Tackling Cancer-Related Stigma Through Education, Language, and Compassionate Care With Gretchen McNally, PhD, MPH, ANP-BC, AOCNP®

Defining Stigma

Dr. McNally’s presentation, developed with colleagues Lisa Carter-Bawa and Carey Ramirez, began with a real-life case study from lung cancer care. A patient overheard negative assumptions about her smoking status at the nurses’ station, setting the stage for a discussion on how stigma can begin at the very first point of care. “Stigma is complex. There can be intersectional stigmas—say race, gender, age, disease or health–related stigma—all different kinds of stigma,” Dr. McNally noted. She emphasized that stigma is multilevel, including internalized (self-stigma), public (perceived stigma), and intersectional forms that combine multiple identities or conditions.

The Impact of Stigma Across the Cancer Continuum

Stigma is not just a social phenomenon; it is a recognized barrier to care at every stage of the cancer journey. “Stigma, embarrassment, and fear can keep people from receiving preventative testing or other things,” Dr. McNally said. She described how stigma can delay presentation for care, reduce engagement with recommended treatments, and even affect survivorship and employment. “Clinicians can also have stigma, and their stigma may keep them from offering high-level, high-quality care to the patient,” she warned.

Dr. McNally shared a personal example: her mother’s experience with lung cancer. “She was afraid of stigma. She had seen family members get cancer and need a lot of care and not able to be active, and she didn’t really see as many success stories, and that was a barrier to her presenting for care and getting diagnosed.” This story illustrated how stigma can be a powerful deterrent, even for those with knowledge of the healthcare system.

Awareness, Education, and Language

For oncology professionals, self-awareness and education are essential tools in combating stigma. “Be aware that you may have that bias or stigma against something. Education is one of the best things to help decrease stigma,” Dr. McNally advised. She highlighted the critical role of language: “Language impacts the way you think, feel, and act, and the words you use are really important. They can influence the care that you provide.” Research in addiction medicine shows that even highly trained clinicians may unconsciously adopt stigmatizing attitudes based on the terminology they use, which can affect treatment decisions and patient outcomes.

Media Portrayal and Public Perception

Dr. McNally discussed how media representations of cancer often reinforce negative stereotypes. Citing a 2024 article by David Benjamin and colleagues, she observed, “People see characters in movies portrayed with cancers, and they start to think that’s really what it’s like to have cancer—all cancer is the same—not recognizing that there are so many differences.” The media’s focus on suffering and death, rather than survivorship and hope, perpetuates stigma and fear, making it harder for patients to seek care and for the public to understand the diversity of cancer experiences.

Eliminating the “But” Statement: Compassion Over Blame

A central message from Dr. McNally’s presentation was the need to eliminate the “but” statement when discussing cancer diagnoses. “You hear, ‘Oh, my mom died lung cancer,’ and then there’s often this ‘but’ statement. ‘My mom died from lung cancer, but she smoked cigarettes,’ That ‘but’ statement makes it seem like that’s okay, like yes, she smoked cigarettes, so it’s okay that she got lung cancer, right? She knew better. I really don’t like that attitude or that blaming.” She urged clinicians to provide compassionate care without judgment or blame, regardless of perceived risk factors.

The Unique Role of Oncology Nurses

Dr. McNally celebrated the unique position of nurses in combating stigma: “Nurses are the number one trusted profession. They’re the ones caring for people. They’re the ones that patients are comfortable asking questions to about side effects that they’re having, so nursing is really an art. It takes skill required to treat something, and then it delivers the skill compassionately.” She also highlighted the importance of nursing research in addressing non-medical barriers to care, such as stigma.

Key Takeaways for Oncology Professionals

• Stigma is a multilevel, intersectional barrier that affects prevention, diagnosis, treatment, and survivorship in cancer care
• Clinicians must be aware of their own biases and the impact of language on patient care
• Media portrayals often reinforce negative stereotypes; more positive stories are needed
• Compassionate, nonjudgmental care is essential—eliminate the “but” statement and focus on the patient’s needs
• Nurses play a critical role in building trust, providing support, and advancing research to address stigma

About Dr. McNally

Gretchen McNally, PhD, MPH, ANP-BC, AOCNP®, is a Hematology Nurse Practitioner at The Ohio State University (OSU) Comprehensive Cancer Center and The James Cancer Hospital. She received her Doctorate in Nursing from OSU and has been a member of the hematology team at The James Cancer Hospital since 2007. Dr. McNally specializes in the care and treatment of patients with lymphomas, and she is passionate about reducing cancer stigma and providing high-quality, personalized care to her patients.