Stigma in COPD and Lung Cancer: A Systematic Review

Objectives: People with chronic obstructive pulmonary disease (COPD) and lung cancer are stigmatized by their history of smoking, but little is known about the similarities and dissimilarities in stigma associated with each condition. A comparison of the two could be useful in advancing the science. This systematic review aimed: 1) to compare existing literature on stigma in people with COPD and lung cancer and 2) to identify existing measures of COPD-related and lung cancer-related stigma.

Methods: We conducted a systematic search of CINAHL/PsycINFO/PubMed/Scopus databases for articles related to stigma in COPD or lung cancer through October 2015. We performed a quality assessment and synthesized findings according to concepts in the models of health-related stigma in people with COPD and lung cancer (Berger et. al., 2011 and Cataldo et al., 2011).

Results: A total of 42 studies met criteria for review: 17 addressed stigma in people with COPD (6 quantitative and 11 qualitative) and 25 addressed stigma in people with lung cancer (14 quantitative and 9 qualitative). We identified no well-established measures of COPD-related stigma; most of the COPD research was qualitative and/or employed unvalidated questions about stigma. The most commonly used measure for lung cancer stigma was the Cataldo Lung Cancer Stigma Scale (Cataldo et. al. 2011); it was used in 8 studies. People with COPD linked stigma to smoking, the diagnosis itself, symptoms of COPD (cough and shortness of breath) and stigma triggers such as the use of inhalers and supplemental oxygen. People with lung cancer linked stigma to their smoking behavior and previous- and current-smokers reported higher levels of stigma than people who never smoked.

Conclusions: People with COPD and lung cancer are similar in their perceptions of stigma, “they did it to themselves”. Less is known about COPD-related stigma in part because there are no reliable and valid measures of COPD-related stigma. It may useful to develop a single instrument that measures stigma in both diseases, thereby facilitating further comparison that could lead to a better understanding of the underlying mechanisms for stigma in these chronic diseases.