Lisa A. Webb

Date of Award

Spring 2019

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Karen Kane McDonnell


Background: Despite the improved screening and treatment modalities, lung cancer is the second leading cause of cancer and accounts for 27% of all cancer deaths in the United States. Survivors of lung cancer experience physical, social, and particularly psychological challenges. Lung cancer stigma is a formidable challenge for survivors of lung cancer that complicates their physical, psychological and social well-being.

The Cataldo Lung Cancer Stigma Scale is the first instrument adapted to measure lung cancer stigma. This instrument was adapted from Berger’s HIV Stigma Scale. HIV stigma and lung cancer stigma share similarities. These health-related stigmas reflect behaviors that are associated with the development of a debilitating disease and where those who partake in this behavior bear responsibility for the development of the disease. In previous studies, the CLCSS was reported to have very good reliability and construct validity. However, those studies lacked adequate African American representation.

African Americans experience a significant disparity in lung cancer incidence and survival rates. In South Carolina, African American men have a higher incidence and lower survival rate in comparison to their Caucasian counterparts, whereas African American women have a lower incidence and lower survival rate compared to Caucasian women. This disparity is concerning and warrants investigation of the possible factors that contribute to the disparate rate. The goal of this research is to enhance existing knowledge of stigma and its effect on individuals in South Carolina living with a lung cancer diagnosis with equal representation of African American and Caucasian survivors of lung cancer.

Methods: This multiple-method study evaluated the reliability and construct validity of the CLCSS among a purposive sample of survivors of lung cancer in South Carolina. Secondly, lung cancer stigma, depression, and QOL were evaluated by the calculation and comparison of means among demographic characteristics. Thirdly, the relationship between lung cancer stigma and race was evaluated, adjusting for demographic characteristics. And lastly, the experience of living with lung cancer and the interpretation of the CLCSS were explored among African American participants.

Findings: Participants (n = 56) included 30 Caucasian and 26 African American survivors of lung cancer recruited from a cancer registry of an American College of Surgeons–accredited program, a support club for survivors of lung cancer, and a private ambulatory oncology practice, all near Columbia, South Carolina. Among the 26 African American participants, quantitative analysis indicated a moderate level of lung cancer stigma, a moderately high level of depressive symptoms, and quality of life (QOL).

Depressive symptoms were positively associated to lung cancer stigma, and QOL was negatively associated to lung cancer stigma. Qualitative analysis revealed social isolation secondary to physical limitations, regrets relative to cigarette smoking, and unfair treatment of insurance providers and employers.

Conclusions: Lung cancer stigma adversely impacts overall QOL of survivors of lung cancer. It is imperative that health professionals acknowledge and are aware of the negative influences lung cancer stigma imposes. A holistic clinical evaluation encompassing physical, psychological, and social well-being is needed to identify and address the needs of survivors of lung cancer relative to lung cancer stigma and the impact it may have on overall QOL. Additional research is needed to assist with the development of tailored interventions that will aid in mitigating the harmful effects of lung cancer stigma.


© 2019, Lisa A. Webb

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