In this study, the CLCSS is a reliable and valid instrument that measures HRS in patients with lung cancer. The four factors that emerged in this analysis are reflected in the four subscales: stigma and shame, social isolation, discrimination, and smoking. These subscales reflect a conceptual linkage with the phenomenon of perceived stigma of having lung cancer in the Berger et al. (2001)
model of HRS. The linkages are social disqualification (social isolation subscale), limited opportunities (discrimination subscale), and negative change in identity (stigma and shame and smoking subscales).
As a result of a lung cancer diagnosis, patients often experience increased psychological distress (Bottorff, Robinson, Sullivan, & Smith, 2009
; Gritz, Dresler, & Sarna, 2005
; Henoch, Bergman, Gustafsson, Gaston-Johansson, & Danielson, 2007
; McBride et al., 2003
). Previous studies have shown that prevalence of depression among patients with lung cancer has ranged from 23%–55% (Carlsen et al., 2005
; Cataldo, Jahan, & Pongquan, 2011
; Montazeri, Milroy, Hole, McEwen, & Gillis, 2001
). Stigma most likely plays an important role in the psychological distress of patients with lung cancer.
A significant consequence of HRS is a disruption in QOL (Van Brakel, 2006
), and QOL is a strong predictor of survival in patients with lung cancer (Balduyck, Hendriks, Lauwers, Nia, & Van Schil, 2009
; Qi et al., 2009
). Lung cancer survivors do not experience the same length or QOL as other cancer survivors (Sugimura & Yang, 2006
). Stigma may be part of the explanation. In Cataldo, Jahan, and Pongquan (2011)
, the authors found that lung cancer stigma explained 11% of the variance of QOL (p < 0.001), over and above the 69% explained by depression.
Although this online sample represented 38 states, it did not reflect the general lung cancer population. Most participants were Caucasian, women, had higher levels of completed education, and fell into wealthier classifications. This may represent a lung cancer population that has access to the Internet. Also, because of the nature of online data, clinical information on the sample (diagnosis, stage of disease, and treatment) was limited.
Future research should include additional psychometric testing of the CLCSS in a larger, more diverse sample with clinical data, investigation of the effect of lung cancer stigma on patient outcomes (i.e., mood, treatment choice, help-seeking behavior, treatment adherence, disability, morbidity, and mortality), and development of an effective stigma intervention.
As treatment for lung cancer becomes more aggressive and successful, the early detection and intervention for psychological distress becomes increasingly more important for patients with lung cancer (Holland et al., 2010
; Lynch, Goodhart, Saunders, & O’Connor, 2010
). This article highlights lung cancer stigma as an important psychosocial issue faced by patients. Because stigma is associated with poorer health status, higher levels of depression, and diminished QOL, including an assessment of stigma in clinical practice is important (Cataldo et al., 2011
). In other diseases, stigma has been amenable to intervention; the development of the CLCSS provides the opportunity to identify and measure the experience of lung cancer stigma and to develop effective interventions. For people experiencing stigma from an HIV and AIDS diagnosis, effective interventions have consisted of three components: education about the disease, skills building for coping with the stigma, and counseling and support (Brown, Macintyre, & Trujillo, 2003
). The authors of the current study are pilot testing a lung cancer stigma intervention with these three components.
Feeling stigmatized causes a fear of rejection, limits the use of potential social support, and is associated with depression, poor treatment adherence, poor health, and shortened survival. Therefore, a sensitive measure of lung cancer stigma will allow for the identification of individuals who feel stigmatized and could benefit from intervention. The prevention and treatment of stigma can have a significant impact on the overall health and QOL of patients with lung cancer.