Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum

Abstract

The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.

Keywords: Cancer control continuum; Lung cancer; Multilevel approach; Stigma.

Figure 1.

Socioecological model to understand multilevel processes of lung cancer stigma. In the context of lung cancer stigma, the intrapersonal level centers on thoughts, feelings, and actions of the affected person. The interpersonal level centers on the social relationships and perceptions of others. The societal level addresses social conditions, structural components, and public attitudes.

Figure 2.

Continuum of Cancer Care. The stages of the cancer continuum include prevention, detection, diagnosis, treatment, and survivorship. At each stage of the continuum, lung cancer stigma may be a barrier to the successful application of research advances to reduce the burden of lung cancer. Therefore, it is crucial that interventions focused on stigma acknowledge and address each element of this extended lung cancer care continuum. Reprinted with permission from Rowland, J.H. (2008). Cancer survivorship: Rethinking the cancer control continuum. Seminars in Oncology Nursing 24(3), 145-152.