Cancer stigma in low- and middle-income countries: A scoping review of frameworks, measurement approaches, and interventions.

Abstract

1590 Background: The incidence and mortality rates of cancer are rising fastest in low- and middle-income countries (LMICs). While cancer early detection and treatment are increasingly available in LMICs, several care barriers contribute to persistent disparities in survival outcomes. One identified barrier is stigma regarding cancer and its treatment approaches. However, there is limited literature on validated measurement tools for cancer stigma and interventions to address this stigma in LMICs. Methods: A systematic search of six electronic databases (OVID Medline, Embase, Web of Science, EBSCO: Africa-Wide Information, EBSCO: Global Health, and WHO Global Index Medicus/ African Index) was performed on August 17, 2023, and updated on November 20, 2025. Two reviewers independently screened 3174 titles/abstracts and 425 full-text articles. Three researchers extracted data from 129 eligible articles following sufficient agreement on pilot testing. The findings were synthesized using descriptive statistics and content analysis based on the Health Stigma and Discrimination framework. Results: Of the 129 articles, the study types included: cross-sectional surveys (109, 84%), randomized controlled trials (9, 7%), prospective cohorts with an intervention (9, 7%), one prospective cohort with no intervention, and one retrospective study. The studies were from 30 LMICs, with the plurality from China (59, 46%), followed by Turkey (12, 9%) and Kenya (10, 8%). Many studies focused on general cancer stigma (rather than a particular type of cancer) (34, 26%) and involved patients with cancer (90, 70%) or the general community (22, 17%). The studies commonly assessed stigma at the individual (113, 88%) and interpersonal (97, 75%) socio-ecological levels. 126 (98%) studies included a quantitative cancer stigma measurement tool, with the most common established tools being the Social Impact Scale (SIS, 33, 26%) and the Cancer Stigma Scale (CASS, 13, 10%). However, many used other adapted cancer stigma or HIV stigma scales. 41 (33%) studies were validation studies of a tool in the local context, 58 (46%) used previously validated tools, and 27 (21%) did not mention local validation. There were 18 studies with interventions, most of which focused on educational approaches, and 15 (83%) were published since 2021. Conclusions: This review demonstrates a wide variation in tools and validation practices in studies measuring cancer stigma in LMICs. Effective comprehensive interventions remain lacking and should be the focus of future studies.