellbeing of patients, which is often shaped by the language used in healthcare and society. While some research has explored stigmatization of breast cancer patients, no study has focused on language as a tool for this stigmatization in Nigeria. This study examines how language perpetuates the stigmatization of breast cancer patients and explores ways to use language to improve their lives and health. Using Norman Fairclough's model of critical discourse analysis and a descriptive design, data was collected through interviews with 50 respondents at the University College Hospital in Ibadan, Nigeria. The study's discourse analysis revealed that stigmatization is perpetuated through language, including negative stereotypes, body shaming, spiritual interpretations, and derogatory terms. These discourses reflect broader social and cultural factors such as norms, beliefs, and power dynamics that reinforce stigmatization. The research highlights the effects of stigmatizing language, including denial, loss of femininity, shame, and fear of a new identity. The findings call for policies and interventions to reduce stigma, improve patient experiences, and raise public awareness of breast cancer.

Stigma, colorectal cancer knowledge and self-efficacy among colorectal cancer survivors: A cross-sectional study based on random forest analysis

PURPOSE

To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors.

METHODS

In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance.

RESULTS

Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16).

CONCLUSIONS

Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

Assessing Breast Cancer Awareness Among Women in Al Baha, Saudi Arabia: A Cross-Sectional Study Using the Breast Cancer Awareness Measure (BCAM)

INTRODUCTION

Breast cancer (BC) awareness and preventive practices are critical for the early detection and effective management of the disease. This study aimed to assess the level of BC awareness among women residing in Al Baha, Saudi Arabia.

METHODS

A cross-sectional study was conducted using the Breast Cancer Awareness Measure (BCAM) survey tool to evaluate BC awareness among female residents of Al Baha between June and July 2023. The sample was obtained through the snowball sampling technique.

RESULTS

A total of 1007 women participated in the study, with a mean age of 29 ± 10.9 years. Overall awareness of BC warning signs and risk factors was low, with 45% of participants demonstrating poor awareness. Significant positive associations were found between BC awareness and factors such as level of education (p = 0.020), employment status (p = 0.023), field of study for students (p < 0.0001), and average monthly family income (p = 0.001). Furthermore, 75% of participants rarely or never practiced breast self-examination, and only 37% of those invited to the Ministry of Health's screening program had attended.

CONCLUSIONS

The results highlight a significant lack of awareness and knowledge about BC among women in Al Baha. These findings underscore the urgent need for targeted educational initiatives and awareness campaigns to address this knowledge gap and promote preventive practices.

Quitting smoking after a cancer diagnosis is associated with reductions in stigma and anxiety: A longitudinal mediation analysis

Internalized cancer stigma is high among cancer patients who smoke, but it is unknown whether the experience of stigma changes after quitting smoking post-diagnosis. Using data from an RCT of tobacco treatment, we conducted a secondary data analysis and hypothesized that 1) cancer patients who quit smoking would report greater reductions in internalized cancer stigma, compared to patients who did not quit and that 2) greater reductions in stigma would significantly mediate the relationship between smoking abstinence and subsequent decreases in anxiety and depressive symptoms. Participants (n=303; 56.1% female) were adults recruited from two comprehensive cancer centers who had smoked in the past 30 days, spoke English or Spanish, and were being treated for a recent diagnosis of cancer. Participants completed questionnaires at baseline, 3-month follow-up, and 6-month follow-up, and biochemically verified smoking abstinence was determined by participants' salivary cotinine or carbon monoxide levels. Smoking abstinence at 3-month follow-up was significantly associated with reductions in cancer-related stigma from baseline to 3-month follow-up (b = -1.50, p < .001), controlling for sociodemographic and medical covariates. Additionally, reductions in stigma were associated with reductions in anxiety at 6-month follow-up (b = 0.28, p < .05), but not depressive symptoms. Reductions in stigma significantly mediated the relationship between smoking abstinence and decreased anxiety (indirect effect = -0.42, p < .05), but not depressive symptoms. Smoking cessation may be associated with reduction in internalized cancer stigma. Thus, in addition to benefits for medical outcomes, quitting smoking post-diagnosis may improve psychosocial well-being.

Responsive cancer care in Asia: stigma and pain must be acknowledged and addressed

PURPOSE

This study investigates whether cancer-related stigma and pain among patients with advanced cancer influences their perceptions of receiving responsive care.

METHODS

We surveyed 2138 advanced cancer patients from 11 hospitals in eight Asian countries. Participants rated their most recent healthcare visit and a hypothetical patient's experience described in vignettes concerning dignity, clarity of information, and involvement in decision-making. We used the vignettes to correct for differences in patients' reporting behaviors.

RESULTS

Overall, 39% of patients perceived cancer-related stigma, and 66% reported moderate or severe pain. While most patients rated their own experience of being treated with dignity (89%), receiving clear information (82%), and involvement in decision-making (79%) as "good" or "very good," they generally rated the vignettes less favorably compared to their own care experience. The negative relationship between perceived stigma and severe pain and health system responsiveness was established through the ordered probit models (p < 0.05 for all domains). Correcting for reporting heterogeneity amplified the negative association for all three domains of health system responsiveness for both moderate and severe pain and perceived stigma (p ≤ 0.01 for all domains).

CONCLUSION

The widespread prevalence of cancer-related stigma and pain documented in this study across a diverse sample of patients with advanced cancer is concerning. Moreover, perceived stigma and pain pervade patients' interactions with the healthcare system, diminishing their experience of being treated with dignity, receiving clear information, and participating in decision-making. Our findings underscore the importance of addressing stigma and pain to ensure responsive care for advanced cancer patients in Asia.

Pathway to care among adolescents and young adults with breast cancer in Nigeria: a mixed methods study

BACKGROUND

The mortality from breast cancer (BC) is still high in Nigeria and other low-and medium-income countries (LMICs) especially among adolescents and young adults. This is partly due to late presentation for diagnosis and treatment. It is recommended that to optimize the effectiveness of treatment, the total time which is the interval from symptom onset to initiation of treatment, should be less than 90 days as recommended by the World Health Organization (WHO). The aim of this study was to determine the extent of delays in accessing care and possible reasons for such delays among young adult females with breast cancer in Nigeria.

METHODS

A mixed-method convergent parallel study design was used. The study was conducted at two academic hospitals in southwest Nigeria. Data were collected using a semi-structured assessment tool and an in-depth interview guide. Both the quantitative and qualitative data were collected concurrently. This approach was adopted to aid in the collection of different but complimentary data at the study sites to enrich the interpretation of the results.

RESULTS

A total of 46 female participants were recruited into the quantitative component of the study, and the mean age was 34.2 ± 4.4 years. Most had higher education, were married, and were in a lower earning bracket. Majority participants had low knowledge of symptoms and signs of breast cancer. As low as 7 (15.2%) patients had the time between symptom discovery and treatment initiation [Total Treatment Time (TT)] within 90 days (median 281.5; range 31-5260). Twenty-seven (58.6%) participants had diagnostic interval within 60 days (median 40 days [Inter Quartile Range (IQR) 7-4745 days]. Most participants interviewed 39 (85%) knew that breast lump was a possible sign of breast cancer while a sizable number 19 (41%) could not name risk factors for breast cancer. Family history was the most recognised risk factor for breast cancer by 21(46%) of participants interviewed.

CONCLUSION

Breast health awareness is low among adolescents and young adults with breast cancer in Nigeria, as most participants 33(72%) lacked knowledge of early symptoms and signs of breast cancer. Very few 7(15%) of the participants commenced treatment within the WHO recommended 90 days of noticing breast symptoms. Sixty percent of the participants met the diagnostic interval of within 60 days as against recommended 80%. There is need to intensify the education of young Nigerian females on breast cancer and the importance of breast self-examination.

Perceived Shame and Stigma, and Other Psychosocial Predictors of Psychological Distress Among Cancer Patients in Malaysia

BACKGROUND

Patients' sociodemographic factors, clinical characteristics, distress factors, perceived shame and stigma may give rise to psychological distress in cancer patients that bring about further psychosocial impact.

AIMS

(1) to determine the degrees of shame and stigma towards cancer and psychological distress among cancer patients in Malaysia and (2) to examine the clinical and psychosocial predictors of psychological distress.

METHODS

This cross-sectional study recruited a total of 217 cancer patients. The participants were administered the sociodemographic and clinical characteristics questionnaires, the Malay version of the Shame and Stigma Scale (SSS-M) to assess for the degree of cancer shame and stigma, and the Malay version of the Distress Thermometer and Problem List to assess for presence of psychological distress and identify its sources.

RESULTS

There was a significant level of shame and stigma among cancer patients with the total mean SSS-M score of 12.08 (SD = 6.09). Anger (adjusted odds ratio [AOR] = 11.97, 95% confidence interval [CI] = 2.96-86.8, p = 0.001), loss of interest or enjoyment (AOR = 14.84, 95% CI = 2.93-75.20, p = 0.001), loneliness (AOR = 8.10, 95% CI = 1.13-58.02, p = 0.001), feeling of worthlessness or being a burden (AOR = 6.24, 95% CI = 1.32-29.59, p = 0.021), fear (AOR = 4.52, 95% CI = 1.79-11.43, p = 0.001), pain (AOR = 4.07, 95% CI = 1.53-10.82, p = 0.005), financial constraint (AOR = 2.95, 95% CI = 1.22-7.13, p = 0.016), and having regret (AOR = 1.89, 95% CI = 1.03-3.79, p = 0.039) increased the odds of developing psychological distress.

CONCLUSION

Treating clinicians should monitor for and provide psychosocial interventions for the biopsychosocial factors which may worsen psychological distress among cancer patients.

Ethical Dimensions of Population-Based Lung Cancer Screening in Canada: Key Informant Qualitative Description Study

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles.

Exploring psychological help-seeking behaviors and stigma perception among cancer patients: a study on their impact on psychosocial adjustment

OBJECTIVE

The study investigates the relationships between psychological help-seeking behaviors, stigma perception, and psychosocial adjustment among cancer patients. Understanding these dynamics is crucial for enhancing the mental health and overall well-being of individuals battling cancer.

METHODS

This descriptive cross-sectional study involved 387 cancer patients, with data collected through structured questionnaires assessing attitudes toward seeking psychological help (ATSPPH-SF), stigma perception (SSRPH), and psychosocial adjustment (PAIS-SR). Statistical analyses, including correlation and hierarchical regression models, were conducted to explore the associations between these variables.

RESULTS

The findings revealed a significant inverse relationship between perceived stigma and help-seeking behaviors, indicating that higher stigma is associated with reduced likelihood of seeking psychological support. Additionally, patients who were more reluctant to seek help demonstrated poorer psychosocial adjustment. Factors such as age, education level, marital status, and treatment status also played significant roles in influencing these outcomes.

CONCLUSION

The study underscores the need for targeted interventions to reduce stigma and encourage help-seeking among cancer patients to improve their psychosocial adjustment and quality of life. Integrating mental health services into oncology care and addressing the stigma associated with psychological support are essential steps in enhancing patient outcomes.

EBCC-14 manifesto: Addressing disparities in access to innovation for patients with metastatic breast cancer across Europe

The European Breast Cancer Council (EBCC) traditionally identifies controversies or major deficiencies in the management of patients with breast cancer and selects a multidisciplinary expert team to collaborate in setting crucial principles and recommendations to improve breast cancer care. The 2024 EBCC manifesto focuses on disparities in the care of patients with metastatic breast cancer. There are several reasons for existing disparities both between and within countries. Our recommendations aim to address the stigma of metastatic disease, which has led to significant disparities in access to innovative care regardless of the gross national income of a country. These recommendations are for different stakeholders to promote the care of patients with metastatic breast cancer across Europe and worldwide.

Participant factors associated with psychosocial impacts of lung cancer screening: A systematic review

BACKGROUND

Psychosocial impacts of lung cancer screening (LCS) can cause both harm to individuals and serve as barriers to screening participation and adherence. Early data suggest that the psychosocial impacts of LCS are moderated by certain factors (e.g. sociodemographic characteristics and beliefs), but evidence synthesis is lacking. This systematic review aimed to understand individual-level risk factors for psychosocial burden during LCS as a precursor to developing strategies to identify and support participants, and improve LCS engagement.

METHODS

Four databases were searched for full-text articles published in English reporting any association between participant factors and psychosocial outcomes experienced during LCS. Study quality was assessed by two independent investigators; findings were synthesised narratively. The review was pre-registered with PROSPERO and adhered to PRISMA guidelines.

RESULTS

Thirty-five articles were included; most (33/35) studies were assessed at high or moderate risk of bias. Study designs were pre-post (n = 13), cross-sectional (n = 13), qualitative (n = 8) and mixed-methods (n = 1) and conducted primarily in the United States (n = 17). Psychological burden in LCS varied, and was often associated with younger age, female gender, current smoking status or increased smoking history, lower education, lower socio-economic group, not being married or co-habiting and experience with cancer. However, results were mixed, and non-significant associations were also reported across all factors. Beliefs (e.g. fatalism, stigma and expectation of LDCT results) and comorbid psychological burden were also linked to psychosocial outcomes, but evidence was sparse. Associations between risk perception, other participant factors and other psychosocial outcomes was inconclusive, likely reflecting individual biases in risk conceptualisation.

CONCLUSION(S)

Several participant factors are consistently reported to be associated with psychosocial impacts of LCS, though study heterogeneity and high risk of bias necessitate more robust evaluation. Further research on how perceptions, beliefs and expectations can be used to improve psychosocial outcomes during LCS is needed.

The effectiveness of interventions to reduce cancer-related stigma: An integrative review

AIMS

The clinical significance of cancer-related stigma on patients' well-being has been widely established. Stigma can be perceived and internalised by cancer patients or implemented by the general population and healthcare workers. Various interventions have been carried out to reduce cancer-related stigma, but their effectiveness is not well-understood. This review aims to synthesise evidence on the effectiveness of interventions to reduce cancer-related stigma.

DESIGN

An integrative review.

METHODS

This integrative review combined both qualitative and quantitative studies and followed five steps to identify problems, search for the literature, appraise the literature quality, analyse data, and present data. Mixed Methods Appraisal Tool (version 2018) was applied to evaluate the quality of the included studies.

DATA SOURCES

Databases included Web of Science, MEDLINE, SpringerLink, Wiley Online Journals, Cochrane Library, ScienceDirect, OVID, and China National Knowledge Infrastructure (from the inception of each database to 30 April 2021).

RESULTS

Eighteen quantitative, six qualitative, and five mixed-methods studies were included in this review. Cultural factors should be considered when conducting interventions to reduce cancer-related stigma. For cancer patients, multi-component interventions have demonstrated a positive effect on their perceived stigma. For general population, interactive interventions show promise to reduce their implemented stigma towards cancer patients. For healthcare workers, there is a paucity of studies to reduce their implemented stigma. Existing studies reported inconclusive evidence, partially due to the lack of a robust study design with an adequate sample size.

CONCLUSIONS

Multi-component and interactive interventions show promise to relieve cancer-related stigma. More methodologically robust studies should be conducted in different cultures to elucidate the most appropriate interventions for different populations to reduce cancer-related stigma.

IMPLICATION FOR THE PROFESSION AND PATIENT CARE

These findings will facilitate healthcare workers to design and implement interventions to reduce cancer-related stigma, thus improving the quality of life for cancer patients.

PATIENT AND PUBLIC CONTRIBUTION

No patient and public contribution.

A "What Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam

BACKGROUND

Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of "respected personhood" (or "what matters most") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam.

METHODS

Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-team meetings.

RESULTS

Analyses elucidated that having chữ tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chữ tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts.

CONCLUSIONS

HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.

Feasibility, acceptability, and initial efficacy of empathic communication skills training to reduce lung cancer stigma in Nigeria: a pilot study

Effective communication about cancer diagnosis and prognosis in sub-Saharan African oncology settings is often challenged by the cancer-related shame and stigma patients and families experience. Enhancing empathic communication between health care providers, including physicians and nurses, and oncology patients and their families can not only reduce cancer stigma but also improve patient engagement, treatment satisfaction, and quality of life. To reduce lung cancer stigma, we adapted an evidence-based empathic communication skills training intervention to reduce patients' experience of stigma in Nigeria and conducted a pilot study examining the feasibility and acceptability of the empathic communication skills training. Thirty health care providers, recruited from University College Hospital, Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, participated in a 2.25-hour didactic and experiential training session. Participant surveys were completed before and after the training. Overall, participants reported highly favorable training evaluations, with at least 85% of health care providers agreeing or strongly agreeing to survey items assessing training relevance, novelty, clarity, and facilitator effectiveness. Self-efficacy to communicate empathically with patients increased significantly from before-training (Mean [SD] = 3.93 [0.28]) to after-training (Mean [SD] = 4.55 [0.15]; t29 = 3.51, P < .05). Significant improvements were observed in health care provider reports of empathy toward lung cancer survivors and attitude toward lung cancer care as well as significant reductions in lung cancer blame were noted. The empathic communication skills training was feasible, well received by oncology clinicians in Nigeria, and demonstrated improvements in health care provider-reported outcomes from before- to after-training.

Impact of a multicomponent navigation strategy on stigma among people living with HIV and Kaposi's sarcoma in Kenya: a qualitative analysis

Persons with HIV-associated Kaposi's sarcoma (KS) experience three co-existing stigmatizing health conditions: skin disease, HIV, and cancer, which contribute to a complex experience of stigmatization and to delays in diagnosis and treatment. Despite the importance of stigma among these patients, there are few proven stigma-reduction strategies for HIV-associated malignancies. Using qualitative methods, we explore how people with HIV-associated KS in western Kenya between August 2022 and 2023 describe changes in their stigma experience after participation in a multicomponent navigation strategy, which included 1) physical navigation and care coordination, 2) video-based education with motivational survivor stories, 3) travel stipend, 4) health insurance enrollment assistance, 5) health insurance stipend, and 6) peer mentorship. A purposive sample of persons at different stages of chemotherapy treatment were invited to participate. Participants described how a multicomponent navigation strategy contributed to increased knowledge and awareness, a sense of belonging, hope to survive, encouragement, and social support, which served as stigma mitigators, likely counteracting the major drivers of intersectional stigma in HIV-associated KS.

Stigmatization of drinking patients with liver cancer: The role of socioeconomic status

Patients with liver cancer may face stigmatization due to cancer, alcohol consumption, or both. This study addresses gaps in the existing literature regarding stigmatization of alcohol-related liver cancer patients, particularly its connection with socioeconomic status (SES). The study explores whether the SES of a fictional character with alcohol addiction and liver cancer influences stigma levels reported by participants. Additionally, it investigates how participants' personal characteristics, such as alcohol consumption and healthcare professional status, impact stigmatization. This study aims to provide new insights regarding the role of stigmatization in liver cancer treatment and management, emphasizing in socioeconomic determinants. The method is based on three scenarios describing a woman character with alcohol abuse and liver cancer. The scenarios depicted a woman character with either low, medium or high SES. Each participant (N = 991) was randomly assigned to one of the three scenarios. After reading it, each participant answered questionnaires assessing negative attitudes towards the character. Four scales were used: "Negative attributions about people with health problems", "Causality of cancer", "Controllability of drinking" and "Reluctance to helping behavior". Data were analyzed using ANOVA and t-tests. The scenario describing a character with a low SES significantly received more "Negative attributions about people with health problems" than the character with medium or high SES. Participants having higher alcohol consumption themselves showed lower stigma scores for three out of four scales than participants with lower consumption. In addition, participants identified as health professionals had lower stigma scores regarding the scales "Negative attributions about people with health problems" and "Controllability of drinking", and higher scores for the subscale "Reluctance to helping behavior", compared with non-professionals. A character with low SES received more negative attributions than the one with higher SES. Participants' own alcohol consumption and professional status (being health professional or not), influenced their stigmatizing attitudes.

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.

Effective Communication About Lung Cancer Screening Without Iatrogenic Stigma: A Brief Report Case Study Using the Lung Cancer Stigma Communications Assessment Tool of LungTalk

Introduction

Stigma thwarts progress in lung cancer risk reduction and control and adversely affects patients across the entire lung cancer care continuum. In developing and disseminating patient and public-facing interventions to increase lung screening, we must be cognizant of how communications have the potential for further stigmatization of at-risk populations. Creation of the Lung Cancer Stigma Communications Assessment Tool (LCS-CAT) version 1 was supported by the American Cancer Society's National Lung Cancer Roundtable to help content developers identify, remove, and replace potentially stigmatizing language and imagery from materials designed to engage individuals across the lung cancer continuum.

Methods

The LCS-CAT considers language, imagery, and context and was used to audit a public-facing health communication and decision support tool called LungTalk.

Results

The audit performed by two behavioral scientists revealed multiple issues in all three areas, and specific feedback and alternatives were identified.

Conclusions

Applying the LCS-CAT to LungTalk was a productive process that helped remove potentially stigmatizing language and imagery from this tool designed to engage individuals in the process of making an informed decision about lung screening. To support destigmatization of lung cancer, communication creators should consider a stigma biopsy on all public-facing campaigns for lung screening to help identify, eliminate, and replace messages that could compromise engagement with the lung cancer screening opportunity.

Culturally-informed adaptation and psychometric properties of the Cataldo Cancer Stigma Scale in Northern Tanzania

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.

Pediatric Palliative Care in Oncology: Basic Principles

Simple Summary

About 4 million children with an oncological disease worldwide require palliative care due to the nature of their condition. The WHO defines pediatric palliative care (PPC) as the prevention and relief of suffering in patients with life-threatening or life-limiting disease and their families. PPC relies on the comprehensive and multidisciplinary management of the child and the family’s physical, psychological, spiritual, and social needs. Importantly, PPC begins at the diagnosis of incurability, or supposed incurability, and continues regardless of whether the patient receives any oncological treatment. As such, PPC is a general approach continuing over the entire disease trajectory, which includes, but is not limited to, end-of-life care. This review addresses the value of integrating PPC in treating children with cancer, focusing on the basic principles of PPC and its application in pediatric oncology.

Abstract

About 4 million children with an oncological disease worldwide require pediatric palliative care (PPC) due to the nature of their condition. PPC is not limited to end-of-life care; it is a general approach continuing over the entire disease trajectory, regardless of whether the patient receives any oncological treatment. This review addresses the value of integrating PPC in treating children with cancer, focusing on the basic principles of PPC and its application in pediatric oncology. Moreover, models for PPC implementation in oncology, end-of-life care, and advanced care planning are discussed.

A systematic review of disease related stigmatization in patients living with prostate cancer

Background

Prostate cancer has been shown to be susceptible to significant stigmatisation, because to a large extent it is concealable, it has potentially embarrassing sexual symptoms and has significant impact on the psychosocial functioning.

Methods

This review included studies that focused on qualitative and/or quantitative data, where the study outcome was prostate cancer and included a measure of stigmatization. Electronic databases (CINAHL, Medline, PubMed, PsycInfo, Cochrane Library, PROSPERO, and the Joanna Briggs Institute) and one database for grey literature Opengrey.eu, were screened. We used thematic analysis, with narrative synthesis to analyse these data. We assessed risk of bias in the included studies using the RoBANS.

Results

In total, 18 studies met review inclusion criteria, incorporating a total of 2295 participants. All studies recruited participants with prostate cancer, however four studies recruited participants with other cancers such as breast cancer and lung cancer. Of the 18 studies, 11 studies evaluated perceived or felt stigma; four studies evaluated internalised or self-stigma; three studies evaluated more than one stigma domain.

Discussion

We found that patients living with prostate cancer encounter stigmatisation that relate to perception, internalisation, and discrimination experiences. We also identified several significant gaps related to the understanding of prostate cancer stigmatization, which provides an opportunity for future research to address these important public health issues.

Registration

This systematic review protocol is registered with PROSPERO, the international prospective register of systematic reviews in health and social care. Registration number: CRD42020177312.