title: Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer.
abstract: OBJECTIVE
  Patients with lung cancer might feel more guilt and shame resulting from previous smoking. This study was designed to determine the levels of guilt and shame among patients with non-small-cell lung cancer (NSCLC) compared with breast and prostate cancer.
  
  
  METHODS
  Surveys were sent to participants 3 times (at enrollment, 2 months, and 6 months). Patients were eligible if they had stage IV NSCLC, breast cancer, or prostate cancer. The survey included tests of generalized guilt, shame, depression, and anxiety as well as guilt, shame, and embarrassment related to one's cancer.
  
  
  RESULTS
  One hundred seventy-two participants completed >or= 1 questionnaire: 96 patients with NSCLC, 30 patients with breast cancer, and 46 patients with prostate cancer. Of the patients with NSCLC, 91.7% were current or former smokers versus 67.1% of the comparison patients. A composite score of embarrassment related to one's cancer (perceived cancer-related stigma; PCRS) was higher in patients with NSCLC (P < .01). Mean baseline generalized guilt and shame scores were not different among groups and did not change over time. A history of smoking correlated with increased levels of guilt and shame, regardless of tumor type. A personal identification of past behaviors as contributing to cancer correlated with higher levels of guilt, shame, anxiety, and depression. Of the patients with NSCLC, 29.5% felt that their behaviors contributed to their cancer compared with 10.5% of the comparison patients.
  
  
  CONCLUSIONS
  Patients with NSCLC had higher levels of PCRS than patients with prostate cancer or breast cancer but not higher baseline levels of shame and guilt. Smoking is correlated with higher levels of guilt and shame. A belief that one caused one's own cancer is correlated with higher levels of guilt, shame, anxiety, and depression. These findings could be translated into an increased need for open communication among patients and their providers surrounding issues of cancer causation, guilt, shame, depression, and anxiety.
authors.affiliation: University of Wisconsin Paul P Carbone Comprehensive Cancer Center, Madison, WI 53792, USA. ns3@medicine.wisc.edu
authors.forename: Noelle K
authors.initials: NK
authors.lastname: LoConte
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Else-Quest
authors.forename: Jens
authors.initials: J
authors.lastname: Eickhoff
authors.forename: Janet
authors.initials: J
authors.lastname: Hyde
authors.forename: Joan H
authors.initials: JH
authors.lastname: Schiller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006167:Guilt; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000523:psychology*; D012752:Shame; D012907:Smoking / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors