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J. Brodsky



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    O25 - Stigma and Nihilism (ID 139)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O25.03 - The Unique Contribution of Lung Cancer Stigma to Patient Quality of Life (ID 2639)

      16:35 - 16:45  |  Author(s): J. Brodsky

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer is associated with greater levels of psychological distress than any other cancer. Anxiety and depression are associated with diminished QOL for lung cancer patients, but do not explain the total variance in QOL. Lung cancer stigma (LCS) may explain some of the additional variance in QOL. LCS is a perceived stigma resulting from negative perceptions about the relationship between smoking and lung cancer. This study’s theoretical framework is the Lung Cancer Stigma Model (LCSM), a patient-centered model that includes precursors, perception and responses to LCS. LCS, according to LCSM, is characterized by diagnosis and connections to tobacco exposure and smoking stigma; experiences of discrimination, isolation or shame; and responses ranging from increased symptom burden to Stigma Resistance (SR), defined as “opposition to the imposition of … stereotypes by others” (Thoits, 2011)and shown to positively correlate with self-esteem, empowerment and QOL. Study aims and hypotheses were to: 1) Investigate the relationship of LCS with anxiety, depression and QOL; 2) Explore whether LCS has a unique contribution to the explanation of QOL after controlling for significant covariates (i.e., sex, age); and 3) Compare whether study variables vary by smoking status.

      Methods
      This was a descriptive, cross-sectional study (N=149). An online survey of lung cancer patients recruited from cancer information and support websites included demographic questions, the Cataldo Lung Cancer Stigma Scale, the Spielberger State Anxiety Questionnaire, the CES-D, and the Quality of Life Inventory.

      Results
      Data from primarily Caucasian female participants with a history of smoking demonstrated strong negative associations among anxiety, depression, LCS and QOL, regardless of smoking status; this confirmed previous findings that LCS is positively correlated with anxiety and depression and negatively correlated with QOL. A final hierarchical multiple regression with revealed an overall model explaining 71.5% of the total variance of QOL (F~5,143~=71.61, p<.001). After controlling for significant covariates, anxiety, and depression, LCS provided a small but significant unique contribution to the explanation of variance in QOL (1.2%; p=.015). Furthermore, results substantiate previous findings of no difference in these relationships by smoking status. Both ever and never smokers’ experiences are similar with respect to anxiety, depression, LCS and QOL.

      Conclusion
      Because lung cancer is widely viewed as a smoker’s disease, patients who have never smoked often experience the same stigmatization as smokers, characterized by a feeling imparted from others that one’s disease was self-inflicted. This investigation explored this experience of LCS and validated previous findings linking QOL and LCS. LCS provides unique explanatory contribution to the understanding of QOL for lung cancer patients. Therefore, providers should consider not only typical psychosocial aspects of the diagnosis, but also patient experience of LCS. Related, LCS literature suggests a gap in the psychosocial care of lung cancer patients; no stigma reduction intervention is currently available. Providers might encourage their patients to engage in potential stigma reduction behaviors that may positively impact QOL: 1) self-educate about their diagnosis, 2) critically evaluate their treatment plans, 3) attend support groups, and 4) advocate against stigma.

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