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Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study

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Abstract

Purpose

Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC.

Methods

This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale–Depression Subscale (HADS–Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson’s product-moment correlation, and multiple regression.

Results

The two top-ranked subscales of shame and stigma were: “speech and social concerns” and “regret”. Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma.

Conclusion

Patients’ body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

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Data availability

The data that support the findings of this study are available from the corresponding author. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of National Science and Technology Council and Chang Gung Memorial Hospital Research Program.

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Acknowledgements

We greatly appreciate the support of the participants and the hard work of the researchers during this study. The authors would like to thank Convergence CT for assistance with English editing during development of the manuscript.

Funding

This study was funded by Ministry of Science and Technology (MOST), Grant/Award Number: MOST 105–2628-B-255–001-MY3. Chang Gung Memorial Hospital, Grant/Award Number: NMRPF3K0051, NMRPF3K0052, NMRPF3K0053, and CMRPF3M0011.

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Authors and Affiliations

  1. Department of Nursing, Asia Eastern University of Science and Technology, Taipei, Taiwan

    Hsi-Ling Peng

  2. Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Yen-Hui Chen, Han-Yen Lee, Wen-Ying Tsai & Ya-Lan Chang

  3. Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

    Ya-Lan Chang

  4. School of Nursing, College of Medicine, National Taiwan University, 1 Jen-Ai Rd., Sec. 1, Taipei, 100, Taiwan

    Yeur-Hur Lai

  5. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

    Yeur-Hur Lai

  6. Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan

    Yeur-Hur Lai

  7. School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

    Shu-Ching Chen

  8. Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shu-Ching Chen

  9. School of Nursing, College of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1 Road, Guishan, Taoyuan, 333, Taiwan

    Shu-Ching Chen

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Contributions

All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE (http://www.icmje.org/recommendations/)]: substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content. HLP, YHL, and SCC designed the study. HLP, YHC, HYL, WYT, YLC, and SCC involved in data collection and analysis. HLP, YHL, and SCC prepared the manuscript.

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Correspondence to Yeur-Hur Lai or Shu-Ching Chen.

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Ethics approval and consent to participate. (Human)

Ethics approval and consent to participate. The study was reviewed and approved by the Institutional Review Board of Chang Gung Medical Foundation in Taiwan (Number: 104-8655B), and all methods were performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants before data collection. The authors also thank the copyright owners for their permission to use the questionnaires.

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Peng, HL., Chen, YH., Lee, HY. et al. Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study. Support Care Cancer 32, 357 (2024). https://doi.org/10.1007/s00520-024-08568-2

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