Big life events, especially events like receiving a cancer diagnosis, can profoundly affect how a person views her/himself physically, mentally, and emotionally. In addition, a person living with cancer quickly becomes aware of and affected by others’ reactions to their diagnosis. For example, it is absolutely heartwarming when the revelation of the diagnosis to family, friends, or coworkers is met with support, understanding, and offers of help with negotiating the challenges that can come with treatment. Conversely, when relatives, friends, or coworkers respond to the diagnosis fearfully or with avoidance, often driven by their own fears of the disease, it can have a negative effect on the person living with cancer. Knowing that revealing one’s diagnosis can be risky leads to some cancer survivors feeling understandably reluctant to share their diagnosis with others; fearing that doing so could result in a loss or significantly change the nature of the relationship with family members and others in their lives. In some instances, this can lead to survivors feeling a sense of responsibility for the emotional reactions of those with whom they share their diagnosis.
Stigma from Others
While feeling a sense of risk associated with sharing one’s cancer diagnosis, no matter where it happens in the body, is common; it is particularly challenging for people living with a lung cancer diagnosis. This is largely the result of the stigma attached to the diagnosis because of its association with smoking tobacco. In addition to feeling the risk that others will retreat from them after revealing their diagnosis, people with a lung cancer diagnosis are also keenly aware that they might also be shunned, blamed, or regarded by others as no longer worthy of the same level of acceptance that a person with another type of cancer diagnosis might expect. Lung cancer stigma often appears as beliefs by others that a person with lung cancer had a weakness of character for smoking. In some instances, these beliefs can lead to indirect suggestions that a person “deserves” or even “caused” their cancer. For example, it is not uncommon for a person with lung cancer to receive the following type of response after revealing their diagnosis: “I’m so sorry to hear that. Did you smoke?” Interestingly, when someone reveals a diagnosis of colon cancer, it’s unlikely the response will include a question like “Did you eat too much red meat?” The “did you smoke?” question conveys the belief that the person with lung cancer somehow participated in getting it; often leaving them feeling blamed, shamed, and responsible for their own diagnosis.
Self-Stigma
In addition to feeling blame from others, it’s also quite common for people diagnosed with lung cancer to blame themselves for their disease. This also holds true for the 25% of people diagnosed with lung cancer who never smoked. Ever. Sadly, the anticipation that blame and stigma will follow a revelation that one has lung cancer can lead many people to conceal their diagnosis from others; often resulting in unnecessary social isolation at a time when emotional support from others could be beneficial. Perhaps even worse, the anticipation of stigma from health care providers can result in a person delaying medical attention and treatment for a cancer that responds best when discovered at earlier stages.
Impact of Social Stigma
Stigmatizing messages can come from other people and society-at-large where it has become quite normal to believe that only people who are smokers or former smokers get lung cancer. This is despite the fact that lung cancer is not exclusively a smoker’s illness. In truth, lung cancer can happen to anyone with lungs. At the social level, stigma can be particularly devastating when we consider that, given the severity of this diagnosis, lung cancer has received little research funding when compared with other cancers. For example, funding for lung cancer research is approximately 5.2% of that for breast cancer, 10.4% of that for prostate cancer, and only 20% of funding for colorectal cancers.
Further, stigma can affect the quality of patient care when it permeates the beliefs and attitudes held by health care team members. For example, suppose a health care professional believes that people with lung cancer are, perhaps, to blame for their illness, or life is less valuable. In that case, it is possible that the same level of care afforded to people with other types of cancers might not be offered, especially when lung cancer is diagnosed at later stages. Research has demonstrated that people who were smoking at the time of diagnosis or had histories of smoking have often felt unjustly blamed by members of their health care teams during and after diagnosis. To be sure, it is most definitely healthier to avoid smoking. However, it is also important to remember that smoking is not a capital offense that deserves the death penalty.
So, what about Smoking and Lung Cancer?
By now, you might still be feeling the tug to believe that an individual’s decision to smoke is their choice and that their lung cancer is essentially self-inflicted. If only it were that simple! The truth is: There are many reasons that lead to a person’s decision to engage in smoking. These can include factors related to a person’s culture or social environment. For example, many people begin smoking in their teens due to both peer pressure and very effective marketing campaigns from the tobacco industry. Generally, people who regularly engage in smoking, or the use of any other substance for that matter, began as experimenters as teens and then progressed to using tobacco intermittently. In these early stages, the choice was certainly possible. However, tobacco has many addictive properties, which makes quitting very difficult. Once a person becomes addicted to nicotine, the ability to choose is no longer available. Nicotine addiction is more powerful than alcohol addiction and as difficult to quit as heroin. It is very difficult to overcome addiction to nicotine on one’s own and often people feel a sense of shame or guilt about their inability to stop smoking; often after many unsuccessful attempts to do so. These feelings can interfere with having cancer symptoms addressed early and can also prevent a person with a smoking history from insisting upon receiving the same levels of care and attention that others receive from their health care teams.
Discussion
In general, stigma refers to a process of singling people out for an individual characteristic that is viewed as flawed and then ostracizing, side-lining or otherwise demoting the person from full access to rights and privileges received by others. Stigma that arises by associating lung cancer with smoking behaviors often leads to assigning blame to people who receive a lung cancer diagnosis even though 25% of people diagnosed with cancer never smoked. Stigmatizing and blaming people for having lung cancer has had a negative effect on lung cancer survivors’ relationships with family members, acquaintances, and coworkers. This often leaves people feeling alienated from significant others and less likely to share the diagnosis with others when doing so could decrease their sense of alienation. Perhaps more importantly, in health care settings, stigmatizing lung cancer can result in judgmental ways of regarding people who have this disease; resulting in some avoiding health care providers unnecessarily out of concern that they will be met with a lack of compassion when they do so.
Finally, it is important to remember no one deserves their lung cancer or any other cancer. While engaging in healthy behaviors is a terrific strategy for ensuring our best quality of life, there are no guarantees. Cancer can happen to anyone. What people with lung cancer deserve is support, understanding, and access to the best treatment options available.