When Michelle Vacca, 58, was diagnosed with non-small-cell lung cancer (NSCLC) 8 years ago, she was stunned by the reactions of those around her.
“The first statement out of everyone’s mouth was, ‘I didn’t know you smoked,’” said Vacca, an office manager in Orange County, California. “I didn’t, but that’s not the point. It felt like they were looking for an excuse to blame me.”
When you’re diagnosed with lung cancer, you may experience a range of emotions — overwhelm, fear, anger — and sometimes self-blame.
“There’s such a human desire to have a cause and effect, and to be able to identify what you did, or what you could have done differently,” says Barbara Mitchell, a senior licensed clinical social worker (LCSW) at Memorial Sloan Kettering Cancer Center in New York City, who works mainly with patients who have lung cancer.
But these attitudes can create barriers to healing. Research shows self-blame in patients with lung cancer can lead to anxiety and depression, and sometimes thoughts of suicide.
Here’s a closer look at why self-blame is common when it comes to NSCLC, why it’s harmful, and how to work through it so you can focus on your healing and well-being.
“Did You Smoke?”
At first, this may sound like a fair question. After all, more than 80% of women and about 90% of men recently diagnosed with lung cancer are current or former smokers.
But these three words often open a flood of emotions, including self-blame. “It can really create a downward spiral for patients. Rather than focusing on managing symptoms and going through treatment, they get stuck and ask themselves what they could’ve done differently,” says Mitchell.
The question may come out of self-protection and fear. “The person who asks the question wants to reassure themselves they’re not at risk. That since they’re not a smoker, they won’t develop lung cancer,” she says.
Vacca understands why. “It scares them. They don’t want it to happen to them, and they look for any reason why they don’t have to worry. But I’m brutally straight with them. I explain that I don’t have any risk factors, and that if a diagnosis of NSCLC could happen to me, it could happen to anybody.”
Whether you never smoked, quit 30 years ago, or continue to this day, you’re at risk. “If you have lungs, you can develop lung cancer,” says Mitchell.
Debunking the Stigma
There can be a lot of stigma surrounding a lung cancer diagnosis. Research shows that about 70% of patients with lung cancer experience stigma, whether from family, friends or even health care providers.
“There’s this assumption that since lung cancer is often caused by smoking, it’s the patient’s fault,” says Mitchell.
But up to 20% of people with lung cancer never smoked.
Here are some other factors that may make you more likely to develop NSCLC:
- Being exposed to radon. This is the second leading cause of lung cancer. Radon is a colorless, odorless gas found in soil that can seep into your home. People who smoke and are also exposed to radon are at a significantly higher risk of developing lung cancer.
- Taking in secondhand smoke.
- Being around dangerous chemicals such as asbestos, uranium, arsenic, cadmium, chromium, and nickel.
- Breathing in particle pollution. This is a mix of tiny solid and liquid particles found in tailpipe exhaust and wildfire smoke.
- Having certain genes. Your genetics may make you more likely to develop lung cancer. If a family member has or has had lung cancer, you may be at a higher risk.
The average age of lung cancer diagnosis is 70. “Many people in their 60s and 70s grew up during a time when people weren’t as aware of the dangers of smoking,” says Mitchell. In 1964, almost half of American adults smoked. The first official warning of smoking dangers wasn’t published until later that year. Smoking rates didn’t begin to significantly decline until the 1970s, and state smoking bans didn’t really take off until the 1990s.
“Smoking is very addictive,” says Mitchell. “Some older patients may have tried to stop once they learned of its dangers, but struggled to.”
Self-Blame and Lung Cancer
Cancer is scary. It can be hard to understand why you have it, which makes it easy to self-blame. “We live in a culture that assumes we have 100% control over everything we do,” explains Emaan Lehardy, PhD, a psychologist at the Dan L Duncan Comprehensive Cancer Center at the Baylor College of Medicine in Houston, Texas.
Public health education efforts about the dangers of smoking have helped millions of people quit. But they’ve also added to stigma about lung cancer. “Since we’ve identified lung cancer so much with smoking, people who go on to develop it often feel a deep sense of personal responsibility,” says Lehardy. “This is true even if they quit smoking years ago, or if they never smoked.”
These feelings can negatively affect your lung cancer treatment and your quality of life. Research shows patients with lung cancer are less likely to seek out medical help when they need it.
Stigma and self-blame are also linked to greater rates of depression, anxiety, distress, and an overall poorer quality of life. “If you blame yourself, you’re less likely to advocate for yourself, which can lead to poorer disease outcomes,” says Lehardy.
How to work through self-blame
Self-blame for lung cancer isn’t easy to deal with. But it must be addressed so you can focus on things that positively affect your health, such as managing your treatment. Here are some tips to help:
Create a script. Every time someone asks if you smoke, Mitchell recommends you reply with the same crafted response. She suggests one of the two options:
- “My medical team told me that not all smokers are diagnosed with lung cancer, and not all patients with lung cancer are smokers.”
- “No one knows why I got lung cancer, so I’ve chosen not to focus on the why, but on my treatment and care.”
Whichever statement you choose, end with a positive request: “I know I’ll need your support as I go through treatment.”
Don’t tailor your response to a specific person or group of people. “Make it one and done, so you can move on,” says Mitchell. “The goal is to shift the conversation focus from what makes the other person feel better, to what you need.”
Consider cognitive behavior therapy (CBT). This talk therapy is especially helpful for patients with cancer. The goal is to target your automatic thoughts and feelings, like self-blame, that can harm your mental health. In one type of CBT, called acceptance and commitment therapy (ACT), you use mindfulness to acknowledge negative thoughts like self-blame. It’s been shown to help reduce feelings of stigma in patients with lung cancer.
Give yourself grace. The first step in stopping self-blame is to be aware when you’re critical of yourself. “Often, we don’t even realize how harsh we can be towards ourselves,” says Lehardy. “I encourage patients to think about what they might tell a friend in the exact same situation. Then speak to yourself in that same gentle voice.”
The Power of Community
Support groups are a great way to connect with others who struggle with similar feelings of self-blame or who’ve had similar experiences. “It can be very validating to be in the same room, or on the same Zoom call with a group of people who’ve all been asked blaming questions like, 'Do you smoke?’” says Mitchell.
Even though Vacca never smoked, she still worried she’d done something to cause her lung cancer. It helped her to talk about her concerns with her medical team, who offered reassurance.
“They explained that sometimes a lung cancer diagnosis happens by chance—it can happen to anyone,” she says. “They stressed that it was important to focus instead on things I could control, like finding ways to reduce stress and live a healthier life.” Vacca says it helped to look for things that brought her joy and eased stress, such as concerts.
“At one point, I had to step away from a lung cancer volunteer group I was passionate about, because I felt like I was focusing too much on others and not on me,” she says. “That’s why it’s so important to put up boundaries when people ask questions that imply you’re to blame for your cancer. It just causes more anxiety for you, and makes life even harder.”
Practice Self-compassion
Being kind and understanding toward yourself is very important when you have NSCLC. It’s been shown to help reduce feelings of self-blame and symptoms of depression.
A therapist can help you learn ways to practice self-compassion. Here are some exercises you can do on your own.
Guided imagery
In this relaxation technique, your imagination guides you through stress. “It’s particularly helpful when you’re ‘stuck’ in feelings of self-blame because they help distract you while also calming your body and mind,” says Mitchell.
The Memorial Sloan Kettering Cancer Center has guided imagery exercises on its website, where they coach you through picturing a day at the beach or in a grassy meadow. You can find them here.
Kindness meditations
These focus on sending feelings of kindness to yourself and others. “They allow you to become more self-aware, which in turn means that you recognize and reformulate thoughts of self-blame,” says Claire Conley, PhD, an assistant professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center in Washington, D.C. They’re easy to do when you walk, she says.
Choose a person who’s been kind and supportive, like a family member, friend, or coworker. Then visualize them as being in front of you, smiling. Imagine them wishing you to be happy and beaming this toward you as you take deep breaths in and out.
As these feelings of warmth wash over your body, relax into them.
Letter to yourself
Pretend it’s from a close friend. Imagine what they’d say to you about your cancer diagnosis. “It encourages you to talk to yourself from a place of kindness, not self-blame,” says Conley. “Over time, you’ll feel more comfortable being compassionate to yourself.”
As you become more comfortable, you can graduate to a self-compassion journal, where you jot down daily thoughts, emotions, and feelings, and try to reframe them in a positive way.
