Life After Cancer: How Does Public Sigma Increase Psychological Distress of Childhood Cancer Survivors?

Background and Purpose: Cancer diagnosis is a traumatic event that may be followed by long-term psychological effects. Public stigma towards cancer is often reported by cancer survivors as a considerable source of distress. However, the factors that buffer or exacerbate the negative effects of public stigma on psychological distress have not been elucidated. This study of adolescent and young adult survivors of childhood cancer was designed to examine how perceived public stigma impacts psychological distress as mediated by cancer disclosure, self-stigma, and social support availability.  

Methods: A total of 223 cancer survivors diagnosed before the age of 19 were recruited from Korean advocacy foundations and support groups for cancer survivors. The proportions of male and female participants were similar, and their mean age was 21.9 years, ranging from 15 to 38 years. The most prominent type of cancer was hematological cancer (72%), followed by solid or soft tissue tumors (14%) and central nervous system or brain tumors (14%).The average age at diagnosis was 9.9 years and the average time since diagnosis was 12 years. The survivors’ psychological distress was assessed by asking about the degree to which they felt bothered during the previous 7 days, using the Brief Symptom Inventory–18. Structural equation modeling was used with 1,000 bootstrap samples. 

Results: The goodness of model fit was acceptable (CFI = .962; TLI = .942; RMSEA = .066). Public stigma perceived by cancer survivors influenced the levels of psychological distress through self-stigma (B = 2.22, 95% CI = .38 to 4.65), social support availability (B = .97, 95% CI = .23 to 2.67), and cancer disclosure (B = -.45, 95% CI = -1.64 to -.02). Greater levels of perceived public stigma predicted greater levels of self-stigma (β = .58) and lower levels of social support availability (β = -.24), which increased psychological distress (β = .25 and -.26). Greater levels of perceived public stigma predicted lower levels of disclosure about cancer history (β = -.16) and cancer disclosure indirectly ameliorated psychological distress by reducing self-stigma (β = -.36). 

Conclusions: Our study findings support the impact of cognitive and social factors on the relationship between perceived public stigma and psychological distress among cancer survivors. A greater understanding of the factors influencing the levels of psychological distress could potentially help social workers and other behavioral health providers to identify childhood cancer survivors in need of psychosocial services and provide them with appropriate resources and interventions. This study extends our knowledge of cancer survivors by examining one stigmatized population of understudied Korean youth.