An investigation of cancer stigma and its impact on posttraumatic growth among cancer patients

Abstract

Increased cancer incidence and decreased disease mortality has resulted in higher rates of cancer diagnosis, treatment and survivorship. Therefore, understanding the psychological impact of coping with cancer is paramount. Stigma can be among the challenges associated with the cancer experience but research into the specific causes and consequences is limited. Stigma reflects a devalued identity, which results in lowered self-esteem and strained social relationships. In addition to these negative changes, positive experiences such as posttraumatic growth (PTG) have also been documented among cancer patients. PTG refers to psychological development in an individual's life after a traumatic event that surpasses their pre-trauma level of functioning. While the benefits of PTG are noteworthy, cancer-related stigma may lead some patients without the support and validation they need to develop PTG. The present program of research presents an examination of cancer-related stigma, by considering the perceptions of community members and the experience of cancer patients. The research also examines and how stigma may impact on the positive and negative changes following cancer diagnosis. The first two studies examined perceptions of cancer stigma among community members (n = 373). Study 1 presents the results of experimental research, which investigated three potential causes of cancer stigma. Findings demonstrated consistent support for the role of blameworthy attributions, some support for the role of physical changes associated with cancer treatment, and minimal support for the role of poor prognosis in eliciting stigmatising responses. Guided by attribution theory, Study 2 assessed community perceptions of cancers perceived to be blameworthy versus non-blameworthy. Using Structural Equation Modelling, controllability in the blameworthy cancer groups (i.e., lung, throat and skin cancers) was found to directly impact on sympathy and hypothetical charitable donation. Study 3 presents the results of a questionnaire that was administered to cancer patients (n = 113), to examine the potential pathways, namely through social support and stigma, that ultimately contribute to well-being among cancer patients. Findings demonstrated the positive effect of social support, and the deleterious effect of stigma, on influencing post-diagnosis psychological change. Core belief examination was found to be a protective factor against any negative effects. Study 4 examined the 'lived experience' of nine head and neck cancer patients who had undergone facial surgical treatment. Using Interpretative Phenomenological Analysis, this study explored participants' journey of coping with a range of stigmas, how they were able to find meaning, and the unique growth that developed from their experiences. Findings of the four studies contribute to cancer-related stigma literature and provides evidence for the ways in which stigma contributes to positive and negative changes among cancer patients. The discussion considers how this program of research augments our understanding of cancer-related stigma, from both community and cancer patients' perspective. Using both quantitative and qualitative methodology, the research demonstrated how stigma can have deleterious consequences, but also how some patients have used their stigmatising experience to promote positive change. Finally, this program of research proposes areas for future research and promising implications for clinical practice in relation to stigma and posttraumatic growth.