Quitting smoking after a cancer diagnosis is associated with reductions in stigma and anxiety: A longitudinal mediation analysis.

Abstract

Internalized cancer stigma is high among cancer patients who smoke, but it is unknown whether the experience of stigma changes after quitting smoking post-diagnosis. Using data from an RCT of tobacco treatment, we conducted a secondary data analysis and hypothesized that 1) cancer patients who quit smoking would report greater reductions in internalized cancer stigma, compared to patients who did not quit and that 2) greater reductions in stigma would significantly mediate the relationship between smoking abstinence and subsequent decreases in anxiety and depressive symptoms. Participants (n=303; 56.1% female) were adults recruited from two comprehensive cancer centers who had smoked in the past 30 days, spoke English or Spanish, and were being treated for a recent diagnosis of cancer. Participants completed questionnaires at baseline, 3-month follow-up, and 6-month follow-up, and biochemically verified smoking abstinence was determined by participants' salivary cotinine or carbon monoxide levels. Smoking abstinence at 3-month follow-up was significantly associated with reductions in cancer-related stigma from baseline to 3-month follow-up (b = -1.50, p < .001), controlling for sociodemographic and medical covariates. Additionally, reductions in stigma were associated with reductions in anxiety at 6-month follow-up (b = 0.28, p < .05), but not depressive symptoms. Reductions in stigma significantly mediated the relationship between smoking abstinence and decreased anxiety (indirect effect = -0.42, p < .05), but not depressive symptoms. Smoking cessation may be associated with reduction in internalized cancer stigma. Thus, in addition to benefits for medical outcomes, quitting smoking post-diagnosis may improve psychosocial well-being.