Document Type : Review Article
Authors
1 Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
2 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
3 Department of Health Psychology, Faculty of Psychology, Islamic Azad University, Emirates Branch (Dubai)
4 Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
5 Department of Psychology and Educational Sciences, Faculty of Psychology and Educational Sciences, Allameh Tabataba’i University, Tehran, Iran
Abstract
Background: An analysis of cancer stigma and the factors affecting it can significantly affect patients’ survival rate, willingness to receive treatment, coping strategies, and quality of life. To this end, the present study investigated the factors affecting self-perceived stigma in cancer patients.
Methods: The present study adopted a meta-synthesis approach. The inclusion criteria were qualitative studies, relevant keywords in the title and abstract, and full-text articles published in English from 2000 to 2022 in Web of Science, PubMed, and Google Scholar databases. After searching and screening the titles, abstracts, and methodologies, 419 articles were extracted. Then, the duplicate articles were removed and the data from the 11 remaining articles that met the inclusion criteria were used in data analysis.
Results: The findings revealed the factors affecting cancer stigma include substantive factors (cancer symptoms reflecting death and nothingness and the visible signs of cancer reminiscent of isolation and loneliness) and moderating factors (the role of false beliefs and misconceptions, fear of public judgment, and the role of the media as a promoter of stigma). The data also showed that false beliefs and misconceptions play the most important role in cancer stigma.
Conclusion: Taking into account factors affecting cancer stigma can contribute to developing an effective strategy to strengthen the psychological support for cancer patients and pave the way for improving optimal and effective management of the public health system in dealing with cancer.
Keywords
- Mao JJ, Pillai GG, Andrade CJ, Ligibel JA, Basu P, Cohen L, et al. Integrative oncology: addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin. 2022;72(2):144-64. doi: 10.3322/caac.21706.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. doi: 10.3322/caac.21660.
- Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; 2018.
- Tang WZ, Yusuf A, Jia K, Iskandar YHP, Mangantig E, Mo XS, et al. Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2022;31(1):55. doi: 10.1007/s00520-022-07506-4.
- Vrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: a population based survey in England. BMC Cancer. 2019;19(1):566. doi: 10.1186/ s12885-019-5787-x.
- Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Lancet. 2006;367(9509):536-8. doi: 10.1016/s0140-6736(06)68189-0.
- Hasan Shiri F, Mohtashami J, Nasiri M, Manoochehri H, Rohani C. Stigma and related factors in Iranian people with cancer. Asian Pac J Cancer Prev. 2018;19(8):2285-90. doi: 10.22034/apjcp.2018.19.8.2285.
- Wong CC, Pan-Weisz BM, Pan-Weisz TM, Yeung NC, Mak WW, Lu Q. Self-stigma predicts lower quality of life in Chinese American breast cancer survivors: exploring the mediating role of intrusive thoughts and posttraumatic growth. Qual Life Res. 2019;28(10):2753-60. doi: 10.1007/s11136- 019-02213-w.
- Huang Z, Yu T, Wu S, Hu A. Correlates of stigma for patients with cancer: a systematic review and meta-analysis. Support Care Cancer. 2021;29(3):1195-203. doi: 10.1007/s00520- 020-05780-8.
- Trusson D, Pilnick A. The role of hair loss in cancer identity: perceptions of chemotherapy-induced alopecia among women treated for early-stage breast cancer or ductal carcinoma in situ. Cancer Nurs. 2017;40(2):E9-16. doi: 10.1097/ncc.0000000000000373.
- Sedney CL, Dekeseredy P, Singh SA, Holbein M. Stigmatizing language expressed towards individuals with current or previous OUD who have pain and cancer: a qualitative study. J Pain Symptom Manage. 2023;65(6):553-61. doi: 10.1016/j. jpainsymman.2023.02.007.
- Ruano A, García-Torres F, Gálvez-Lara M, Moriana JA. Psychological and non-pharmacologic treatments for pain in cancer patients: a systematic review and meta-analysis. J Pain Symptom Manage. 2022;63(5):e505-20. doi: 10.1016/j. jpainsymman.2021.12.021.
- Esser P, Mehnert A, Johansen C, Hornemann B, Dietz A, Ernst J. Body image mediates the effect of cancer-related stigmatization on depression: a new target for intervention. Psychooncology. 2018;27(1):193-8. doi: 10.1002/pon.4494.
- Harding R, Nair S, Ekstrand M. Multilevel model of stigma and barriers to cancer palliative care in India: a qualitative study. BMJ Open. 2019;9(3):e024248. doi: 10.1136/ bmjopen-2018-024248.
- Hasan Shiri F, Mohtashami J, Manoochehri H, Rohani C. Cancer stigma and its consequences and influencing factors in Iranian society: a qualitative study. J Qual Res Health Sci. 2022;11(3):180-8. doi: 1034172/jqr.2022.05.
- Knaul FM, Doubova SV, Gonzalez Robledo MC, Durstine A, Pages GS, Casanova F, et al. Self-identity, lived experiences, and challenges of breast, cervical, and prostate cancer survivorship in Mexico: a qualitative study. BMC Cancer. 2020;20(1):577. doi: 10.1186/s12885-020-07076-w.
- Clements ML. Chemotherapy-Induced Alopecia and Quality-of-Life: Ovarian and Uterine Cancer Patients and the Aesthetics of Disease. University of South Florida; 2017.
- Nyblade L, Stockton M, Travasso S, Krishnan S. A qualitative exploration of cervical and breast cancer stigma in Karnataka, India. BMC Womens Health. 2017;17(1):58. doi: 10.1186/ s12905-017-0407-x.
- Tang PL, Mayer DK, Chou FH, Hsiao KY. The experience of cancer stigma in Taiwan: a qualitative study of female cancer patients. Arch Psychiatr Nurs. 2016;30(2):204-9. doi: 10.1016/j.apnu.2015.08.015.
- Kaur R. Cultural beliefs, cancer and stigma: experiences of patients from Punjab (India). Studies on Ethno-Medicine. 2015;9(2):247-54. doi: 10.1080/09735070.2015.11905442.
- Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJ. Stigma among patients with lung cancer: a patient-reported measurement model. Psychooncology. 2014;23(1):81-92. doi: 10.1002/pon.3371.
- Lehto RH. Patient views on smoking, lung cancer, and stigma: a focus group perspective. Eur J Oncol Nurs. 2014;18(3):316- 22. doi: 10.1016/j.ejon.2014.02.003.
- Zannini L, Verderame F, Cucchiara G, Zinna B, Alba A, Ferrara M. ‘My wig has been my journey’s companion’: perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia. Eur J Cancer Care (Engl). 2012;21(5):650-60. doi: 10.1111/j.1365- 2354.2012.01337.x.
- Chapple A, Ziebland S, McPherson A. Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. BMJ. 2004;328(7454):1470. doi: 10.1136/ bmj.38111.639734.7C.
- Rosman S. Cancer and stigma: experience of patients with chemotherapy-induced alopecia. Patient Educ Couns. 2004;52(3):333-9. doi: 10.1016/s0738-3991(03)00040-5.
- Ucok O. The meaning of appearance in surviving breast cancer. Hum Stud. 2005;28(3):291-316. doi: 10.1007/ s10746-005-7412-z.
- Hesketh PJ, Batchelor D, Golant M, Lyman GH, Rhodes N, Yardley D. Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer. 2004;12(8):543-9. doi: 10.1007/s00520-003-0562-5.
- O’Donnell AT, Habenicht AE. Stigma is associated with illness self-concept in individuals with concealable chronic illnesses. Br J Health Psychol. 2022;27(1):136-58. doi: 10.1111/bjhp.12534.
- Arévalo SP, Tucker KL, Falcón LM. Beyond cultural factors to understand immigrant mental health: neighborhood ethnic density and the moderating role of pre-migration and post-migration factors. Soc Sci Med. 2015;138:91-100. doi: 10.1016/j.socscimed.2015.05.040.
- Hashemizadeh S, Salehi M, Rafiepoor A, Ghanbaripanah A. Psychological distress based on cognitive, metacognitive, and meta-emotional components in cancer patients. Iran J Health Psychol. 2022;5(2):47-62. doi: 10.30473/ ijohp.2022.57982.1170.
- Pachankis JE, Hatzenbuehler ML, Wang K, Burton CL, Crawford FW, Phelan JC, et al. The burden of stigma on health and well-being: a taxonomy of concealment, course, disruptiveness, aesthetics, origin, and peril across 93 stigmas. Pers Soc Psychol Bull. 2018;44(4):451-74. doi: 10.1177/0146167217741313.
- Featherstone M, Turner BS, Hepworth M. The Body: Social Process and Cultural Theory. SAGE Publications; 1990. p. 1-352.
- Mead GH, Schubert C. Mind, Self and Society. Chicago: The University of Chicago Press; 1934.
- Warner ET, Park ER, Luberto CM, Rabin J, Perez GK, Ostroff JS. Internalized stigma among cancer patients enrolled in a smoking cessation trial: the role of cancer type and associations with psychological distress. Psychooncology. 2022;31(5):753-60. doi: 10.1002/pon.5859.