Warner Erica T, Park Elyse R, Luberto Christina M, Rabin Julia, Perez Giselle K, Ostroff Jamie S
Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Psychooncology. 2022 May;31(5):753-760. doi: 10.1002/pon.5859. Epub 2021 Nov 19.
Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress.
This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups.
Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers.
Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.
吸烟的癌症患者可能因其疾病以及对吸烟的负面态度和观念而遭受显著的污名化。我们调查了目前吸烟且被诊断患有肺癌、头颈癌、其他与吸烟相关的癌症以及非吸烟相关癌症的患者之间内化污名是否存在差异，以及内化污名是否与心理困扰相关。
这项横断面分析使用了参与一项多中心随机戒烟干预试验的293名近期诊断为癌症患者的基线数据。内化污名使用疾病社会影响量表中的五个内化羞耻项目进行评估。与吸烟相关的癌症包括肺癌、头颈癌、食管癌、膀胱癌、肾癌、肝癌、胰腺癌、结直肠癌、肛门癌、小肠癌、胃癌和宫颈癌。我们使用多变量线性回归来检验肺癌和头颈癌患者、其他与吸烟相关的癌症患者以及非吸烟相关癌症患者之间的平均内化污名水平是否存在差异，并对潜在混杂因素进行调整。我们进一步研究了内化污名与抑郁、焦虑和感知压力之间的关联，包括总体情况以及癌症类型组之间的情况。
39%的参与者被诊断患有肺癌或头颈癌，21%患有其他与吸烟相关的癌症，40%患有非吸烟相关的癌症。在多变量调整模型中，与非吸烟相关癌症患者（9.3，95%置信区间（CI）=8.6 - 10.0）相比，肺癌或头颈癌患者（11.6，95% CI = 10.8 - 12.2；p < 0.0001）或其他与吸烟相关的癌症患者（10.7，95% CI = 9.8 - 11.7；p = 0.03）的平均内化污名得分更高。我们在与吸烟相关和非吸烟相关癌症的参与者中观察到内化污名与抑郁症状、焦虑和感知压力之间存在类似的正相关。
在吸烟者中，患有与吸烟相关癌症的人经历的内化污名水平最高，并且更高的内化污名与所有癌症类型中更大的心理困扰相关。医疗服务提供者应评估患者的内化污名和其他形式的污名，为患者转介适当的心理社会支持服务，并在戒烟项目中解决污名问题。
