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J.K. Cataldo
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NU01 - Prevention (ID 265)
- Event: WCLC 2016
- Type: Nurses Session
- Track: Nurses
- Presentations: 1
- Moderators:L. Darlison, I. Nohavova
- Coordinates: 12/05/2016, 11:00 - 12:30, Schubert 5
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NU01.04 - Stigma in Lung Cancer (ID 6434)
11:00 - 12:30 | Author(s): J.K. Cataldo
- Abstract
- Presentation
Abstract:
Despite substantial reductions in smoking prevalence, lung cancer is the leading cause of cancer-related mortality for both genders in the United States. In 2016, lung cancer is expected to be responsible for 158,080 deaths. Tobacco smoking is still the number one risk factor for lung cancer and has been linked to 90% of all lung cancer cases. Currently, only 15% of all lung cancer cases are diagnosed at an early stage. Historically, these poor rates were due to the lack of effective routine screening. This changed dramatically in November 2011 when the National Lung Cancer Screening Trial (NLST), released their results that showed low-dose computed tomography (LDCT) could reduce lung cancer mortality by 20%. LDCT is now widely recommended for current and former smokers. Identification of all barriers and facilitators is essential for the successful promotion of lung cancer screening. Denormalization of smoking has been one of the most successful tobacco control measures and is associated with a sharp decrease in the prevalence of smoking. However, smoking is now concentrated in the most vulnerable populations (e.g. lower income groups and the mentally ill) who have the least ability and/or willingness to quit. In addition, denormalization has the effect of sanctioning smoking related stigma. A majority (95 %) of lung cancer patients experience stigma, with 48 % of lung cancer patients specifically reporting feeling stigmatized by their medical providers. Perceived lung cancer stigma is defined as a personal experience characterized by exclusion, rejection, blame or devaluation. Lung cancer conjures up attributions of blame because it is associated with smoking cigarettes and is perceived to be a controllable behavior. Perceived lung cancer stigma is a risk factor for poor psychosocial and medical outcomes in the context of lung cancer diagnosis and treatment. People often associate lung cancer with previous smoking behavior, regardless of whether the person with lung cancer was a smoker or not. There is growing body of evidence that patients, caregivers, healthcare providers, and members of the general public have negative implicit attitudes toward lung cancer. Perceived lung cancer stigma is one barrier that can delay the detection of lung cancer because of fear of health professionals’ censure associated with smoking. In our previous work we found that there were four beliefs associated with whether older (>55) current and former smokers would agree to lung cancer screening (LDCT): Perceives accuracy of the LDCT as an important factor in the decision to have a LDCT scan; Believes that early detection of LC will result in a good prognosis; Believes that they are at high risk for lung cancer; and is not afraid of CT scans. This study showed that older smokers are aware of the risks of smoking, are interested in smoking cessation, and most are interested in and positive about LDCT. There are no studies that have examined the impact of perceived lung cancer stigma on the decision to have an LDCT. To address this gap, we conducted a secondary analysis in which lung cancer stigma was measured by five true or false items: doctors treat smokers badly; doctors have a bias against smokers; cigarette smokers keep their smoking a secret from important people in their lives; cigarette smokers avoid talking about smoking with their doctor; cigarette smokers feel guilty about their smoking; and friends and family are upset that I smoke. Four variables demonstrated a significant association with LDCT agreement: People treat smokers badly; Doctors have a bias against smokers; Smokers feel guilt about smoking; and Friends and family do not approve of my smoking. Only two of the independent variables made a unique statistically significant contribution to the model. A test of the model against a constant only model was statistically significant, indicating that the predictors as a set, reliably distinguished between those who would agree to an LDCT and those who would not agree (chi square = 8.5 p. = <.1 with df = 4). The model as a whole explained between 43% of the variance in agreement to have a CT scan, and correctly classified 83.2% of cases. The strongest predictor for agreeing to a LDCT was “People treat smokers badly”, (OR 3.7, 95% CI .143-.971). Participants with this belief were almost 4 times less likely to agree to a CT scan than those who did not have the belief. The odds ratios for the remaining predictor, Doctors have bias against smokers, was OR 1.7, 95% CI 1.47- 4.90); Believes that they are at high risk for LC (OR 2.1, 95% CI 1.8 – 3.12). DISCUSSION The decision to agree to a LDCT is negatively associated with two indicators of perceived stigma, “people treat smokers badly” and “doctors have a bias against smokers.” These findings suggest that stigma is a barrier to preventative care utilization much like it is for patients with HIV, STDs, TB and mental health problems. Smokers from deprived communities are an important group to engage with lung cancer screening but thus far participation in trials has been skewed towards former smokers and better educated smokers. With the current demographic profile of smokers, the effectiveness of a lung cancer screening program depends in part on whether there are inequalities in participation which has the potential to exacerbate disparities in lung cancer survival. Given the impact of lung cancer stigma on satisfaction with care and patient outcomes it is imperative that further research explore the association of perceived lung cancer stigma and the decision to have LDCT.
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OA14 - Nurses in Care for Lung Cancer and in Research (ID 398)
- Event: WCLC 2016
- Type: Oral Session
- Track: Nurses
- Presentations: 1
- Moderators:M. Culligan, M. Nematollahi
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 5
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OA14.07 - The Relationship between Lung Cancer Stigma and Patient Reported Outcomes (ID 6379)
16:00 - 17:30 | Author(s): J.K. Cataldo
- Abstract
- Presentation
Background:
Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared to other cancer populations (Hewitt et al, 2013). Lung cancer stigma (LCS) may in part explain these findings. Evidence from studies in the Unites States has shown associations between LCS and lower QoL, higher symptom burden and higher levels of anxiety and depression (Cataldo et al, 2013). Whether these associations exist in people diagnosed with LC in the United Kingdom is unknown. Therefore this study explored the prevalence of LCS and its relationship with patient outcomes as well as QoL in a Scottish population.
Methods:
This study was a cross-sectional study. Patients (n=201) diagnosed with LC were recruited by health care professionals at follow-up clinics at four hospitals in Scotland. Participants completed questionnaires to collect demographic data and assess perceived LCS, QoL, symptom severity and level of depression. Clinical data was collected by casenote review. Bivariate correlations were performed to investigate the relationships between stigma, demographics, and patient outcomes. Multiple regression further explored the individual contributions of LCS on symptom burden and quality of life.
Results:
Participants had a mean age of 69 years (range 41-89 years), 46.8% were males, 92.0% were ever smokers, 17.9% current smokers. The mean LCS score was 53.1 (SD=14.1, range 31-124,). There were significant correlations between higher LCS and age (r= -0.28, p<0.001), being a current smoker (r= 0.17, p<0.05), deprivation index (r=0.15, p<0.05) depression (r=0.40, p<0.001), symptom burden (r=2.60, p<0.001), and QoL (r= - 0.52, p<0.001). Multiple regression revealed an overall model that explained 30.6% of the total variance of stigma (F=14.82, p<0.001). Perceived stigma also accounted for significant unique variance in QoL (4.3%, p<0.001) and depression (3.6%, p<0.001) above and beyond that accounted for by relevant variables. No contribution of stigma on symptom burden was found.
Conclusion:
Stigma was correlated with depression, and QoL. Therefore, it is expected that depression and stigma share some of the explanation of variance of QoL. Nevertheless, stigma was found to have a unique contribution on QoL, and on depression. With this in mind, management of patients with LC could determine the patients’ experience of stigma to tailor treatment plans to improve QoL and psychosocial outcomes. Being younger was correlated with higher LCS. This might reflect changed attitudes toward smoking due to changed marketing strategies in the 1960s.
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P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.01-028 - High Risk Older Smokers’ Perceptions, Attitudes and Beliefs About Lung Cancer Screening (ID 6244)
14:30 - 15:45 | Author(s): J.K. Cataldo
- Abstract
Background:
The US Preventive Services Task Force recommends that smokers aged 55-80 should be screened annually with low dose computed tomography (LDCT). Successful implementation of lung cancer screening depends on being able to reach high-risk individuals. This study identified demographic, smoking history, health risk perceptions, knowledge, and attitude factors of older smokers related to LDCT agreement. Using binary logistic regression we produced a predictive model of factors to explain LDCT agreement.
Methods:
As part of a larger Tobacco Attitudes and Beliefs Study, we conducted a cross-sectional, national, online survey of 549 older (≥ 45 years) current and former smokers. Univariate differences between groups for agreement and non-agreement for LDCT was conducted. Using all variables that demonstrated a significant association with LDCT agreement, a binary logistic regression analysis was conducted to predict agreement to have an LDCT.
Results:
Almost 80% of the sample believed that a person who continues to smoke after the age of 40 has at least a 25% chance of developing lung cancer and if asked, 79.4% would agree to a LDCT. Using Chi Square analyses, nine variables that were significant at the 0.10 level were selected for inclusion in model development. Four of the independent variables made a unique statistically significant contribution to the model: Believes that early detection of lung cancer will result in a good prognosis; Perceives accuracy of LDCT as an important factor in the decision to have a LDCT scan; Believes that they are at high risk for lung cancer; and Believes that a negative LDCT result would decrease worry without encouraging continued smoking.
Conclusion:
Older smokers are aware of the risks of smoking, are interested in smoking cessation, and most are interested in and positive about LDCT. Cognitive aspects of participation in screening are key to increasing the uptake of lung cancer screening and smoking cessation among high-risk smokers.
