We evaluated public attitudes towards cancer survivors and identified the characteristics associated with these attitudes in Korea.
We performed this cross-sectional study using proportionate quota random sampling of the 2015 Korean Census. In May 2017, investigators conducted face-to-face interviews with 1,500 Korean volunteers aged between 20 and 79 years. The questionnaire recorded sociodemographic factors, smoking and drinking habits, cancer history in family and acquaintances, interest in cancer survivors, cancer-survivor blame, and attitudes towards cancer survivors.
Many participants had negative attitudes towards cancer survivors. People with a monthly household income above US $7,000 were less likely to have a negative attitude than those with monthly incomes below US $1,499. People in their 70s, without a religion, living in rural areas, smokers, or those who blame cancer survivors for their own cancer were more likely to have a negative attitude than people outside these categories. People interested in cancer survivors were less likely to have a negative attitude than those who were not interested.
To improve attitudes towards cancer survivors, it will be necessary to increase interest in cancer survivors through education, publicity, and advocacy using strategic messaging that focuses on social and institutional aspects and emphasizes that responsibility for cancer should not be attributed to cancer patients. Inducing the public to be interested in cancer survivors will be important for positive attitudes toward cancer survivors.
There were an estimated 14 million patients a year worldwide with cancer in 2012, and cancer incidence is projected to increase by 50% to 21.6 million patients a year by 2030 [
Cancer survivors need initial support from people close to them to successfully cope with their diagnosis and treatment as well as continual support to improve their quality of life after treatment. Patients tend to disclose their cancer diagnosis when they perceive themselves to be part of a supportive social network [
An increasing number of cancer prevention campaigns supported by well-established theories about healthy behaviors have improved public health communication, leading to increased public awareness about the lifestyle risk factors related to cancer [
Cancer survivors’ perception of stigma, blame, and other negative reactions can lead to self-blame, shame, and fear of discrimination. In turn, these can cause medical and psychosocial problems in cancer survivors and contribute to insufficient patient-clinician communication, distress, depression, physical and emotional maladjustment, reduced treatment adherence, and a poor quality of life [
In Korea, the 5-year relative cancer survival rate has increased remarkably from 41.2% in 1993-1995 to 70.7% in 2011-2015, with 1.61 million cancer survivors in 2015 [
The problems of cancer survivors are probably worsened by negative perceptions and prejudices formed by the general public about cancer survivors. Therefore, our objective in this study was to evaluate public attitudes towards cancer survivors and identify the characteristics associated with these attitudes in Korea.
Our goal was to survey 1,500 members of the general public in Korea who were between 20-79 years old and had no immediate personal experience of cancer. Initially, we stratified samples by age and sex for each of the 17 administrative districts (cities and provinces) based on the 2015 Korean Census, then obtained the sample size using a probability proportional to size method. Of the randomly selected 2,190 responders who were telephoned, we excluded 690 responders from the interview due to absence, refusal to participate for various reasons, or because the responder was a cancer patient. Finally, a total of 1,500 participants were interviewed (response rate, 68.5%), and face-to-face interviews were conducted by professional interviewers from the Metrix Corporation (Seoul, Korea) in May 2017. Our researchers carefully reviewed and monitored the interview process.
We used eight questions developed by Cho et al. [
Interest in cancer survivors was assessed by participants’ response to the question “How much interest do you generally have in the cancer survivor problem?” This item was measured using a 5-point Likert scale ranging from 1 (not interested at all) to 5 (very interested). We combined “not interested at all” with “almost not interested” responses to form a “lowly interested” category and combined “very interested” with “mostly interested” to form a “highly interested” category. Cancer-survivor blame was measured by participants’ response to the yes/no question “Are cancer survivors responsible for their cancer?” This item was developed from previous studies [
We also considered other variables, including sex, age, education, monthly household income, marital status, religion, employment, residential area, smoking and drinking habits, as well as cancer history of family and acquaintances. Education level was classified into three categories: less than middle school education, high school graduate, and college graduate or higher. Monthly household income was classified into four categories: ≤ $1,499, $1,500-$3,999, $4,000-$6,999, and ≥ $7,000. These cut-off points are the quartiles of monthly household income in Korea [
We used descriptive statistics to summarize attitudes towards cancer survivors. A multivariate logistic regression analysis determined the adjusted odds ratios (aORs) for relationships between a negative attitude towards cancer survivors and sex, age, education, monthly household income, marital status, religion, occupation, residential area, smoking, drinking, cancer history in family or acquaintances, interest in cancer survivors, and cancer survivor blame. We performed all analyses using SAS ver. 9.4 (SAS Institute Inc., Cary, NC).
We obtained written consent from all respondents after informing them that completion of the survey was voluntary, anonymous, and confidential. The study protocol was approved by the Institute Review Board at the National Cancer Center (NCC2017-0109). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
In this study, 50.3% of participants were male, 12.4% of participants had less than a middle school education, 38.7% had a high school education, and 48.9% had a college education or higher. For monthly household income, 17.7% of participants earned below US $1,499 and 7.0% earned above US $7,000. We found that 72.1% of participants were married people, 5.3% were divorced/separated/widowed, and 22.6% were single; 46.3% of participants had a religion; 29.3% of participants were white-collar workers; 20.0% of participants lived in the capital city, and 54.5% lived in rural regions. Smokers were 27.2% and drinkers were 76.5% of participants. There was history of cancer for family or acquaintances in 54.5% of participants. The proportion of people who were highly interested in cancer survivors was 40.8%, and 49.7% of participants attributed some blame for cancer to cancer survivors (
The proportion of participants who agreed or strongly agreed that cancer survivors are easily recognized by their looks was 42.2%. We found that 51.8% agreed or strongly agreed that cancer survivors would have a difficult time having sexual intimacy, 77.2% agreed or strongly agreed that cancer survivors deserve to be protected in society, and 22.9% agreed or strongly agreed that cancer survivors would not be able to contribute to society. Additionally, 40.4% of participants agreed or strongly agreed that they felt uncomfortable when in the presence of cancer survivors, 28.1% agreed or strongly agreed that they tended to avoid interacting with neighbors who are cancer survivors, 63.2% agreed or strongly agreed that they would avoid marrying people with cancer-survivor family members, and 30.9% agreed or strongly agreed that they would avoid working with cancer survivors (
This study evaluated public attitudes towards cancer survivors and identified the public attitude associations in the Korean population. Many participants had negative attitudes about cancer survivors, including stereotyped, discriminatory, and prejudiced views. People with a monthly household income above US $7,000 were less likely to have a negative attitude than those with monthly incomes below US $1,499. People in their 70s, who had no a religion, who lived in rural areas, or smoked were more likely to have a negative attitude towards cancer survivors than those who did not fall into these categories. People who have interest in cancer survivors were less likely to have a negative attitude than those who were not interested. People who hold cancer survivors responsible for their own cancer were more likely to have a negative attitude than those who did not.
A lot of study participants had negative attitudes towards cancer survivors. These results are worse than those from a previous study conducted with the same questionnaire in Korea [
Participants who earned more than US $7,000 in monthly household income were less likely to have a negative attitude to cancer survivors than those who earn less than US $1,499, and people in their 70s, individuals without a religion, and rural residents were more likely to have a negative attitude towards cancer survivors than their 20s, respondents with a religion, and those who live in capital city. Our results regarding the effects of age, income, and city versus rural areas are consistent with previous studies that found a higher frequency of negative perceptions about cancer survivors returning to work among people in rural or urban areas than in metropolitan areas [
Nonsmokers were less likely to have negative attitudes towards cancer survivors. Some studies have found that happiness is related to non-smoking [
People with interest in cancer survivors were less likely to have a negative attitude towards them. Interest, as part of the affective dimensions, has a strong influence on learning and is often associated with positive emotions and curiosity [
People who blame cancer survivors for their cancer were more likely to have a negative attitude towards cancer survivors than those who do not. Several studies have shown that respondents who attribute some blame to someone with cancer were discriminatory and held stereotyped views [
This study had several limitations. Respondents may have reported a more positive attitude towards cancer survivors because of social desirability, rather than as a true reflection of their attitude. This would result in an underestimation of the negative attitude towards cancer survivors. In addition, this study focuses on survivors of all cancer types; thus, it is difficult to rule out any differences in attitudes towards different cancer types. The reaction to someone with cancer may depend on the ability to control or prevent the disease. Cancers caused by modifiable lifestyle factors may cause more negative reactions than other types. Therefore, future studies should explore public attitudes towards cancer survivors according to different cancer types.
In summary, we identified negative attitudes towards cancer survivors among Korean adults and characterized some factors related to negative feelings towards cancer survivors. Strategic messaging in education, publicity, and advocacy are required to raise awareness and increase interest in cancer survivors. These activities should highlight social and institutional aspects of cancer, and not transfer the responsibility for disease to cancer patients. Researchers, health care professionals, and communication specialists should work together to build social environments that help cancer survivors get the best treatment and care.
Conflict of interest relevant to this article was not reported.
This study was supported by a grant from the National Cancer Center (1610311) and the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1731920).
Characteristics of study participants
Variable | No. (%) (n=1,500) |
---|---|
Male | 754 (50.3) |
Female | 746 (49.7) |
20-29 | 253 (16.9) |
30-39 | 280 (18.7) |
40-49 | 328 (21.9) |
50-59 | 317 (21.1) |
60-69 | 201 (13.4) |
70-79 | 121 (8.1) |
Middle school graduate or less | 186 (12.4) |
High school graduate | 580 (38.7) |
College graduate or more | 734 (48.9) |
≤ 1,499 | 266 (17.7) |
1,500-3,999 | 646 (43.1) |
4,000-6,999 | 483 (32.2) |
≥ 7,000 | 105 (7.0) |
Married | 1,082 (72.1) |
Divorced/Separated/Widowed | 79 (5.3) |
Single | 339 (22.6) |
Yes | 695 (46.3) |
No | 805 (53.7) |
White-collar | 439 (29.3) |
Blue-collar | 586 (39.1) |
Unemployed | 475 (31.7) |
Seoul (capital city) | 300 (20.0) |
Metropolitan | 383 (25.5) |
Rural | 817 (54.5) |
Yes | 408 (27.2) |
No | 1,092 (72.8) |
Yes | 1,148 (76.5) |
No | 352 (23.5) |
Yes | 818 (54.5) |
No | 682 (45.5) |
Low | 339 (22.6) |
Moderate | 549 (36.6) |
High | 612 (40.8) |
Yes | 746 (49.7) |
No | 754 (50.3) |
Attitudes toward cancer survivors
No. (%) |
Mean±SE |
||||
---|---|---|---|---|---|
Strongly disagree | Disagree | Agree | Strongly agree | ||
Cancer survivors are easily recognized through their looks | 85 (5.7) | 782 (52.1) | 575 (38.3) | 58 (3.9) | 2.40±0.02 |
Cancer survivors would have a difficult time having sexual intimacy | 79 (5.3) | 645 (43.0) | 658 (43.9) | 118 (7.9) | 2.54±0.02 |
Cancer survivors deserve to be protected in society | 17 (1.1) | 325 (21.7) | 936 (62.4) | 222 (14.8) | 2.91±0.02 |
Cancer survivors would not be able to make contributions to society | 176 (11.7) | 980 (65.3) | 323 (21.5) | 21 (1.4) | 2.12±0.02 |
I feel uncomfortable when I am with cancer survivors | 186 (12.4) | 707 (47.1) | 524 (34.9) | 83 (5.5) | 2.34±0.02 |
I tend to avoid interacting with neighbors who are cancer survivors | 188 (12.5) | 890 (59.3) | 371 (24.7) | 51 (3.4) | 2.19±0.02 |
I would avoid marrying people whose family members are cancer survivors | 64 (4.3) | 488 (32.5) | 775 (51.7) | 173 (11.5) | 2.70±0.02 |
I would avoid working with cancer survivors | 182 (12.1) | 854 (56.9) | 420 (28.0) | 44 (2.9) | 2.22±0.02 |
SE, standard error.
A higher mean indicates a higher negative attitude to cancer survivors.
Factors associated with negative attitude toward cancer survivors
Variable | Percent | aOR (95% CI) |
---|---|---|
Male | 9.2 | 1.00 |
Female | 9.0 | 1.49 (0.92-2.40) |
20-29 | 7.5 | 1.00 |
30-39 | 6.4 | 0.99 (0.44-2.21) |
40-49 | 9.5 | 1.92 (0.78-4.74) |
50-59 | 9.1 | 2.11 (0.82-5.37) |
60-69 | 10.9 | 2.76 (0.99-7.63) |
70-79 | 14.0 | 4.11 (1.30-10.97) |
Middle school graduate or less | 12.4 | 1.00 |
High school graduate | 9.7 | 0.82 (0.41-1.64) |
College graduate or more | 7.8 | 0.85 (0.38-1.87) |
≤ 1,499 | 11.1 | 1.00 |
1,500-3,999 | 10.5 | 0.90 (0.65-1.21) |
4,000-6,999 | 9.7 | 0.81 (0.59-1.17) |
≥ 7,000 | 6.7 | 0.59 (0.36-0.94) |
Married | 9.2 | 1.00 |
Divorced/Separated/Widowed | 11.4 | 1.08 (0.47-2.46) |
Single | 8.0 | 1.32 (0.62-2.80) |
Yes | 7.6 | 1.00 |
No | 10.3 | 1.50 (1.02-2.22) |
White-collar | 7.3 | 1.00 |
Blue-collar | 10.2 | 1.19 (0.72-1.98) |
Unemployed | 9.3 | 1.09 (0.60-1.97) |
Seoul (capital city) | 7.8 | 1.00 |
Metropolitan | 10.0 | 1.35 (0.98-1.87) |
Rural | 12.1 | 1.42 (1.07-1.88) |
Yes | 11.5 | 1.00 |
No | 8.2 | 0.58 (0.35-0.95) |
Yes | 9.4 | 1.00 |
No | 8.0 | 0.66 (0.39-1.11) |
Yes | 9.8 | 1.00 |
No | 8.2 | 0.75 (0.51-1.11) |
Low | 12.1 | 1.00 |
Moderate | 9.0 | 0.68 (0.51-0.91) |
High | 5.9 | 0.36 (0.22-0.60) |
No | 7.6 | 1.00 |
Yes | 10.6 | 1.36 (1.09-1.67) |
aOR, adjusted odd ratio; CI, confidence interval.
All variables were adjusted for the logistic regression analyses.