Gregory A. Masters, MD, is an attending physician at the Helen F. Graham Cancer Center and serves as an associate professor at the Thomas Jefferson University Medical School. Dr Masters is a lung cancer specialist, and also has interest in esophageal, gastrointestinal, head and neck cancers, thoracic oncology, and palliative care. He believes addressing the stigmatization many patients with lung cancer experience is an important component of care.

How do you think oncologists can address the problem of stigmatization of patients with lung cancer?

Dr Masters: I think as oncologists we see many patients who have contributed to the development of cancer with various activities – mainly smoking – so we do have to confront that and recognize that sometimes cancers are at least in part related to behaviors that could have been avoidable.

I think most patients understand that smoking is the main cause of lung cancer, and if they’ve been smokers they probably feel some of that guilt. At the same time each patient is going to deal with that differently. I certainly see plenty of patients who try to avoid that responsibility and look for other causes.

Rather than assign any blame I just try to be as factual as I can. If a patient who has been a heavy smoker with lung cancer comes in, I say “Yes, this is probably related to smoking.” On the other hand, you can’t undo what’s already done, so I try to emphasize that.

Sometimes it can be relieving to patients to understand that we can’t undo what we’ve done in the past, so let’s just deal with the problem today.

Do you think there’s a degree to which helping patients deal with their own responsibility can impact their quality of life?

Dr Masters: Yes. One of the biggest things that we see in people with cancer, especially more advanced cancer, is that they feel they’ve lost control and that they don’t have any power to change anything.

That’s a very debilitating feeling emotionally, and so if you can get people to take some responsibility for the things that they can change, they often find that uplifting, and they feel they’ve done something to help themselves, and that improves quality of life. There’s no question that we can channel that into improving how they function day-to-day and how they feel about themselves.

I try to use that as a motivation to improve their habits and lifestyle. They’re less likely to get pneumonia and more likely to have improvement in their breathing if they quit smoking. If they’ve had an early stage lung cancer, they’re less likely to get a second malignancy if they quit smoking.

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When my patients cut back or quit smoking, they are very proud, because it is one of the toughest things to do. So I try to create something positive that will help the patient physically and emotionally.