Aim
It has been proposed that stigma and nihilism surrounding lung cancer may influence lung cancer outcomes. A clear understanding of the impact of lung cancer related stigma and nihilism from the perspectives of health professionals and consumers will assist in informing best practice lung cancer care and health promotion messages in Australia.

Method
Phase 1: A systematic literature review examined the evidence on the influence of stigma and nihilism on lung cancer patterns of care; patients' psychosocial and quality of life (QOL) outcomes; and how this may link to public health programs.
Phase 2: The perspectives of health professionals on the impact of stigma and nihilism on diagnosis and disease management were investigated. Semi-structured interviews and a Delphi process with 31 key informants developed a consensus view, which was then tested with 323 health professionals in a national survey.
Phase 3: The perspectives of lung cancer patients and carers on the effects of stigma and nihilism on their cancer experience were investigated through qualitative interviews with 16 patients and 12 carers followed by a cross-sectional survey with 147 lung cancer patients in QLD and NSW.

Results
Each study phase supported the view that health-related stigma is a part of the lung cancer experience in Australia. Health professionals’ reported health-related stigma and the need for positive messaging about lung cancer and smoking cessation as priorities for action. Geographical barriers to access and a lack of rural/regional services were also described by health professionals. Patients and carers consistently described perceptions of stigma. High levels of psychological distress in patients were evident with health-related stigma significantly related to poorer psychological outcomes.

Conclusion
This research builds the evidence about factors influencing lung cancer outcomes in Australia and will provide a foundation for strategies to address the effects of stigma on patients and carers.