Body image dimensions and cancer: a heuristic cognitive behavioural model

Radiation-induced fibrosis in breast cancer: A protocol for an observational cross-sectional pilot study for personalised risk estimation and objective assessment

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Radiation-induced fibrosis is a side-effect after treatment for breast cancer.

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An important question is the best plan for breast reconstructive surgery.

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Objective measures of radiation-induced fibrosis are needed.

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Patient reported outcome measures will provide a more comprehensive assessment.

Introduction

About 30% of patients request breast reconstruction following surgery for breast cancer, but radiation therapy negatively influences the outcome. Post-reconstruction radiotherapy is associated with more complications, including more severe capsular contracture and inferior cosmetic results. In general, less fibrosis is seen if autologous reconstruction is performed after radiotherapy, so surgeons will often delay reconstruction until after radiotherapy is complete. Drawbacks to this approach include additional surgery, recuperation, cost, and an extended reconstructive process. Randomised clinical trials are required to determine the best approach.

Methods and analysis

The aim of this cross-sectional pilot study is to see if it is feasible to recruit women, and gather the required data. This information will be used to design a subsequent, larger study whose aim is to identify factors that increase the risk of radiation-induced fibrosis, and use these to develop a personalised risk-prediction tool, to enable the clinician and patient to have a more informed discussion when treatment for breast cancer is being discussed. Identification of the risk factors will also enable the development of methods to minimise the risk, which would have applications in other medical conditions where fibrosis is a problem. In addition, the project will develop objective methods of assessing fibrosis, and will determine the psychological and economic impacts that fibrosis has affected individuals. A better understanding of the long-term effects of radiotherapy on normal tissues such as the heart and lungs may also have applications in other medical conditions where fibrosis is a problem.

Ethics and dissemination

The study has been submitted for ethical approval (REC reference). Findings will be made available to patients and clinicians through presentations at national and international meetings, peer-reviewed publications, social media and patient support groups.

Trial registration

Registered on ClinicalTrials.gov (after REC approval).

'I would describe myself as a deformed troll': Using interpretative phenomenological analysis to explore body image struggles among palliative care patients

Background:

Illness adjustment is a widely studied area in the palliative care context. However, research focussing on how altered body image can affect men and women in palliative care is limited and unclear.

Aim:

To explore the links between palliative care patients’ affected sense of self, altered body image and terminal illness adjustment.

Design:

Semi-structured interviews were conducted, and the Interpretative Phenomenological Analysis approach was used to analyse patients’ experiences.

Setting/participants:

English-speaking, adult palliative care outpatients were interviewed at a local community hospice in the United Kingdom. The mean age was 55 years (ranging from 35–65 years).

Results:

Analysis of accounts indicated three superordinate themes: (1) ‘Not being me’: self-discrepancy, (2) existing in the landscape of loss, (3) living and thriving in the landscape of loss. The most disturbing issues, such as appearance-focussed struggles and low body-confidence, were stemming from participants’ frustration over their lack of control and their attachment to their former self-image.

Conclusions:

The patients’ insights demonstrated that body image distress was prevalent among all respondents regardless of gender or diagnosis. A spiral model is described showing how discrepancy-based processing (i.e. ‘not being me’) and rigid attachment to former self can have harmful consequences on palliative patients’ abilities to cope. In order to facilitate adjustment to a self-identity crisis resulting from a terminal diagnosis, it is necessary for professionals to recognise and address body image changes among palliative care outpatients.

eHealth for improving quality of life in breast cancer patients: A systematic review

Breast cancer patients (and survivors) use to deal with important challenges daily, such as coping with stress and depression, and adopting healthy lifestyles in order to improve treatment effectiveness; moreover, some experiential issues are quite specific of this disease, such as sexuality and fertility disfunctions after hormonal therapy, and distortions in body image after breast surgery. Recent literature highlighted the utility of eHealth or the use of new technologies to promote health management and quality of life in chronic diseases generally. The present contribution aims at (1) exploring usage and effectiveness of eHealth resources to improve breast cancer patients/survivors' quality of life, and (2) describing whether existing eHealth interventions addressed specific characteristics of breast cancer, or employed a generic approach only. A systematic literature search according to PRISMA guidelines was performed. Twenty-four studies met inclusion criteria and were included. Discussion highlights a majority of encouraging results about eHealth in breast cancer patients' health management, especially in those interventions featuring eHealth tools for improving patients' abilities (e.g., coping) and complex eHealth systems with multiple resources. However, generic use of eHealth is still predominant over disease-focused solutions. Guidelines for future eHealth research and development are listed in order to promote technology design centered on the lived experience of specific illness.

Body Image of Women Submitted to Breast Cancer Treatment

Background: The study of body image includes the perception of women regarding the physical appearance of their own body. The objective of the present study was to verify the prevalence of body image dissatisfaction and its associated factors in women submitted to breast cancer treatment. Methods: A cross-sectional study carried out with 103 female residents of the municipality of Natal (Northeast Brazil), diagnosed with breast cancer who had undergone cancer treatment for at least 12 months prior to the study, and remained under clinical monitoring. The variable body image was measured through the validated Body Image Scale (BIS). Socioeconomic variables and clinical history were also collected through an individual interview with each participant. The Pearson’s chi-squared test (Fisher’s Exact) was utilized for bivariate analysis, calculating the prevalence ratio with 95% confidence interval. Poisson regression with robust variance was utilized for multivariate analysis. The statistical significance considered was 0.05. Results: The prevalence of body image dissatisfaction was 74.8% CI (65%-82%). Statistically significant associations were observed between body image and multi-professional follow-up (p=0.009) and return to employment after treatment (p=0.022). Conclusion: It was concluded that women who reported employment after cancer treatment presented more alterations in self-perception concerning their appearance. Patients who did not receive multi-professional follow-up reported negative body image, evidencing the need for strategies that increase and improve healthcare, aiming to meet the demands of this population.

Conceptual Issues Surrounding Body Image for Oncology Nurses

Cancer and its treatment can uniquely influence survivors' body image. Oncology nurses should understand how this quality-of-life issue can affect patients. To better understand the body image experiences of patients with cancer, this article will present a historic overview of body image conceptualization, as well as a more contemporary, cancer-specific approach to understanding how this population of patients may be particularly affected.

Factors associated with romantic relationship formation difficulties in women with breast cancer

OBJECTIVE

Many un-partnered women report difficulty in forming romantic relationships after breast cancer, characterized by high dating-related anxiety and low perceived interpersonal competence. This study examined the relationship between poor body image (appearance investment and body dissatisfaction) and self-compassion, and women's ability to form romantic relationships post-breast cancer.

METHODS

Women (N = 152) diagnosed with breast cancer, who were either un-partnered and expressed interest in romantic dating, or who had commenced a relationship post-diagnosis, completed an online survey. Assessments included the Interpersonal Competence Questionnaire, Dating Anxiety Scale, Self-compassion Scale, Appearance Schemas Inventory-Revised, Body Image Scale, and Experiences in Close Relationships Scale. Multiple regression analyses assessed the relationships between these variables.

RESULTS

Partnered and un-partnered women differed in levels of dating anxiety, interpersonal competence, anxious attachment, and the self-evaluative salience facet of appearance investment. Analyses revealed a significant model for dating anxiety, with high self-evaluative salience, body image dissatisfaction, and attachment avoidance independently associated with this outcome. The model for interpersonal competence was also significant, with low attachment avoidance and high self-compassion independently associated with this outcome.

CONCLUSIONS

Un-partnered women who place high importance on appearance for their self-worth and who report poor body image and low self-compassion are at risk of experiencing difficulties in forming new romantic relationships after breast cancer. Future interventions should target these variables to facilitate romantic dating during cancer survivorship.

Restoring Body Image After Cancer (ReBIC): Results of a Randomized Controlled Trial

Purpose This study aimed to test a group psychosocial intervention focused on improving disturbances of body image (BI), sexual functioning, and quality of life in breast cancer (BC) survivors. Methods A prospective, randomized controlled trial was conducted to assess the efficacy of an 8-week group intervention in women after BC treatment. The manual-based intervention combined two powerful ingredients: expressive guided-imagery exercises integrated within a model of group-therapy principles. The intervention facilitates exploration of identity, the development of new self-schemas, and personal growth. In addition, the intervention included an educational component on the social and cultural factors affecting women's self-esteem and BI. The control condition included standard care plus educational reading materials. One hundred ninety-four BC survivors who had expressed concerns about negative BI and/or difficulties with sexual functioning participated in the study; 131 were randomly assigned to the intervention, and 63 were assigned to the control condition. Participants were followed for 1 year. Results Women in the intervention group reported significantly less concern/distress about body appearance ( P < .01), decreased body stigma ( P < .01), and lower level of BC-related concerns ( P < .01), compared with women in the control group. BC-related quality of life was also better in the intervention group compared with the control group at the 1-year follow-up ( P < .01). There was no statistically significant group difference in sexual functioning. Conclusion Restoring Body Image After Cancer (ReBIC), a group intervention using guided imagery within a group-therapy approach, is an effective method for addressing BI-related concerns and quality of life post-BC. The manual-based intervention can be easily adapted to both cancer centers and primary care settings.

Distress from changes in physical appearance and support through information provision in male cancer patients

Objective

This study aims to reveal the present situation of changes in physical appearance induced by treatment, the effects of these changes on social activities, and support from medical staff in male cancer patients.

Methods

A questionnaire survey was administered to 949 male patients (response rate: 90.1%) visiting the National Cancer Center Hospital in Tokyo over 3 days in January 2015.

Results

The final respondents were 823 patients (mean age: 65.3, standard deviation (SD) = 12.32). Fifty-two percent of the sample, and 79.4% of patients aged under 65 were employed. A total of 84.9% experienced changes in physical appearance, and the highest mean scores of psychological were observed for stoma (3.1) and skin eczema (2.9). A total of 66.4% reported no difference in daily life even after their physical appearance changed. However, patients younger than 65 years old who were employed experienced high social difficulties (12.5%). Many wanted to stop going to work and experienced severe distress in their social lives; 74.1% reported it is important to have the same physical appearance at work as before treatment. The majority of patients obtained information from doctors (35.2%) and consulted with their wife or partner (66.2%) regarding their appearance changes, and 5.7% did not have anyone to consult with.

Conclusion

This study clarified important aspects for supporting male cancer patients: timing, content, target audience and steps of information provision. Appropriate information provision from medical staff prior to treatment can be useful in preparing patients for physical appearance changes and decreasing the severity of symptoms.

Body image in head and neck cancer patients treated with radiotherapy: the impact of surgical procedures

Background

In this study, we aimed to investigate the impact of surgical procedures on the body image of head and neck cancer patients treated with radiotherapy and with or without radical surgery.

Methods

A cross-sectional survey of 150 patients with head and neck cancer was conducted. Sixty patients had nasopharyngeal cancer treated with definitive radiotherapy without surgery, and 90 patients had oral cavity cancer treated with radical surgery plus adjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction. Among all patients, the socio-demographic and clinical variables were age, gender, partnership, education, employment, and radical surgery. In surgically-treated patients, the clinical variables were facial skin sacrificed, mouth angle sacrificed, glossectomy, maxillectomy, and mandibulectomy. ANOVAs, t-tests, and multiple regressions were used to evaluate the relationships between these variables and BIS results.

Results

In all patients, radical surgery was the strongest independent predictor of BIS scores. Surgically-treated patients had significantly worse BIS scores than the patients without surgery. In surgically-treated patients, facial skin sacrificed, mouth angle sacrificed, maxillectomy, and mandibulectomy were significantly associated with body image. According to multivariable analyses, inferior maxillectomy and segmental mandibulectomy were independent prognosticators of a poor BIS score in surgically-treated patients.

Conclusion

Radical surgery for head and neck cancer patients has a significant impact on their body image, especially for those undergoing facial bone destructive surgery.

Do male esophageal cancer patients have impaired sexual function after esophagectomy? A self-reported outcomes study

PURPOSE

Sexual function is a significant part of patients' quality of life, which is another important aspect of cancer. This study assessed and compared the sexual function of male esophageal cancer patients to that of age-matched normal controls through postoperative follow-up surveys.

METHODS

The study included 105 male esophageal cancer patients aged 38-81 years who underwent a curative-intent esophagectomy between April 2012 and May 2014. This observational study included sociodemographic and clinicopathological characteristics and responses to sexual function questionnaires International Index of Erectile Function (IIEF) at 6 and 12 months after surgery. An age-matched normal control group was recruited. Non-parametric tests were used when appropriate.

RESULTS

The median patient age was 59 years. The factors significantly associated with sexual dysfunction on the 6-month survey included older age, and postoperative complications. At 12 months after surgery, older age was significantly associated with poorer sexual function. The sexual function scores significantly increased from 6 to 12 months after surgery (P < 0.05); there was no difference in the patients' 12-month sexual function scores and those of the normal controls (P > 0.05). Notably, compared to older patients (age ≥60 years), the younger (age <60 years) patients reported a significantly better sexual function scores (P < 0.05).

CONCLUSIONS

Age, and postoperative complications were the factors significantly associated with sexual function. Impaired sexual function after primary treatment can be recovered in male esophageal cancer patients; younger patients may regain sexual function better than their older counterparts.

Staring at My Body: The Experience of Body Reconstruction in Breast Cancer Long-term Survivors

BACKGROUND

Breast cancer takes time for its survivors after a mastectomy to adjust to their changed bodies. There are limited studies about the process of how those survivors accept the changes of their bodies and how they reestablish their new selves.

OBJECTIVE

The aim of this study was to understand the perception of body from women diagnosed with breast cancer more than 5 years previously and whose treatment included a mastectomy.

METHODS

A phenomenological method was applied to this study. Women who received a mastectomy at least 5 years previously were invited to participate. Eight participants were recruited from southern Taiwan.

RESULTS

Twenty transcripts were obtained and analyzed using Colaizzi's method. Three themes were obtained from the data analysis: "restoration of the body image," "abandonment of objectification," and "redefinition of self." Subthemes were also identified and described.

CONCLUSION

The results indicate that women with breast cancer have embodied the recovering experience to a new self and have adapted to identify their new bodies. They overcome being a female body with an absent breast(s) by discovering the value of their existence and being free from self-objectification.

IMPLICATIONS FOR PRACTICE

This study contributes to the understanding of the perception of body in long-term breast cancer survivors, which reflects the process of adjusting to the loss of a breast/breasts to reconstructing a new body experience. Health professionals could help and encourage women undergoing a mastectomy to engage in self-recovery by searching for and affirming self-value.

Factors associated with healthcare professional's rating of disfigurement and self-perceived body image in female patients with head and neck cancer

The purpose of this study was to determine factors associated with self-perceived body image in female patients with head and neck cancer (HNC), and factors associated with healthcare professional's rating of disfigurement, as well as the correlation between patient and observer ratings. This cross-sectional study recruited 105 women with HNC at a large medical centre. Measures of facial disfigurement and body image, as well as demographic and clinical characteristics, were collected. Multivariate multiple linear regression modelling was used to identify factors associated with healthcare professional's rating of disfigurement and patient self-perceived body image. Disfigurement ratings by healthcare professionals were positively associated with patient self-perceived body image. Medical treatment, cancer stage, radiation dose and cancer site were significantly associated with disfigurement. Medical treatment was an important predictor of perceived body image. These findings indicate a moderate prevalence of disfigurement among women with HNCs. Patients with more disfigurement were more likely to have dissatisfaction with their body image. Nursing professionals need to carefully assess the appearance of women with HNC. Camouflage interventions can be used to help appropriately cope with the disfigurement, and to achieve improved satisfaction with their body image.

Body image and emotional distress in newly diagnosed cancer patients: The mediating role of dysfunctional attitudes and rumination

Body image concerns (BIC) has been reported to be associated with emotional distress for cancers across various sites. This study sought to examine two cognitive vulnerability mechanisms: dysfunctional attitudes and rumination, and their combined effects on the relationship between BIC and emotional distress in newly diagnosed Asian cancer patients. Participants were 221 newly diagnosed adult cancer patients who were assessed on BIC, rumination, dysfunctional attitudes, and emotional distress. Path analysis was used to examine the hypothesized mediation model. The hypothesized mediation model controlling for age, sex, marital status, education level, cancer type, cancer stage, and treatment modality revealed that both dysfunctional attitudes and rumination mediated the relationship between BIC and emotional distress. The present study provides evidence for a mediating role of dysfunctional attitudes and rumination between BIC and emotional distress. Psychological treatment should target dysfunctional attitudes and rumination in cancer patients experiencing BIC.

The Management of Altered Body Image: A Role for Occupational Therapy

While historically a number of approaches and disciplines have proved to be effective in the management of altered body image, there is little evidence within the occupational therapy literature to suggest that this is an area actively pursued outside the realm of eating disorders. The concept of altered body image in relation to occupational therapy is explored, within the context of life-threatening disease. A review of multidisciplinary input in this area indicates that a number of factors contribute to the difficulty in identifying, assessing and treating this complex concept.

This article suggests that occupational therapists, with their unique perspective of activity as a facilitator of change in occupational performance, are well placed to address altered body image concerns. Education and training in this area are required if occupational therapists are to do so with confidence and competence, irrespective of clinical condition or setting, in order to contribute positively to the rehabilitation process and the individual's overall quality of life. Further research in the management of altered body image by occupational therapists is recommended.

Perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, appraise and synthesize the evidence on perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer to provide evidence for improving support and care.The specific review question is: What are the perceived factors that contribute to an increase or a reduction in distress among women taking part in surgical continuity of care for breast cancer?

Salient body image concerns of patients with cancer undergoing head and neck reconstruction

BACKGROUND

Patients with cancer undergoing head and neck reconstruction can experience significant distress from alterations in appearance and bodily functioning. We sought to delineate salient dimensions of body image concerns in this patient population preparing for reconstructive surgery.

METHODS

Participants completed self-report questionnaires evaluating numerous aspects of body image. We used Bayesian factor analysis modeling methods to identify latent factors emerging from the data.

RESULTS

We identified 2 latent factors: appearance distress and functional difficulties. The highest level of preoperative body image concerns were related to distress about appearance changes and its perceived social consequences. Appearance distress items displayed greater variability compared with functional difficulties.

CONCLUSION

Appearance and functional changes to body image are important areas of concern for patients with head and neck cancer as they prepare for reconstructive surgery. Knowledge regarding specific body image issues can be used to guide psychosocial assessments and intervention to enhance patient care. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1035-1042, 2016.

Psychosocial Predictors and Outcomes of Delayed Breast Reconstruction in Mastectomized Women in Mainland China: An Observational Study

Background

The aim of the present study was to evaluate potential psychosocial factors that impact Chinese female breast cancer patients to select breast reconstruction (BR), and potential connection of psychosocial outcomes with their satisfaction with BR.

Methods

A total of 264 female breast cancer patients with mastectomy were recruited from 2012 to 2014. All patients were informed with BR options at their first visit. Personal and medical profiles were collected. Body image, self-esteem, depression and anxiety were assessed using validated scales. Patients who were selected to undergo BR after the first visit were followed up for six months. The same assessment was performed at 6 months post BR, and their satisfaction with BR was evaluated using the Alderman scale. Multivariate linear and logistic regressions were performed.

Results

Forty-seven percent of the patients (126/264) opted to undergo BR within six months after the initial visit. Multivariate logistic regression analysis revealed that self-esteem (P < 0.05), body image (P < 0.01), education level (P < 0.05), and their husband’s recommendation (P < 0.05) were highly related to the patients’ decision to undergo BR. In addition, multivariate linear regression analysis showed that patient satisfaction with BR was significantly associated with preoperative body image (P < 0.01), postoperative improvement in self-esteem (P < 0.01), improvement in body image (P < 0.01), reduction in depression (P < 0.05), pain (P < 0.05), and scarring (P < 0.01).

Conclusions

The psychosocial factors including self-esteem and body image are highly related to selecting the BR option and post-BR satisfaction in Chinese female breast cancer patients.

Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer

PURPOSE

Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress.

METHODS

Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), controlling for relevant covariates. Measures included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-CR38) Diarrhea, GI Symptoms, and Body Image subscales and Brief Symptom Index Depression and Anxiety subscales.

RESULTS

Women averaged 55 years old (SD = 11.6), White (79 %), and were 4 years post-treatment. Greater Depression was related to poorer Body Image (r = -.61) and worse Diarrhea (r = .35) and GI Symptoms (r = .48). Greater Anxiety was related to poorer Body Image (r = -.42) and worse GI Symptoms (r = .45), but not Diarrhea (r = .20). Body Image mediated the effects of bowel and GI symptoms on Depression, but not on Anxiety.

CONCLUSIONS

Long-term bowel and GI dysfunction are distressing and affect how women perceive and relate to their bodies, exacerbating survivorship difficulties. Interventions to improve adjustment post-treatment should address treatment side effects, but also target body image problems to alleviate depressive symptoms. Reducing anxiety may require other strategies. Body image may be a key modifiable factor to improve well-being in this understudied population. Longitudinal research is needed to confirm findings.

Body image and quality of life of breast cancer patients: influence of timing and stage of breast reconstruction

OBJECTIVE

The process of cancer-related breast reconstruction is typically multi-staged and can take months to years to complete, yet few studies have examined patient psychosocial well-being during the reconstruction process. We investigated the effects of reconstruction timing and reconstruction stage on body image and quality of life at specific time points during the breast reconstruction process.

METHODS

In this cross-sectional study, 216 patients were grouped into four reconstructive stages: pre-reconstruction, completed stage 1, completed stage 2, and final stages. Multiple regression analyses examined the roles of reconstruction timing (immediate vs delayed reconstruction) and reconstruction stage as well as their interaction in predicting body image and quality of life, controlling for patient age, BMI, type of reconstruction, chemotherapy, radiation therapy, and major complication(s).

RESULTS

A difference in pattern of body image was observed across the reconstructive stages, with those receiving delayed reconstruction showing significant decrease in body image dissatisfaction compared with those with immediate reconstruction. At pre-reconstruction, patients awaiting delayed reconstruction reported significantly lower social well-being compared with those awaiting immediate reconstruction. Reconstruction stage predicted emotional well-being, with higher emotional well-being observed in those who had commenced reconstruction.

CONCLUSIONS

Timing and stage of reconstruction are important to consider when examining psychosocial outcomes of breast cancer patients undergoing reconstruction. Those waiting to initiate delayed reconstruction appear at particular risk for body image, emotional, and social distress. Our findings have implications for delivery of psychosocial treatment to maximize body image and quality of life of patients undergoing cancer-related breast reconstruction.Copyright © 2015 John Wiley & Sons, Ltd.

Body image and sexual function in women after treatment for anal and rectal cancer

OBJECTIVE

Treatment for anal and rectal cancer (ARCa) often results in side effects that directly impact sexual functioning; however, ARCa survivors are an understudied group, and factors contributing to the sexual sequelae are not well understood. Body image problems are distressing and may further exacerbate sexual difficulties, particularly for women. This preliminary study sought to (1) describe body image problems, including sociodemographic and disease/treatment correlates, and (2) examine relations between body image and sexual function.

METHODS

For the baseline assessment of a larger study, 70 women completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and Colorectal Cancer-specific Module, including the Body Image subscale, and Female Sexual Function Index. Pearson's correlation and multiple regression evaluated correlates of body image. Among sexually active women (n = 41), hierarchical regression examined relations between body image and sexual function domains.

RESULTS

Women were on average 55 years old (standard deviation = 11.6), non-Hispanic White (79%), married (57%), and employed (47%). The majority (86%) reported at least one body image problem. Younger age, lower global health status, and greater severity of symptoms related to poorer body image (p's < 0.05). Poor body image was inversely related to all aspects of sexual function (β range 0.50-0.70, p's < 0.05), except pain. The strongest association was with Female Sexual Function Index Sexual/Relationship Satisfaction.

CONCLUSION

These preliminary findings suggest the importance of assessing body image as a potentially modifiable target to address sexual difficulties in this understudied group. Further longitudinal research is needed to inform the development and implementation of effective interventions to improve the sexual health and well-being of female ARCa survivors.

Body Image in Adult Women: Moving Beyond the Younger Years

In spite of copious literature investigating body dissatisfaction and its correlates in adolescents and young adult women, exploration of body image disturbances in adult women remains an underrepresented domain in the literature. Yet, there are many reasons to suspect that body image in adult women both may differ from and possibly be more complex than that of younger women. Adult women face myriad factors influencing body image beyond those delineated in the body image literature on adolescents and young adult women. For instance, aging-related physiological changes shift the female body further away from the thin-young-ideal, which is the societal standard of female beauty. Further, life priorities and psychological factors evolve with age as well. As such, adult women encounter changes that may differentially affect body image across the lifespan. This paper aims to provide an up-to-date review of the current literature on the relationship between body image and associated mental and physical health problems and behaviors in adult women. In addition, we explore factors that may influence body image in adult women. Lastly, we use this review to identify significant gaps in the existing literature with the aim of identifying critical targets for future research.

Body Image and the Female Adolescent Oncology Patient

Female adolescent oncology patients undergo many physical changes throughout treatment that have challenging psychological, emotional, and social implications. Body image for this population is a subject that tends to be overlooked in the midst of the cancer experience. This article will examine the complex concept of body image and discuss why female adolescent patients are at such high risk for negative body image. Assessment and care strategies are needed to foster a positive body image, resiliency, and overall well-being. Although survivorship studies may offer insightful information about the effects of the cancer journey on long-term body image, focus should be on prevention and holistic care as part of the treatment itself. The health care team, especially nursing professionals, should acknowledge, recognize, and address this vital issue as a critical part of oncology care.

The psychosocial experiences of women with breast cancer across the lifespan: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

What are the psychosocial experiences of women with breast cancer across the lifespan, including similarities and differences in the psychosocial experiences of younger, middle-aged and older women with breast cancer?

BACKGROUND

The experience of a life threatening illness, such as cancer, requires a person to consider an array of emotional, medical, social and existential demands. Specific to breast cancer, research shows that the experience of diagnosis and treatment of breast cancer may result in considerable distress.It is also known that a diagnosis of invasive breast cancer propels women into a time of uncertainty, that brings fear and emotional work. This disease oftentimes challenges a woman's identity, self-esteem, body image and relationships. However, even with these commonly felt distresses, most women adjust well to a breast cancer diagnosis and the treatments experienced, particularly if they do not experience a recurrence of cancer. Protective factors for distress include supportive care networks, such as family and support groups and professional resources provided by clinical staff, such as timely referrals to specialized services.Although most women adjust well to breast cancer, understanding distressing experiences among this population is crucial because, when experienced, the negative psychosocial impacts can be significant. Women who do experience distress due to breast cancer are at a risk of distress accompanying them through the breast cancer journey and impacting their long-term quality of life.Although literature suggests that the psychosocial experience of a breast cancer diagnosis may be different across the lifespan, less is known about the similarities and differences in the psychosocial experience between younger and older women with breast cancer. However, this studyexamines the experience of one age group and no comparisons between different age groups in this or other studies have been found at this time. Among what is known, younger women with breast cancer are at a heightened risk of anxiety and depression in comparison to older women and younger women experience more worries about their careers and finances than older women. There is also evidence that young women perceive their quality of life to be lower than older women as a result of breast cancer. This may be attributed to poorer emotional wellbeing, specific cancer-related concerns, depression and intrusive thoughts for this younger group. On the other hand, older women with breast cancer experience more health problems than younger women in survivorship, independent of receiving chemotherapy. In general, older breast cancer survivors experience overall better quality of life and mental health than their younger counterparts, but they tend to have poorer physical health and health-related quality of life due to comorbid conditions. Another risk factor for psychosocial distress is low income, which may be particularly salient for older women who are more likely to be on a fixed income than their younger counterparts. However, literature suggests that a higher degree of psychosocial adaptation can be found among older women with breast cancer because these women have had more life experience, including prior experiences with the health care system, witnessing the diagnosis of others with cancer, and having few competing demands. It is thought that these factors contributed to coping and successful adaption to the disease among older women.When studying how women acclimatize to breast cancer in the early stages of the cancer journey, it has been found that the main concerns for these women were concepts connected to identity. Breast cancer threatens women's self-integrity and the restructuring of life after a cancer diagnosis calls for the new experiences and feelings to be integrated into a revised self-narrative, sometimes referred to as 'meaning-making'. Little is understood about the differences between younger and older women in their construction of identity or how they make meaning in the context of breast cancer. What is known is that, for younger women, the diagnosis of cancer is shocking, and is an opportunity to contemplate mortality. Older women are more likely to approach their diagnoses in a matter-of-fact manner associated with the expected process of aging.The concept of body image can be found as a focus of breast cancer literature which describes the level of investment women put into their body in order to help them determine their wellbeing. The disruption of body image in breast cancer is attributed to hair loss, as well as changes in the breast and weight. Studies show younger women do seek normality in their breasts following mastectomy, and seek breast reconstruction more often than older women. Regarding older women with breast cancer, little is known about the experience of specific body image concerns, such as short- or long-term changes in the body due to treatment. It is known that older women with cancer experience body dissatisfaction and may even experience higher levels of dissatisfaction than younger women, possibly due to more persistent problems with the physical functioning of their body.It is also known that the diagnosis and treatment of breast cancer affect relationships including spousal relationships, and relationships with children and older parents. As a woman with breast cancer experiences vulnerabilities, so too does her family. Spouses and partners of women with breast cancer work to adjust roles and to balance added household responsibilities, particularly during times of treatment. Children of women with breast cancer are impacted by the level of interaction with their mothers, with increased positive mother-child interactions associated with the increased wellbeing of family members. On the other hand, children are impacted negatively by a negative change in the mother's mood or marital tension. Lastly, parents of women with breast cancer are also affected since, they too, need to come to terms with the early timing of their daughters' diagnoses.Family relationships are vital for women with cancer because these relationships provide a high degree of social support, including emotional, tangible, informational and experiential support. Literature shows family relationships are improved for both younger and older breast cancer survivors. However, the intimate relationships of younger women are more likely to be strained in comparison to the intimate relationships of older women in the context of breast cancer survivorship. Also, younger adults with cancer experience increased loneliness, and a greater sense of isolation from peer and support networks than older adults perhaps because they perceive themselves to be different from their peers as a result of cancer.This incomplete understanding of the psychosocial experience of women with breast cancer across the lifespan requires an urgent need for research to facilitate a greater understanding of the psychosocial needs of these women. To allow for the effective delivery of appropriate cancer care support to these populations, a greater understanding of the unmet needs of these women must occur, including an understanding of the similarities and differences of younger and older women with this disease. A synthesis of literature from multiple contexts of the psychosocial experiences of younger and older women with breast cancer will add to the understanding of the experiences of these women. No systematic review on this topic was found when searching Cochrane Database of Systematic Reviews, PROSPERO and the JBI Database of Systematic Reviews and Implementation Reports.

Psychological distress in women with breast and gynecological cancer treated with radical surgery

OBJECTIVES

The objective of this study is to compare psychological distress (body image disturbance,self-esteem, depression, and anxiety) in women with breast or gynecological cancer treated by radical surgery. Additionally, another objective is to analyze the association between psychological distress and sociodemographic characteristics, medical history, and social support to produce a prediction model for the outcome measures.

METHODS

A cross-sectional study was carried out with 100 women who had undergone radical surgery for breast or gynecological cancer. Both groups were divided into the following: younger than 50 years old and 50 years old or older. Body Image Scale, Rosenberg's Self-Esteem Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used.

RESULTS

Age had a significant main effect on psychological distress but the type of cancer did not.Younger women showed significantly greater distress than older women (p-values<0.001). A significant interaction between age and type of cancer was found, indicating that older women with breast cancer had worse body image and more depression than those with gynecological cancer (p-values 0.001); no significant differences were found between younger groups.The prediction model for increased body image disturbance and depression included the joint effect of the following variables: being younger, inactive occupational status, and post-adjuvant therapy side effects. For lower self-esteem, the variables were: being younger, post-adjuvant therapy side effects,and dissatisfaction with social support. And for higher anxiety, the sole variable included was post-adjuvant therapy side effects.

CONCLUSIONS

Both mastectomy and hysterectomy/oophorectomy cause similar psychological distress in younger women, but mastectomy causes greater distress in older women than hysterectomy/oophorectomy.

Screening for body image dissatisfaction in patients with advanced cancer: a pilot study

BACKGROUND

Cancer and its treatment can significantly affect appearance and body integrity. A number of studies have explored the impact of cancer and its treatment on body image, primarily in head and neck and breast cancer. The aim of this pilot study was to examine the construct of body image dissatisfaction and its measurement using a single question in patients with advanced cancer.

METHODS

Outpatients with advanced cancer were recruited (n=81). Assessments included Body Image Scale (BIS), Appearance Schema Inventory (ASI-R), Edmonton Symptom Assessment System (ESAS) with a total symptom distress score (TSDS) and two subscales scores (physical distress [PHS] and psychological distress [PSS]), Hospital Anxiety Depression Scale (HADS), and one question assessing the overall appearance satisfaction from the Multidimensional Body-Self Relations Questionnaire (MBSRQ). We also asked patients to rate the body image changes importance compared with five symptoms (pain, fatigue, depression, insomnia, lack of appetite).

RESULTS

Forty-seven (58%) patients had a BIS score >10 (body image dissatisfaction) with a median of 11 (first-third quartiles, Q1-Q3; 5-16) and a median ASI-R of 3.1 (Q1-Q3; 2.8-3.5). Sensitivity and specificity of ≤3 for body image dissatisfaction in the single overall appearance question using the BIS as a standard was 0.70 and 0.71, respectively. BIS score was significantly correlated with ASI-R (r=0.248; p=0.025), age (r=-0.225; p=0.043), HADS-A (r=0.522, p<0.001), HADS-D (r=0.422, p<0.001), PSS score (r=0.371, p=0.001), PHS score (r=0.356, p=0.001), TSDS score (r=0.416, p<0.001), and the overall appearance question (MBSRQ; r=-0.449, p<0.001).

CONCLUSION

Body image dissatisfaction was frequent and associated with symptom burden. A single item ≤3 has a sensitivity of 70% for body image satisfaction screening.

Body image struggles and breast cancer care: an under-recognized and undertreated issue with important implications for all patients

SUMMARY 

Body image encompasses the relationship between perceptions, cognitions, behaviors and emotions regarding the body and its functions. Breast cancer treatment can have a profound impact on body image, with body image issues occurring throughout diagnosis, treatment and survivorship. Despite this, a potential disconnect exists between breast cancer care providers and patients with respect to understanding and addressing body image difficulties. This article provides an overview of body image issues related to breast cancer treatment and offers recommendations that will enable healthcare providers to assist patients who are struggling with body image issues. More emphasis must be placed on the importance of body image as a means of improving the quality of care for all breast cancer patients.

Validation of the instrument "Body image after breast cancer" in Brazil

The body image is an important aspect to be considered during the treatment of women with breast cancer. Therefore, we understand the importance of the quality of an instrument that evaluates this condition. The instrument validated in this study can bring new possibilities of studying the effects of cancer treatments on body image. Validation of the questionnaire, translation, cultural adaptation and pre-tests were done with women with breast cancer residents of the States of Alagoas, Pernambuco and São Paulo. A Confirmatory Factor Analysis (CFA) demonstrated that the original model of the instrument is valid, reliable and can be an important tool for identifying the impact of breast cancer on body image of women with this health condition, allowing adjustments in clinical treatment, psychological support and actions of other professionals involved in the treatment.

Body image screening for cancer patients undergoing reconstructive surgery

OBJECTIVES

Body image is a critical issue for cancer patients undergoing reconstructive surgery, as they can experience disfigurement and functional impairment. Distress related to appearance changes can lead to various psychosocial difficulties, and patients are often reluctant to discuss these issues with their healthcare team. Our goals were to design and evaluate a screening tool to aid providers in identifying patients who may benefit from referral for specialized psychosocial care to treat body image concerns.

METHODS

We designed a brief four-item instrument and administered it at a single time point to cancer patients who were undergoing reconstructive treatment. We used simple and multinomial regression models to evaluate whether survey responses, demographic, or clinical variables predicted interest and enrollment in counseling.

RESULTS

Over 95% of the sample (n = 248) endorsed some concerns, preoccupation, or avoidance because of appearance changes. Approximately one-third of patients were interested in obtaining counseling or additional information to assist with body image distress. Each survey item significantly predicted interest and enrollment in counseling. Concern about future appearance changes was the single best predictor of counseling enrollment. Sex, age, and cancer type were not predictive of counseling interest or enrollment.

CONCLUSIONS

We present initial data supporting use of the Body Image Screener for Cancer Reconstruction. Our findings suggest benefits of administering this tool to patients presenting for reconstructive surgery. It is argued that screening and treatment for body image distress should be provided to this patient population at the earliest possible time point.

Surviving breast cancer: women's experiences with their changed bodies

In this study, we explored women's experiences with their bodies following treatment for breast cancer. Eleven women who had been treated for the disease (M(time since treatment)=4.45 years) were interviewed. Data were collected and analyzed using interpretative phenomenological analysis (Smith et al., 2009). Four main themes emerged from the data: changing visibly and invisibly; experiencing intense thoughts and emotions; meaning of the body: a vehicle of health, well-being, and social expression; and managing and dealing with physical changes. Overall, the women experienced various physical changes that shaped, mostly in a negative way, their perceptions, thoughts, attitudes, feelings, and beliefs about their bodies. The women described attempts to make positive lifestyle behavior choices (e.g., diet, participate in physical activity), and used other strategies (e.g., wigs, make-up, clothes) to manage their appearances and restore positive body-related experiences. Based on these findings, it is important to be cognizant of women's body image concerns following breast cancer given the poignant and lasting effects they can have on their psychosocial and emotional well-being.

Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction

Within the field of breast reconstruction there is increasing focus on patient-reported outcomes related to satisfaction, body image, and quality of life. These outcomes are deemed highly relevant because the primary goal of breast reconstruction is to recreate the appearance of a breast (or breasts) that is satisfying to the patient. Prominent researchers have suggested the need to develop improved standards for outcome evaluation which can ultimately benefit patients as well as physicians. The purpose of this article is to summarize key findings in the area of patient-reported outcomes for breast reconstruction and introduce a theoretical framework for advancing research in this field. We conducted an extensive literature review of outcome studies for breast reconstruction focusing on patient-reported results. We developed a theoretical framework illustrating core patient-reported outcomes related to breast reconstruction and factors associated with these outcomes. Our theoretical model highlights domains and distinguishing features of patient satisfaction, body image, and quality of life outcomes for women undergoing breast reconstruction. This model further identifies a broad range of variables (e.g., historical/premorbid influences, disease and treatment-related factors) that have been found to influence patient-reported outcomes and need to be taken into consideration when designing future research in this area. Additional attention is given to examining the relationship between patient reported outcomes and outside evaluation of breast reconstruction. Our proposed theoretical framework suggests key opportunities to expand research in this area with the goal of optimizing body image adjustment, satisfaction, and psychosocial outcomes for the individual patient.