How Oncology Nurses Can Dismantle Lung Cancer Stigma

Stigma that frames lung cancer as self-inflicted can keep patients from screening, symptom reporting, and treatment, and oncology nurses can disrupt it through the words they choose and through sustained community engagement, according to Lisa Carter-Bawa, PhD, MPH, APRN, ANP-C, FAAN, FSBM, director of the Cancer Prevention Precision Control Institute at the Hackensack Meridian Center for Discovery and Innovation and deputy associate director for community outreach and engagement at Georgetown Lombardi Comprehensive Cancer Center.

How does stigma affect patients’ willingness to seek care?

Self-blame often returns when lung cancer recurs, Carter-Bawa said, and it can become a barrier to further treatment and adherence. “Patients think that they’re not worthy. They self-blame. They think they’re not worthy of treatment,” she said. “I’ve had patients tell me that I did this to myself. I don’t deserve treatment. Please spend your resources on someone else who didn’t smoke or didn’t do this to themselves.”

Stigma has persisted even as treatment has improved. In a GO2 Foundation for Lung Cancer survey reported by Oncology Nursing News, 70% of patients and 68% of oncologists agreed that there is a stigma surrounding lung cancer.¹

What does stigma sound like in practice?

Carter-Bawa contrasted lung cancer with other diagnoses. “When someone tells you that they are diagnosed, maybe they had a heart attack, nobody looks at them and says, ‘Oh, you’re not vegan and you don’t run 5 days a week,’” she said. With lung cancer, the first question is often whether the person smoked.

“Stigma is not necessarily always blatant. It’s that silence that then leads to not screening, not coming back and telling your doctor you’re having certain symptoms and getting treated, not staying the course of treatment,” she said. “We built this. It’s not on the patient. We did it ourselves.”

Nurses can dismantle stigma through empathic communication, which she described as approaching patients without judgment and “with hope and compassion because nobody deserves lung cancer.”

Why can “never smoked” messaging backfire?

Even within the advocacy community, statements such as “I had lung cancer, I never smoked” can reinforce stigma, Carter-Bawa said. “What that communicates to the world is there’s two buckets of people who have lung cancer: people who deserve it and people who don’t,” she said, noting that people who never smoked do not intend that message.

How can nurses reach people outside the health system?

Much of Carter-Bawa’s work takes place upstream, in communities, before people engage with health care. She pointed to a level of medical mistrust among African American individuals that is “rightfully so and rightfully earned,” along with barriers such as lack of insurance and distance from treatment centers. She has previously described nurses as well positioned to bridge that gap.²

“We spend a lot of time making those relationships with our community partners and physically going out, and not just once. We don’t helicopter in and helicopter out,” she said. Over time, people begin to ask questions and trust the team, creating chances to navigate them to screening.

What are the key takeaways for oncology nurses?

• Self-blame can resurface at recurrence and become a barrier to treatment.
• Avoid leading with blame-laden questions; approach patients without judgment.
• “Never smoked” framing can unintentionally divide patients into deserving and undeserving groups.
• Sustained, repeated community engagement builds the trust needed to reach underserved populations.

References

1. King JC. Lung cancer treatment improves, but stigma does not. Oncology Nursing News. September 11, 2019. Accessed November 2, 2026. https://www.oncnursingnews.com/view/lung-cancer-treatment-improves-but-stigma-does-not

2. Dobkowski D. Empathetic conversations with patients may alleviate lung cancer screening disparities. Oncology Nursing News. February 2, 2024. Accessed November 2, 2026. https://www.oncnursingnews.com/view/empathetic-conversations-with-patients-may-alleviate-lung-cancer-screening-disparities