Intended for healthcare professionals

Primary Care

Stigma, shame, and blame experienced by patients with lung cancer: qualitative study

BMJ 2004; 328 doi: (Published 17 June 2004) Cite this as: BMJ 2004;328:1470
  1. A Chapple, senior research fellow (alison.chapple{at},
  2. S Ziebland, senior research fellow1,
  3. A McPherson, research lecturer1
  1. 1DIPEx Research Group, Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  1. Correspondence to: A Chapple
  • Accepted 1 April 2004


Objectives To draw on narrative interviews with patients with lung cancer and to explore their perceptions and experience of stigma.

Design Qualitative study.

Setting United Kingdom.

Participants 45 patients with lung cancer recruited through several sources.

Results Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatised because the disease is so strongly associated with smoking. Interaction with family, friends, and doctors was often affected as a result, and many patients, particularly those who had stopped smoking years ago or had never smoked, felt unjustly blamed for their illness. Those who resisted victim blaming maintained that the real culprits were tobacco companies with unscrupulous policies. Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people. Some indicated that newspaper and television reports may have added to the stigma: television advertisements aim to put young people off tobacco, but they usually portray a dreadful death, which may exacerbate fear and anxiety. A few patients were worried that diagnosis, access to care, and research into lung cancer might be adversely affected by the stigma attached to the disease and those who smoke.

Conclusion Patients with lung cancer report stigmatisation with far reaching consequences. Efforts to help people to quit smoking are important, but clinical and educational interventions should be presented with care so as not to add to the stigma experienced by patients with lung cancer and other smoking related diseases.


  • Contributors AC interviewed the patients and analysed the data in collaboration with SZ. The lung cancer study is part of the DIPEx project. AC drafted the paper; all authors contributed to subsequent drafts and the final version. AC and SZ will act as guarantors for the paper.

  • Funding Department of Health and Macmillan Cancer Relief.

  • Competing interests AMcP is a cofounder of DIPEx and all of the authors are on the DIPEx steering group. This does not, however, represent a conflict of interest for this paper.

  • Ethical approval This study was approved by a multiple research ethics committee.

  • Accepted 1 April 2004
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