Did you smoke? Lung cancer, smoking and associated stigma

Amanda Lyons

5/11/2018 3:28:46 PM

As smoking has become increasingly stigmatised, so has the disease most commonly associated with it.

Stigma related to smoking and lung cancer can be a barrier to patients seeking timely diagnosis and treatment.
Stigma related to smoking and lung cancer can be a barrier to patients seeking timely diagnosis and treatment.

Lung cancer is the fifth most commonly diagnosed cancer in Australia, and is the country’s leading cause of cancer death. And, at just 17%, it also has a far lower five-year survival rate than other cancers.
According to Associate Professor Joel Rhee, Chair of the RACGP Specific Interests Cancer and Palliative Care network, one of the reasons for lung cancer’s relative deadliness is the fact it is often not detected early enough for effective treatment.
‘Often when people develop symptoms and they start doing investigation, [lung cancer] is quite advanced,’ he told newsGP.
A number of factors can contribute towards delay in identifying lung cancer, but one barrier that can be especially significant for some patients is the stigma related to the disease, which largely stems from its association with smoking.
‘Smoking has become almost a moral issue nowadays,’ Associate Professor Rhee said.
One of the most common questions asked of people diagnosed with lung cancer is, “Did you smoke?” Meanwhile, research released by the Lung Foundation last year revealed that 35% of respondents considered people with lung cancer to be ‘their own worst enemy’ who had ‘only themselves to blame’, while almost a quarter of people diagnosed with the disease felt shame, guilt or fear of discrimination.
Associate Professor Rhee believes that in order to reduce the harms of lung cancer, it is very important for patients to feel free from this kind of stigma when consulting with their GP.
‘The last thing we want to do is be judgemental of smokers; that will lead to greater stigma, which may then lead to later presentation if there are any problems,’ he said.
It remains important, however, to acknowledge that smoking is a risk factor for lung cancer and teach patients to be vigilant about possible symptoms.
‘Educate patients about what to watch out for,’ Associate Professor Rhee said. ‘For example, if they have a cough for three weeks or more, they should go and see their GP for a chest X-ray.’
Such vigilance applies to GPs, as well.
‘We have to watch out for smokers and if they do develop any change or symptoms, organise chest X-rays and get them diagnosed as soon as possible,’ Associate Professor Rhee said.
‘This means understanding our local referral pathways for lung cancer, because you need to get [these patients] seen by the specialist early.’
While smoking is a risk factor for lung cancer, it is not the sole cause, which can be difficult to explain to patients who develop the disease without smoking.
‘One of the things they often ask is, “I never smoked, why did I get it?”’ Associate Professor Rhee said. ‘It’s hard to answer that, because we don’t really know for sure.
‘Ultimately, smoking is a risk factor, so just because someone smokes doesn’t guarantee anything, it just makes [disease] much more likely. But people can also become really unlucky and develop lung cancer even if they never smoke.
‘So you try to talk about it in that way, but it’s never easy – I’m not sure how satisfied people are with that explanation.’
Associate Professor Rhee believes that as smoking rates drop and the demographics of smokers change, so will the numbers and types of people who develop smoking-related disease.
‘There has been a change in pattern in terms of smokers; a lot more women, especially younger women, are taking up smoking nowadays, which is a concern,’ he said. ‘But whether that’s going to impact on lung cancer in that population, it’s hard to know.
‘It’s probably also going to become more commonplace to see lung cancer in people who have never smoked or quit many years ago, than the traditional smoker-equals-lung-cancer kind of paradigm.’
But no matter how a patient may have developed the disease, Associate Professor Rhee again emphasises the importance of addressing the issue without judgement.
‘Smokers need to feel comfortable in being truthful to their GP, so that means having an open mind and not being judgemental,’ he said.
‘I think that’s really important; maintaining good relationships and making patients feel comfortable around us, which allows them to come back to us if there are any concerns.’

Lung cancer smoking stigma

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