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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 95-102

Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country


1 Department of Nursing, Faculty of Health Sciences, University of Izmir Katip Celebi, Izmir, Turkey
2 Medical Oncology Unit, Atatürk Training and Research Hospital, University of Izmir Kâtip Celebi, Izmir, Turkey
3 Department Izmir Public Association, University of Izmir Kâtip Celebi, Cigli, Izmir, Turkey

Date of Submission28-Jan-2019
Date of Acceptance28-Mar-2019
Date of Web Publication23-Oct-2019

Correspondence Address:
RN, PhD Medine Yilmaz
Department of Nursing, Faculty of Health Sciences, University of Izmir Katip Celebi, Cigli-Izmir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apjon.apjon_45_19

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  Abstract 


Objective: The aim of the current study are to determine the depression levels of adult oncology patients in the cancer treatment phase and identify both cancer-related stigma and the factors affecting their depression levels. Methods: In this correlational study, 303 adult patients who had been treated at a medical outpatient clinic were surveyed using the convenience sampling method. The “questionnaire for measuring attitudes toward cancer – patient version,” a sociodemographic characteristics questionnaire, and the beck depression inventory were used. A multivariable linear regression model was used for the analysis. Results: The questionnaire and its subscale scores indicated a positive relationship between depression and attitudes toward cancer. The predictive variables for depression were “being younger than 40-year-old” and “feelings of social exclusion,” which accounted for 4% of the total variance. Four factors indicating negative attitudes toward cancer were “being more than 60-year-old,” “higher education,” “low income,” and “feelings of social exclusion,” which accounted for 11% of the total variance. Conclusions: Cancer-related stigma, which underlies patients' emotional and behavioral outlooks, should be reduced in cancer patients. Members of health teams should be sensitive to cancer-related stigma.

Keywords: Attitude, cancer, depression, stigma


How to cite this article:
Yilmaz M, Dissiz G, Usluoğlu AK, Iriz S, Demir F, Alacacioglu A. Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country. Asia Pac J Oncol Nurs 2020;7:95-102

How to cite this URL:
Yilmaz M, Dissiz G, Usluoğlu AK, Iriz S, Demir F, Alacacioglu A. Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country. Asia Pac J Oncol Nurs [serial online] 2020 [cited 2020 Jan 26];7:95-102. Available from: http://www.apjon.org/text.asp?2020/7/1/95/269841






  Introduction Top


Negative attitudes, stereotypes, and discriminating attitudes toward cancer patients are very common in many societies.[1],[2] Over 30% of cancer survivors have been found to have negative attitudes toward cancer and hold stereotypical views of themselves.[3] The prevalence of cancer stigmatization ranges from 13% to 80%.[3],[4],[5]

Health-related stigma can occur in a variety of areas, such as health-related situations and shows its effects through varied mechanisms, such as negative attitudes, stereotypes, and discriminating attitudes.[6],[7] It has been associated with an increase in the stress associated with an illness, and its potential consequences are numerous.[4],[5],[7],[8],[9] [Figure 1] shows a conceptual framework of cancer-related stigma.[9] Cancer-related stigma is associated with poor self-esteem, anxiety, depression, poor adherence to treatment, delayed seeking of medical help, social isolation, limitation of living space, obstacles to employment, social exclusion, lack of social support, and diminished quality of life (QOL) in different patient groups.[4],[10],[11],[12],[13],[14],[15],[16] Older cancer patients face double stigmatization due to negative self-perceptions of aging and cancer (breast, gynecological, lung, or hematological).[17] Furthermore, cancer survivors continue to experience the negative effect of cancer-related stigma on their QOL[18] and have problems returning to work.[16],[19]
Figure 1: A conceptual framework of cancer stigma

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Depression is the most common psychiatric disorder in patients with cancer, with prevalence rates ranging from 21% to 70.6%.[8],[10],[20],[21],[22],[23],[24],[25] Depression rates vary according to certain conditions (i.e., the cancer type, treatment modalities, intensity and/or severity of the symptoms, and presence of social support).[10],[12],[22],[26] The relationship between stigmatization and depression in cancer patients has been demonstrated in many studies.[5],[8],[9],[14],[27] Patients who displayed negative attitudes toward cancer were 2.5 times more likely to experience depression than patients who displayed positive attitudes.[8] Thirty-one percent of respondents endorsed at least one item in a measure of cancer stigma, and 25% reported feeling that it was at least “a little true” that they were to blame for their illness. Perceived stigma can be associated with poorer psychological adjustment;[14] there is a positive association between perceived stigma and depressive symptomatology in cancer patients,[27] and strong negative relationships have emerged between QOL and anxiety, depression, and cancer stigma.[10] In addition to the effect of depression on stigma, factors such as older age,[17] lower education level,[28] marital status, and work and income have been reported as negative attitudes toward cancer. Qualitative studies have yielded similar results to quantitative studies.[15],[29],[30] However, the studies referred to above mainly reflect results obtained from socioculturally and economically developed countries.[4],[5],[12],[18],[23] Cross-cultural myths can also affect negative attitudes toward cancer. A large portion of the Turkish population, due to their cultural health beliefs, has a perspective that “cancer cannot be cured,” “cancer is fatal,” “patients with cancer are disabled,” “patients with cancer cannot return to their work,” and “a person with cancer is an incompetent person.” All these beliefs and discourses cause a person with cancer to feel they have been labeled and excluded from society and allow communities to discriminate against people with cancer. Because the results of the current study will provide data on stigma and depression in cancer patients, the study aimed to (a) document attitudes toward cancer-related stigma and depression levels among cancer patients in Turkey during the cancer treatment phase and (b) predict the factors that affect cancer patients' attitudes toward cancer and depression.


  Methods Top


The current study used a descriptive, cross-sectional design. Patients treated in an outpatient medical oncology clinic of training and research hospital in a city in western Turkey comprised the study population. The study was conducted with individuals undergoing cancer treatment in outpatient clinic rooms. During the 6-month study, 303 patients were reached. A post hoc power analysis performed by the GPower® 3.1 program (Universität Düsseldorf, Germany) indicated that for a population of 303 patients, the power of the study was 99%, at an effect size of 0.03 and a 95% confidence interval. Patients who were aged between 18 and 75 years, had received cancer therapy between October 2016 and April 2017, had a new diagnosis or relapse, volunteered to participate in the study, and were literate were assigned to the sample using the convenience method. Patients in the population who were in remission had psychiatric disorders, had speech or hearing problems, were illiterate, or did not want to participate were not included in the study. During the data collection process, 17 patients were unable to participate in the study due to their physiological symptoms, such as nausea, vomiting, and fatigue.

Instruments

Sociodemographic characteristics questionnaire

This questionnaire was prepared by the researchers in accordance with the relevant literature[3],[8],[12],[23] and included 14 items that questioned the sociodemographic characteristics of the participants. The participants were asked to respond to the question “what is your concern about your illness?” by choosing one of the following options: “The spread of my disease,” “my relatives' feelings of sadness,” or “being in need of others' support,” “death,” or “others.” They were also asked to respond to the question “do you think that you are excluded because of your illness” by choosing either “no,” “yes,” or “sometimes.”

Cancer-related stigma

The validity and reliability study of the Turkish version of the “questionnaire for measuring attitudes toward cancer (cancer stigma) – patient version,” developed by Cho et al.,[8] was performed by Yılmaz et al.[31] The questionnaire includes 12 questions to assess cancer stigma categorized into three domains: (i) Impossibility of recovery (4 items), (ii) cancer stereotypes (4 items), and (iii) discrimination.[8],[31] Mean scores of ≥2.5 indicate that the patient displays negative attitudes towards cancer. The Cronbach's alpha value of the questionnaire for the original form was 0.88[31] and 0.80 in the current study.

Depression

The beck depression inventory (BDI),[32] used to measure somatic, emotional, cognitive, and motivational symptoms in patients with depression, was adapted to Turkish by Hisli.[32],[33] Scores from 0 to 9 indicate low depression levels, scores from 10 to 16 indicate mild depression levels, scores from 17 to 29 indicate moderate depression levels, and scores from 30 to 63 indicate severe depression levels. The cutoff point for the validity and reliability of the inventory is 17. Scores ≥18 are accepted as indicative of moderate or severe depression levels.[33] Cronbach's alpha coefficient was 0.74 in the Turkish version of the inventory and 0.86 in the current study.

Procedures

Data collection was conducted in the outpatient chemotherapy unit. The paper-and-pencil method was used to collect data from the patients who were able to write. For patients who were unable to write because they were undergoing vascular access, the inventory was filled in by the same researcher (the author, amoebic gill disease) based on the patients' responses. Each interview lasted about 15 min.

Statistical analysis

The data were analyzed using the statistical program for social sciences®, version 22 (SPSS Inc., Chicago, Illinois, USA). To assess attitudes toward cancer, mean and standard deviation values were calculated for each item in each subdomain (impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination). The dependent variables of the study were the total and domain scores for the questionnaire for measuring attitudes toward cancer (cancer stigma) – patient version and the BDI scores. The independent variables of the study were age, gender, education level, marital status, working status, income, and exclusion experience. Correlations between cancer stigma scores and depression scores were analyzed using Pearson's product-moment correlations (r). To explain the relationships among the independent and dependent variables, a multivariable linear regression model was used. The dummy variables used for the regression analysis were age (being between 40 and 60 years old), gender (being a woman), educational status (being a primary school graduate), marital status (being married), working status (not employed), depression (BDI score between 0 and 9), and the experience of exclusion (not feeling excluded). Multicollinearity was set using a cutoff value of 10 for the variance inflation factor of the independent variables. The Durbin–Watson statistic (1.82) was within the acceptable range. The standardized residuals were normally distributed according to the Kolmogorov–Smirnov test (P = 0.20). These findings indicated that were no serious issues related to the multicollinearity assumptions and the normal distribution of the residuals.[34]

Ethical approval

Permissions were obtained from the Ethics Committee for non-interventional investigations (Approval No. 2016/25) and the relevant institution. Before the data collection, the participants were informed about the purpose of the research, and their written consent obtained.


  Results Top


Sample characteristics

The mean age of the patients was 54.1 ± 12.5, and 60.1% were female. Other characteristics are shown in [Table 1]. The major concerns of the patients regarding their illnesses were “the spread of my disease” (55.1%) and “my relatives' feelings of sadness” (33.7%). Of the participants, 9.2% thought they were always socially excluded because of their cancer diagnosis, while 8.6% thought they were sometimes socially excluded. Of those who thought they were socially excluded, 57.2% thought they were excluded by their friends, and 42.6% thought they were excluded by their family [Table 1].
Table 1: Sociodemographic characteristics of patients, findings of discrimination and depression scale (n = 303)

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Depression findings

The mean total score for the BDI was 14.1 ± 8.7. Of the participants, 38% had low, 29.4% had mild, 18.5% had moderate, and 14.2% had severe depression scores [Table 1].

Cancer stigma: Attitudes toward cancer

The mean score for the attitudes toward cancer questionnaire was 2.7 ± 0.6. The mean levels for each dimension of the negative attitudes were in the middle range or higher. There was a low positive correlation between the BDI and the attitudes questionnaire and its three domain scores [Table 2]. The responses the participants gave to the inventory items that indicated negative attitudes displayed by patients toward cancer are shown in [Table 3].
Table 2: Correlation analysis between scores of depression scale and stigma subscales

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Table 3: Distribution of the responses the patients gave to the items in the “questionnaire for measuring attitudes toward cancer (cancer stigma) - Patients version” (n = 303) [n (%)]

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Regression analysis for attitudes toward cancer and depression

According to the results of the multiple regression analysis, the predictive variables for depression were “being under the age of 40” and “feeling socially excluded.” These two variables accounted for 4% of the total variance [Table 4]. In the regression analysis, variables such as gender, marital status, education status, working status, and income were not considered as factors that lead to depression.
Table 4: Multiple backward regression analysis of the patients' depression scores

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The multiple regression analysis of the stigma scores revealed that the variables that affected attitudes toward cancer were “being a high school or university graduate,” “having a low income,” and “feeling socially excluded” [Table 5]. These four variables accounted for 11% of the total variance. In the “impossibility of recovery” domain, the variables affecting views about healing were “being ≥60-year-old,” “being a high school or university graduate,” “having a low-income level,” and “feeling socially excluded,” which accounted for 11% of the total variance. In the “stereotypes of cancer patients” domain, the affecting variables were “being ≥60-year-old,” “being a high school or university graduate,” and “having a low-income level.” These four variables accounted for 10% of the total variance. In the “experience of social discrimination” domain, the expected variables were “being a high school or university graduate” and “feeling socially excluded.” These variables accounted for 6% of the total variance. The regression analysis demonstrated that gender, marital status, and working status were not factors that lead to stigmatization.
Table 5: Multiple backward regression analysis of patients stigma scores

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  Discussion Top


Cancer treatment-related physical changes, such as alopecia, anemic appearance, mastectomy, colostomy, changes in skin color, and surgical scars, play an important role in patients' social interactions by causing them to feel excluded.[4],[5],[28],[35] In the current study, half of the patients stated that “cancer patients are easily recognized by their look,” and one in every 10 patients thought they were always excluded because of their cancer diagnosis; more than half of these patients were excluded by friends and people around them. Almost half of the patients thought that they were discriminated against by employers and/or co-workers. In a review study,[16] cancer survivors said that they underwent workplace discrimination after they started working and, another important finding was that the percentage of patients with negative stereotypes was quite high. The regression analysis revealed that “I'm excluded” is a factor in the “impossibility of recovery” and “discrimination” domains. In Turkey, a middle-income country, changes in the appearance of individuals due to some of the side effects of their cancer treatment and the misbelief that cancer is contagious explain the social discrimination felt by the participants. While the mean discrimination scores of a Korean study[3] were much lower compared with those of the current study, in contrast, the stereotypes and impossibility of recovery mean scores were close to those of the current study, which may be due to societal differences, such as social, lifestyle, and cultural factors. These striking results demonstrate the importance of increasing the number of attempts aimed at reducing the negative attitudes displayed by society toward cancer. These attempts should be conducted within the framework of reducing society's negative reactions and attitudes toward cancer patients. Cancer-related nongovernmental organizations (i.e., cancer advocacy groups) should carry out anti-stigma campaigns, governments should televise public service announcements, and mass media should actively provide powerful messages to society to prevent stigmatization.

Another important finding of the current study was that although their depression level was mild, almost one-third of the patients experienced moderate or severe depression. Previous studies have found widely distributed rates of depression[12],[25],[27] closely related to the type and stage of the cancer, the treatments, and the coping methods used by individuals. In Cataldo et al.'s study, 54.9% of the total sample was depressed, and there was a strong positive relationship between cancer and depression.[12] A positive relationship has been determined between feelings of stigma and depressive symptomatology in cancer patients.[10],[27] Cancer patients who experienced social discrimination were up to 4 times more likely to experience depression, and patients who had negative attitudes toward cancer were more depressed than patients with positive attitudes.[8] Previous studies have reported similar findings.[3],[9],[10],[14],[27],[36] Depressed or anxious individuals without mental illness were 2 times more likely to experience stigma.[28] Cancer-related stigma was significantly associated with depressive symptoms in a multivariate model of colorectal cancer patients.[5] Strong negative relationships have emerged between QOL and anxiety, depression, and lung cancer stigma.[8],[10] The regression analysis in the current study revealed that the factors affecting depression in cancer patients were age (“being under 40 years old”) and “exclusion.” Because being under the age of 40 years has negative effects on an individuals' education, family, or business life, it can be considered a severe factor for depression, especially because individuals under the age of 40 years are actively involved in their working life. After being diagnosed with cancer, many people quit their jobs and suffer a loss of role and status.

The current study showed that cancer patients over 60 years of age displayed negative attitudes toward cancer, especially in the “impossibility of recovery” and “stereotypes” domains. During the geriatric period, also defined as a period of losses, sufferers experience losses in health and social life and the independence of the elderly diminishes. Increased dependence and losses expose advanced-age people to more discrimination. In the current literature, older patients with different cancer types have been shown to face double stigmatization[17] and display more negative attitudes.[3] According to the results of the current study, the patients displayed negative attitudes in the “impossibility of recovery,” “stereotypes,” and “discrimination” domains. This may be because awareness increases as education level increases. In another study of cancer patients, high levels of stigma were associated with lesser educational attainment.[28] In all the domains except for “discrimination,” another factor that negatively affected attitudes toward cancer was low-income level. However, as in other studies,[2],[4],[8] no association was found between negative attitudes and the variables of gender, marital status, and place of residence in the current study. Because these characteristics were not associated with stigma, this could reflect the influence of sociocultural factors, such as an extended family structure, close relationships between individuals, and high levels of family and/or community social support for chronic diseases in the society where the research is conducted.

Stigma may interfere with a cancer patient's integration into the community and the normalization of their lives. Therefore, members of health teams should be sensitive to cancer-related stigma. When providing comprehensive cancer care to individuals with different sociodemographic characteristics, it is important to consider that these can affect an individual's fight against and coping with the disease. In this way, not only the course of the treatment but also the quality of the service provided and the patient's satisfaction will be improved.

Limitations

The diagnoses of the cancer patients were not included in the regression analysis because they were not homogeneous, and the sample size was not large. The study used the results of patients who were receiving cancer treatment, not cancer survivors, which could be clarified by investigating cancer-related stigma in cancer survivors. Cross-cultural myths exist, and they contribute to cancer stigma.


  Conclusion Top


The current study's findings emphasized that negative attitudes toward cancer may interrupt the treatment process and create additional problems, such as depression, the limited use of possible social support, resulting poor health, shortened survival periods, and low QOL. Measuring cancer-related stigma to identify patients exposed to negative attitudes can lead to its prevention and have a significant impact on their QOL. Future studies, conducted with larger samples, should investigate the relationship between stigma and QOL by focusing on different types of cancer.

Educating patients about the diagnosis and prognosis of their disease and support group attendance are effective interventions that strengthen cancer patients' attitudes toward stigma. In addition, public education that provides people with accurate information about the causes, treatment, and prognosis of cancer may be required in different cultures. The exposure of cancer patients returning to work after their treatment to discrimination should be prevented, supportive work environments should be organized, and advocacy and education strategies should be implemented.

Developing countries can implement innovative social and community entrepreneurship by considering their society's cultural, social, and economic structure and analyzing these results. This could take the form of implementing valuable family- and community-based interventions to manage cancer-related stigma. Health professionals, nongovernmental organizations, governments, and social services should perform anti-stigma interventions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chambers SK, Dunn J, Occhipinti S, Hughes S, Baade P, Sinclair S, et al. Asystematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer 2012;12:184.  Back to cited text no. 1
    
2.
Lebel S, Castonguay M, Mackness G, Irish J, Bezjak A, Devins GM. The psychosocial impact of stigma in people with head and neck or lung cancer. Psychooncology 2013;22:140-52.  Back to cited text no. 2
    
3.
Cho J, Choi EK, Kim SY, Shin DW, Cho BL, Kim CH, et al. Association between cancer stigma and depression among cancer survivors: A nationwide survey in Korea. Psychooncology 2013;22:2372-8.  Back to cited text no. 3
    
4.
Ernst J, Mehnert A, Dietz A, Hornemann B, Esser P. Perceived stigmatization and its impact on quality of life – Results from a large register-based study including breast, colon, prostate and lung cancer patients. BMC Cancer 2017;17:741.  Back to cited text no. 4
    
5.
Phelan SM, Griffin JM, Jackson GL, Zafar SY, Hellerstedt W, Stahre M, et al. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology 2013;22:65-73.  Back to cited text no. 5
    
6.
Deacon H, Boulle A. Commentary: Factors affecting HIV/AIDS-related stigma and discrimination by medical professionals. Int J Epidemiol 2007;36:185-6.  Back to cited text no. 6
    
7.
Major B, O'Brien LT. The social psychology of stigma. Annu Rev Psychol 2005;56:393-421.  Back to cited text no. 7
    
8.
Cho J, Smith K, Choi EK, Kim IR, Chang YJ, Park HY, et al. Public attitudes toward cancer and cancer patients: A national survey in Korea. Psychooncology 2013;22:605-13.  Back to cited text no. 8
    
9.
Fujisawa D, Hagiwara N. Cancer stigma and its health consequences. Curr Breast Cancer Rep 2015;7:143-50.  Back to cited text no. 9
    
10.
Brown Johnson CG, Brodsky JL, Cataldo JK. Lung cancer stigma, anxiety, depression, and quality of life. J Psychosoc Oncol 2014;32:59-73.  Back to cited text no. 10
    
11.
Cataldo JK, Slaughter R, Jahan TM, Pongquan VL, Hwang WJ. Measuring stigma in people with lung cancer: Psychometric testing of the cataldo lung cancer stigma scale. Oncol Nurs Forum 2011;38:E46-54.  Back to cited text no. 11
    
12.
Cataldo JK, Jahan TM, Pongquan VL. Lung cancer stigma, depression, and quality of life among ever and never smokers. Eur J Oncol Nurs 2012;16:264-9.  Back to cited text no. 12
    
13.
Carter-Harris L, Hermann CP, Schreiber J, Weaver MT, Rawl SM. Lung cancer stigma predicts timing of medical help-seeking behavior. Oncol Nurs Forum 2014;41:E203-10.  Back to cited text no. 13
    
14.
Else-Quest NM, LoConte NK, Schiller JH, Hyde JS. Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychol Health 2009;24:949-64.  Back to cited text no. 14
    
15.
Liu H, Yang Q, Narsavage GL, Yang C, Chen Y, Xu G, et al. Coping with stigma: The experiences of Chinese patients living with lung cancer. Springerplus 2016;5:1790. [Doi: 10.1186/s40064-016-3486-5].  Back to cited text no. 15
    
16.
Stergiou-Kita M, Pritlove C, Kirsh B. The “Big C”-stigma, cancer, and workplace discrimination. J Cancer Surviv 2016;10:1035-50.  Back to cited text no. 16
    
17.
Schroyen S, Marquet M, Jerusalem G, Dardenne B, Van den Akker M, Buntinx F, et al. The link between self-perceptions of aging, cancer view and physical and mental health of older people with cancer: A cross-sectional study. J Geriatr Oncol 2017;8:64-8.  Back to cited text no. 17
    
18.
Wood AW, Barden S, Terk M, Cesaretti J. The influence of stigma on the quality of life for prostate cancer survivors. J Psychosoc Oncol 2017;35:451-67.  Back to cited text no. 18
    
19.
Lebel S, Devins GM. Stigma in cancer patients whose behavior may have contributed to their disease. Future Oncol 2008;4:717-33.  Back to cited text no. 19
    
20.
Bhattacharyya S, Bhattacherjee S, Mandal T, Das DK. Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India. Indian J Public Health 2017;61:14-8.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Bottino SM, Fráguas R, Gattaz WF. Depression and cancer. Arch Clin Psychiatry (São Paulo) 2009;36:109-15.  Back to cited text no. 21
    
22.
Brown LF, Kroenke K, Theobald DE, Wu J, Tu W. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 2010;19:734-41.  Back to cited text no. 22
    
23.
Gray NM, Hall SJ, Browne S, Johnston M, Lee AJ, Macleod U, et al. Predictors of anxiety and depression in people with colorectal cancer. Support Care Cancer 2014;22:307-14.  Back to cited text no. 23
    
24.
Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis. Lancet Oncol 2013;14:721-32.  Back to cited text no. 24
    
25.
Rhondali W, Perceau E, Berthiller J, Saltel P, Trillet-Lenoir V, Tredan O, et al. Frequency of depression among oncology outpatients and association with other symptoms. Support Care Cancer 2012;20:2795-802.  Back to cited text no. 25
    
26.
Arrieta O, Angulo LP, Núñez-Valencia C, Dorantes-Gallareta Y, Macedo EO, Martínez-López D, et al. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Ann Surg Oncol 2013;20:1941-8.  Back to cited text no. 26
    
27.
Gonzalez BD, Jacobsen PB. Depression in lung cancer patients: The role of perceived stigma. Psychooncology 2012;21:239-46.  Back to cited text no. 27
    
28.
Tripathi L, Datta SS, Agrawal SK, Chatterjee S, Ahmed R. Stigma perceived by women following surgery for breast cancer. Indian J Med Paediatr Oncol 2017;38:146-52.  Back to cited text no. 28
[PUBMED]  [Full text]  
29.
Mohabbat-Bahar S, Bigdeli I, Mashhadi A, Moradi-Joo M. Investigation of stigma phenomenon in cancer: A grounded theory study. Int J Cancer Manag 2017;10:e6596.[Doi: 10.17795/ijcp-6596].  Back to cited text no. 29
    
30.
Tang PL, Mayer DK, Chou FH, Hsiao KY. The experience of cancer stigma in Taiwan: A Qualitative study of female cancer patients. Arch Psychiatr Nurs 2016;30:204-9.  Back to cited text no. 30
    
31.
Yılmaz M, Dişsiz G, Demir F, Irız S, Alacacioglu A. Reliability and validity study of a tool to measure cancer stigma: Patient version. Asia Pac J Oncol Nurs 2017;4:155-61.  Back to cited text no. 31
    
32.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.  Back to cited text no. 32
    
33.
Hisli N. A study on the validity of the Beck Depression Inventory. Turkish J Psychol 1998;6:118-23.  Back to cited text no. 33
    
34.
Chatterjee S, Hadi AS. Regression Analysis by Example. 5th ed. New Jersey: John Wiley and Sons; 2012.  Back to cited text no. 34
    
35.
Marlow LA, Waller J, Wardle J. Does lung cancer attract greater stigma than other cancer types? Lung Cancer 2015;88:104-7.  Back to cited text no. 35
    
36.
Alonso J, Buron A, Bruffaerts R, He Y, Posada-Villa J, Lepine JP, et al. Association of perceived stigma and mood and anxiety disorders: Results from the world mental health surveys. Acta Psychiatr Scand 2008;118:305-14.  Back to cited text no. 36
    

 
  Authors Top

Medine Yılmaz


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