1876P - Cancer stigma: How Tunisian patients perceive their cancer

Background

Societal beliefs about cancer can impact how patients perceive their disease generating cancer stigma (CS) with risk of emotional distress especially in Arab countries where cancer remains a taboo. This study aimed to evaluate aspects of CS according to Tunisian cancer patients, explore risk factors and describe the impact on mental health.

Methods

The study was a cross-sectional questionnaire-based study, conducted between February and April 2023, including 100 patients treated for cancer regardless of gender, type or stage. We developed the questionnaire by adapting items from the “Cancer stigma scale” using questions grouped in three domains: impossibility of recovery, stereotypes of cancer patients and experience of social discrimination. Depression and anxiety were evaluated by using the “Hospital Anxiety and Depression Scale”.

Results

Median age was 50 years old, 75% of patients were women. On average, patients were surveyed 20.48 months after diagnosis. Patients reported at least one form of CS in 57% of cases. They believed in the impossibility of recovery after cancer experience in 47% of cases. Forty percent of patients held stereotypical views of themselves: 48% endorsed that cancer patients would have a difficult time having sexual intimacy which was the item with the highest mean (2.45) among all questions. Thirty four percent of patients reported social discrimination on grounds of cancer: by family/spouse in 31%, at the workplace in 15% and by friends/neighbors in 13% of cases. Cancer stigma was significantly more perceived by patients with low socioeconomic status (OR= 3.74 [1.42-9.82]), living in rural areas (OR=26 [3.38-205] and with advanced stage disease (OR=4.2 [1.67-10.5]). Forty percent of patients reported significant depressive symptoms and 47% significant anxiety symptoms. Patients who experienced CS were 4.27 times more likely to have depression (p <0.001) and 3.57 times more probably to be anxious (p <0.001) than patients with positive attitudes.

Conclusions

Despite increased awareness, cancer patients had high levels of CS with negative impact on mental health. These results ring the alarm bell to change societal beliefs and to help patients perceive “better” their disease.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.