Pengaruh Stigma Sosial pada Manajemen Pengobatan Kanker Kolorektal

M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Nurzahara Sihombing; Romaito Nasution; Milna Sari

doi:10.55606/termometer.v3i1.4501

Authors

M. Agung Rahmadi Universitas Islam Negeri Syarif Hidayatullah Jakarta
Helsa Nasution Universitas Negeri Padang
Luthfiah Mawar Universitas Sumatera Utara
Nurzahara Sihombing SD Negeri 107396 Paluh Merbau
Romaito Nasution Universitas Islam Negeri Sumatera Utara
Milna Sari Universitas Islam Negeri Sumatera Utara

DOI:

https://doi.org/10.55606/termometer.v3i1.4501

Keywords:

social stigma, colorectal cancer, quality of life

Abstract

This study investigates the impact of social stigma on colorectal cancer treatment management through a meta-analysis of 47 studies involving 12,358 patients. Results demonstrate significant negative correlations between social stigma and both colorectal cancer treatment adherence (r = -0.42, p < 0.001) and patient quality of life (r = -0.38, p < 0.001). More specifically, regression analyses reveal that social stigma predicts 18% of variance in diagnostic delay (β = 0.43, p < 0.001) and 22% of variance in treatment-seeking delay (β = 0.47, p < 0.001). These findings, when compared to Gonzalez and Smith's (2019), reported a weaker correlation (r = -0.29) between social stigma and treatment adherence, identifying a stronger effect between these variables. Furthermore, unlike Lee et al.'s (2020) study focusing on lung cancer, this research specifically demonstrates that colorectal cancer patients experience 23% higher levels of social stigma (d = 0.58, p < 0.01). In the context of intervention, results confirm that community-based interventions can reduce perceived social stigma by 31% (95% CI: 24%-38%), exceeding the effectiveness reported in Courtens (1996) previous study. Finally, mediation analyses confirm that social support mediates 26.2% of social stigma's effect on treatment adherence and 34.2% on quality of life, while coping strategies mediate 21.4% and 26.3%, respectively. These findings underscore the urgency of integrating social stigma reduction strategies into colorectal cancer treatment management protocols to improve treatment outcomes and patient well-being.

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References

Aizer, A. A., Chen, M. H., McCarthy, E. P., Mendu, M. L., Koo, S., Wilhite, T. J., ... & Nguyen, P. L. (2013). Marital status and survival in patients with cancer. Journal of Clinical Oncology, 31(31), 3869–3876.

Allemani, C., Matsuda, T., Di Carlo, V., Harewood, R., Matz, M., Nikšić, M., ... & Hood, M. (2018). Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): Analysis of individual records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. The Lancet, 391(10125), 1023–1075.

Arndt, V., Merx, H., Stegmaier, C., Ziegler, H., & Brenner, H. (2004). Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: A population-based study. Journal of Clinical Oncology, 22(23), 4829-4836.

Baade, P. D., Meng, X., Youl, P. H., Aitken, J. F., Dunn, J., & Chambers, S. K. (2011). The impact of body mass index and physical activity on mortality among patients with colorectal cancer in Queensland, Australia. Cancer Epidemiology, Biomarkers & Prevention, 20(7), 1410-1420.

Bao, Y., Fox, S. A., & Escarce, J. J. (2007). Socioeconomic and racial/ethnic differences in the discussion of cancer screening: "Between‐" versus "within‐" physician differences. Health Services Research, 42(3p1), 950-970.

Benson, A. B., Venook, A. P., Al-Hawary, M. M., Cederquist, L., Chen, Y. J., Ciombor, K. K., ... & Freedman-Cass, D. A. (2018). NCCN guidelines insights: Colon cancer, version 2.2018. Journal of the National Comprehensive Cancer Network, 16(4), 359–369.

Berger, B. E., Kapella, M. C., & Larson, J. L. (2011). The experience of stigma in chronic obstructive pulmonary disease. Western Journal of Nursing Research, 33(7), 916-932.

Brenner, H., & Kloor, M. (2014). Colorectal cancer. Lancet, 383(9927), 1490–1502.

Carlsson, E., Berndtsson, I., Hallén, A. M., Lindholm, E., & Persson, E. (2010). Concerns and quality of life before surgery and during the recovery period in patients with rectal cancer and an ostomy. Journal of Wound, Ostomy & Continence Nursing, 37(6), 654-661.

Chambers, S. K., Baade, P., Youl, P., Aitken, J., Occhipinti, S., Vinod, S., ... & O'Connell, D. L. (2015). Psychological distress and quality of life in lung cancer: The role of health‐related stigma, illness appraisals, and social constraints. Psycho‐Oncology, 24(11), 1569–1577.

Chao, H. H., Schwartz, A. R., Hersh, J., Hunnibell, L., Jackson, G. L., Provenzale, D. T., ... & Rose, M. G. (2009). Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system. Clinical Colorectal Cancer, 8(1), 22-28.

Cho, J., Choi, E. K., Kim, S. Y., Shin, D. W., Cho, B. L., Kim, C. H., ... & Park, J. H. (2013). Association between cancer stigma and depression among cancer survivors: A nationwide survey in Korea. Psycho‐Oncology, 22(10), 2372–2378.

Chou, A. F., Stewart, S. L., Wild, R. C., & Bloom, J. R. (2012). Social support and survival in young women with breast carcinoma. Psycho‐Oncology, 21(2), 125–133.

Clements, A., Henderson, B., Tyndel, S., Evans, G., Brain, K., Watson, E., ... & Management Group. (2008). Diagnosed with breast cancer whilst on a family history screening programme: An exploratory qualitative study. Breast Cancer Research, 10, 1–1.

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16.

Courtens, A. M., Stevens, F. C. J., Crebolder, H. F. J. M., & Philipsen, H. (1996). Longitudinal study on quality of life and social support in cancer patients. Cancer Nursing, 19(3), 162-169.

Crowley, M. M., McCoy, M. E., Bak, S. M., Caron, S. E., Ko, N. Y., Kachnic, L. A., ... & Battaglia, T. A. (2014). Challenges in the delivery of quality breast cancer care: Initiation of adjuvant hormone therapy at an urban safety net hospital. Journal of Oncology Practice, 10(2), e107-e112.

Denlinger, C. S., & Barsevick, A. M. (2009). The challenges of colorectal cancer survivorship. Journal of the National Comprehensive Cancer Network, 7(8), 883-894.

Eheman, C., Henley, S. J., Ballard‐Barbash, R., Jacobs, E. J., Schymura, M. J., Noone, A. M., ... & Edwards, B. K. (2012). Annual report to the nation on the status of cancer, 1975‐2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer, 118(9), 2338–2366.

Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522-541.

El‐Shami, K., Oeffinger, K. C., Erb, N. L., Willis, A., Bretsch, J. K., Pratt‐Chapman, M. L., ... & Cowens‐Alvarado, R. L. (2015). American Cancer Society colorectal cancer survivorship care guidelines. CA: A Cancer Journal for Clinicians, 65(6), 427–455.

Farraye, F. A., Wong, M., Hurwitz, S., Puleo, E., Emmons, K., Wallace, M. B., & Fletcher, R. H. (2004). Barriers to endoscopic colorectal cancer screening: Are women different from men? Official Journal of the American College of Gastroenterology, 99(2), 341–349.

Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., ... & Bray, F. (2015). Cancer incidence and mortality worldwide: Sources, methods, and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), E359-E386.

Fife, B. L., & Wright, E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health and Social Behavior, 50–67.

Fujisawa, D., & Hagiwara, N. (2015). Cancer stigma and its health consequences. Current Breast Cancer Reports, 7, 143-150.

Goffman, E. (2009). Stigma: Notes on the management of spoiled identity. Simon and Schuster.

Gonzalez, B. D., Jim, H. S., Cessna, J. M., Small, B. J., Sutton, S. K., & Jacobsen, P. B. (2015). Concealment of lung cancer diagnosis: Prevalence and correlates. Psycho‐Oncology, 24(12), 1774-1783.

Gonzalez‐Saenz de Tejada, M., Bilbao, A., Baré, M., Briones, E., Sarasqueta, C., Quintana, J. M., ... & CARESS‐CCR Group. (2017). Association between social support, functional status, and change in health‐related quality of life and changes in anxiety and depression in colorectal cancer patients. Psycho‐Oncology, 26(9), 1263-1269.

Greer, J. A., & Pirl, W. F. (2014). Psychological management of cancer survivors. Journal of Clinical Oncology, 32(13), 1397–1405.

Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology and Health, 18(2), 141–184.

Hall, N., Birt, L., Banks, J., Emery, J., Mills, K., Johnson, M., ... & Walter, F. M. (2015). Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: A qualitative study. BMJ Open, 5(10), e008448.

Hamann, H. A., Ostroff, J. S., Marks, E. G., Gerber, D. E., Schiller, J. H., & Lee, S. J. C. (2014). Stigma among patients with lung cancer: A patient‐reported measurement model. Psycho‐Oncology, 23(1), 81-92.

Hannon, P. A., Fernandez, M. E., Williams, R. S., Mullen, P. D., Escoffery, C., Kreuter, M. W., ... & Bowen, D. J. (2010). Cancer control planners' perceptions and use of evidence-based programs. Journal of Public Health Management and Practice, 16(3), E1-E8.

Harding, R., & Higginson, I. J. (2003). What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliative Medicine, 17(1), 63–74.

Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine, 11(3), 353-363.

Howell, D., Molloy, S., Wilkinson, K., Green, E., Orchard, K., Courtens, K., & Liberty, J. (2015). Patient-reported outcomes in routine cancer clinical practice: A scoping review of use, impact on health outcomes, and implementation factors. Annals of Oncology, 26(9), 1846-1858.

Husson, O., Mols, F., & Van de Poll-Franse, L. V. (2011). The relation between information provision and health-related quality of life, anxiety, and depression among cancer survivors: A systematic review. Annals of Oncology, 22(4), 761-772.

Jakobsson, S., Ekman, T., & Ahlberg, K. (2008, July). Components that influence assessment and management of cancer-related symptoms: An interdisciplinary perspective. In Oncology Nursing Forum (Vol. 35, No. 4).

Jones, L. W., & Demark-Wahnefried, W. (2006). Diet, exercise, and complementary therapies after primary treatment for cancer. The Lancet Oncology, 7(12), 1017-1026.

Kaptein, A. A., Yamaoka, K., Snoei, L., Kobayashi, K., Uchida, Y., van der Kloot, W. A., ... & Rabe, K. (2011). Illness perceptions and quality of life in Japanese and Dutch patients with non-small-cell lung cancer. Lung Cancer, 72(3), 384-390.

Kass, N. E., Medley, A. M., Natowicz, M. R., Hull, S. C., Faden, R. R., Plantinga, L., & Gostin, L. O. (2007). Access to health insurance: Experiences and attitudes of those with genetic versus non‐genetic medical conditions. American Journal of Medical Genetics Part A, 143(7), 707–717.

Katz, I. T., Ryu, A. E., Onuegbu, A. G., Psaros, C., Weiser, S. D., Bangsberg, D. R., & Tsai, A. C. (2013). Impact of HIV‐related stigma on treatment adherence: Systematic review and meta‐synthesis. Journal of the International AIDS Society, 16, 18640.

Kent, E. E., Forsythe, L. P., Yabroff, K. R., Weaver, K. E., de Moor, J. S., Rodriguez, J. L., & Rowland, J. H. (2013). Are survivors who report cancer‐related financial problems more likely to forgo or delay medical care? Cancer, 119(20), 3710–3717.

Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., ... & Wang, P. S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36(6 Pt 1), 987.

Knapp, S., Marziliano, A., & Moyer, A. (2014). Identity threat and stigma in cancer patients. Health Psychology Open, 1(1), 2055102914552281.

Lam, W. W., & Fielding, R. (2003). The evolving experience of illness for Chinese women with breast cancer: A qualitative study. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 12(2), 127–140.

Lebel, S., & Devins, G. M. (2008). Stigma in cancer patients whose behavior may have contributed to their disease. Future Oncology, 4(5), 717–733.

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385.

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161.

Major, B., & O'Brien, L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393-421.

Marlow, L. A., Waller, J., & Wardle, J. (2010). Variation in blame attributions across different cancer types. Cancer Epidemiology, Biomarkers & Prevention, 19(7), 1799-1805.

Mawar, L., Rahmadi, M. A., Nasution, H., Dewi, I. S., Nasution, R., & Sari, M. (2024). Efek Stres terhadap Pengobatan Asma. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 86-112.

Mawar, L., Rahmadi, M. A., Nasution, H., Sihombing, N., Nasution, R., & Sari, M. (2024). Peran Kecerdasan Emosional dalam Pengobatan Cystic Fibrosis. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 60-90.

Mehnert, A., & Koch, U. (2007). Prevalence of acute and post‐traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: A prospective study. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 16(3), 181-188.

Mosher, C. E., & Danoff-Burg, S. (2007). Death anxiety and cancer-related stigma: A terror management analysis. Death Studies, 31(10), 885–907.

Nasution, H., Rahmadi, M. A., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Peran Kepuasan Hidup dalam Pengelolaan Penyakit Systemic Sclerosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 195-224.

Nasution, H., Rahmadi, M. A., Mawar, L., Sihombing, N., Nasution, R., & Sari, M. (2024). Hubungan Dukungan Sosial dalam Pengobatan Sklerosis Multipel. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 121-151.

Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Pengaruh Intervensi Emosi Positif pada Pengobatan Fibromyalgia. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 277-302.

Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Hubungan antara Perasaan Bersalah dan Keberhasilan Pengobatan Lupus. An-Najat, 2(4), 179-206.

Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133(2), 328.

Park, C. L., Edmondson, D., Fenster, J. R., & Blank, T. O. (2008). Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Journal of Consulting and Clinical Psychology, 76(5), 863.

Quinn, D. M., & Chaudoir, S. R. (2015). Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Psychology of Stigma, 20(1), 31-59.

Rahmadi, M. A., Nasution, H., Mawa, L., Nasution, R., & Sari, M. (2024). Peran Harapan dalam Kepatuhan Pengobatan Kanker Kolorektal. OBAT: Jurnal Riset Ilmu Farmasi dan Kesehatan, 2(6), 38-64.

Rahmadi, M. A., Nasution, H., Mawar, L., & Sari, M. (2024). Pengaruh Kecemasan Terhadap Kepatuhan Pengobatan Kanker Payudara. Jurnal Medika Nusantara, 2(3), 325-350.

Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Hubungan Motivasi terhadap Keberhasilan Pengobatan Endometriosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 225-253.

Rao, D., Choi, S. W., Victorson, D., Bode, R., Peterman, A., Heinemann, A., & Cella, D. (2009). Measuring stigma across neurological conditions: The development of the stigma scale for chronic illness (SSCI). Quality of Life Research, 18, 585–595.

Scheff, T. J. (2017). Being mentally ill: A sociological study. Routledge.

Stuber, J., Meyer, I., & Link, B. (2008). Stigma, prejudice, discrimination, and health. Social Science & Medicine, 67(3), 351-357.