Memorial Sloan Kettering Cancer Center Leads Collaborative Effort to End Lung Cancer Related Stigmas

Memorial Sloan Kettering Cancer Center (MSK) is committed to helping eliminate the stigmas associated with a lung cancer diagnosis and is working to raise awareness in close collaboration with other national organizations such as the GO2 Foundation for Lung Cancer and American Cancer Society.

Stigma can have profound and lasting effects, and studies have shown that people living with lung cancer may encounter challenges in receiving the support they need from their social network and healthcare providers.

Recently, MSK behavioral scientists Dr. Smita Banerjee and Dr. Jamie Ostroff, initiated the next phase of a long-term project that kicked off in 2021. Funded in part by a National Cancer Institute (NCI) grant, the collaborative effort included the development of a unique training module for healthcare providers – including nurses and physicians who care for people with lung cancer – in empathic communication, the act of conveying an understanding of a patient perspective that includes skills such as encouraging people to express their feelings, and acknowledge, validate, normalize, and praise their efforts. The program offers providers tools to help them communicate more effectively without using stigmatizing language.

During this next phase, 16 sites nationwide, including eight GO2 Foundation Centers of Excellence, will test the Empathic Communication Skills module. Providers will receive the tested training module and evaluate its impact on their communication and empathy skills, and their patients may be selected to share their perception of stigma and care satisfaction afterward. The combination of patient and provider focused feedback will help drive progress in de-stigmatizing lung cancer and smoking cessation.

“The unfortunate reality is that healthcare providers themselves can unintentionally perpetuate the stigma when conducting assessments of tobacco use during consultations with their patients,” says Dr. Banerjee. “Sometimes, the way in which discussions about tobacco are initiated can lead to people feeling one way or another about their diagnosis. Empathic patient-provider communication is at the heart of providing compassionate and supportive cancer care, and our training module was developed to improve this.”

“The focus is on training healthcare providers how to take a smoking-related history and advise cessation in a way that is caring, compassionate and, most of all, nonjudgmental,” adds Dr. Ostroff.

According to Dr. Ostroff, who also directs MSK’s Tobacco Treatment Program, the stigma surrounding lung cancer is a result of its historically poor prognosis and its close association with smoking. “While smoking remains the leading preventable cause of lung cancer and is known to cause at least 12 other types of cancer, providers must recognize the strength of nicotine addiction, and that patients are often reluctant to discuss smoking and their challenges in quitting,” she says.

The Empathic Communication Skills training module was created utilizing other modules developed by MSK’s Comskil program – Communication Skills Training Program and Research Laboratory. Comskil was the nation’s first formally structured communication initiative at an NCI-Comprehensive Cancer Center, and its goal was to identify the most effective and lasting approaches for guiding healthcare providers in serving people with cancer across the trajectory. In 2018, when the lung cancer training module was first developed, it was tested with MSK physicians and advanced practice providers. Encouraging results from this pilot study were published in 2021 in the journals Translational Behavioral Medicine and Chest.

Today, thanks to advances in early detection and treatment, the prognosis for people diagnosed with lung cancer is improving and there are more lung cancer survivors than ever before. Cancer epidemiologists have tracked a 41 percent decline in lung cancer-related deaths (from 1991 to 2018). There are also tools for early detection, including robust screening programs for those in high-risk categories, including across multiple MSK locations in New York and New Jersey.

“Eliminating the stigma of lung cancer will save even more lives by empowering people to speak up and get help,” says Dr. Banerjee.

“We’re at a very exciting juncture. We’re moving from describing and understanding lung cancer stigma to actually doing something about it,” Dr. Ostroff says.

This study is funded by National Cancer Institute R01 Grant #1R01CA255522-01A1 to PIs Dr. Smita Banerjee and Dr. Jamie Ostroff.