Body image dimensions and cancer: a heuristic cognitive behavioural model

Associations among speech, eating, and body image concerns for surgical patients with head and neck cancer

BACKGROUND

Body image can be affected by bodily experiences extending beyond physical appearance. This study evaluated associations among speech, eating, and body image concerns for surgically treated patients with oral cavity, midface, and cutaneous cancers of the head and neck.

METHODS

Using a cross-sectional design, 280 participants completed the Body Image Scale, a survey evaluating disease-specific body image issues, and the Functional Assessment of Cancer Therapy Scale-General.

RESULTS

Participants with speech and eating concerns reported the highest levels of body image/appearance dissatisfaction compared with those without such concerns. This group also reported greater cognitive and behavioral difficulties associated with body image concerns and significantly higher levels of interest in psychosocial interventions to address appearance-related difficulties compared with all other participants.

CONCLUSIONS

Findings point to the need for more comprehensive psychosocial care for patients with head and neck malignancies reporting speech and eating difficulties, which extent beyond functional rehabilitation.

A brief assessment tool for body image in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) may adversely affect body image in multitude ways. Development and validation of a brief and valid SLE specific body image tool were undertaken. Eleven items were identified on interview of 21 SLE patients for the Body Image Lupus Scale (BILS v1.0). The tool was administered to 70 SLE patients. Based on analysis, feedback, and refinement of items, the final iteration BILS v1.2 with five items was administered to 233 SLE patients along with validated body image measures (Situational Inventory of Body Image Dysphoria and Body Image Quality of Life Inventory) and health-related quality of life measures for a subsample. The BILS scores' had an internal consistency reliability of .94. It correlated with both the referent body image measures, and with health-related quality of life. It differentiated participants by health status and disease activity. Test-retest reliability estimates exceeded .90. These results support the psychometric properties of BILS.

The meaning of body experience evaluation in oncology

Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily wholeness or bodily integrity. Since this experience is contextualized by a person’s life story, evaluation should also focus on narrative aspects. I finally suggest that the interpretation of body experience is not only valuable to assess a person’s quality of life after treatment, but that it can also be useful in counseling prior to interventions, since it can support patients in making decisions about interventions that will change their bodies. To apply this type of evaluation to oncology practice, a rich and tailored vocabulary of body experiences has to be developed.

Psychological aspects of prostate cancer: a clinical review

Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.

Pilot feasibility study of a telephone-based couples intervention for physical intimacy and sexual concerns in colorectal cancer

No studies have tested interventions addressing the sexual concerns of colorectal cancer patients and their partners. The authors reported findings from a pilot feasibility study of a novel telephone-based intimacy enhancement protocol that addresses the intimacy and sexual concerns of couples facing colorectal cancer. On the basis of a flexible coping model, the intervention was designed to help couples make cognitive and behavioral shifts in their intimate relationships. Participants were 18 individuals (9 dyads) who completed the intervention and measures of feasibility (frequency, ease of use, helpfulness of skills, ratings of rapport), program evaluations, and measures of sexual and relationship functioning. Most participants reported that the intervention was "quite a bit" or "extremely" helpful and that they had used the skills taught within the past week. The skills most commonly practiced and perceived as most helpful tended to be behavioral (e.g., trying a new sexual activity). The authors found the largest effect sizes (≥.60) for sexual distress, sexual function (female), and sexual communication. Findings from this pilot study suggest that the intimacy enhancement protocol is feasible and holds promise for improving sexual and intimacy outcomes in colorectal cancer patients and their partners. The authors discuss the research and clinical implications.

Assessing the body image: relevance, application and instruments for oncological settings

PURPOSE

Body image is the sum of physical, cognitive, emotional, and relational elements that, when integrated, allow the development of a whole, healthy self-identity. Even though body image is normally studied in relation to eating disorders, it can also be influenced by other pathologies, including cancer. In oncology, an effective body image assessment is fundamental. The physical effects of cancer and cancer treatments are important and frequently irreversible also on a functional and emotional level; however, only few surveys have investigated body image in this peculiar context.

METHODS

An extensive literature review was carried out in PubMed and PsycINFO. We considered articles published from 1990 to 2010.

RESULTS

Two hundred sixty-three papers matched the search criteria. Assessment methodologies included clinical interviews, self-report measures, questionnaires, symptom check lists, and graphic tests and projective techniques. After excluding the instruments that referred to eating disorders, validated only for adolescents, and/or projective and graphic tests, we found 81 articles with six questionnaires specifically dedicated to body image assessment in oncology.

CONCLUSIONS

From our systematic review, we could identify six instruments specifically designed for assessing body image in the oncological area. In this paper, we discuss their general characteristics, psychometrics properties and the clinical implications, and body image relevance on the quality of life in cancer patients.

[Research on body image in oncology: a methodological synthesis]

Cancer and its treatments induce important physical transformations, which could be source of psychological and social difficulties. Since about 15 years, interest for cancer and treatments consequences on body image had grown in oncology. Nevertheless studying body image remains complex because of conceptual and methodological limits. This article aims at a clarification about the methods employed in the field of cancer to assess body image, in order to make accessible reference marks about adapted instruments for every person who would like to study this theme.

The nature and extent of body image concerns among surgically treated patients with head and neck cancer

BACKGROUND

The purpose of this study was to describe body image concerns for surgically treated patients with head and neck cancer and evaluate the relationship between body image concerns and quality of life outcomes.

METHODS

Data were obtained from 280 patients undergoing surgical treatment for head and neck cancer. We used a cross-sectional design and obtained data from individuals at different time points relative to initiation of surgical treatment. Participants completed the Body Image Scale, the Functional Assessment of Cancer Therapy Scale-Head and Neck Version, and a survey designed for this study to evaluate disease-specific body image issues, satisfaction with care regarding body image issues, and interest in psychosocial intervention.

RESULTS

Body image concerns were prevalent in the majority of participants with 75% acknowledging concerns or embarrassment about one or more types of bodily changes at some point during treatment. Significant associations were found between body image concerns and all major domains of quality of life. Age, gender, cancer type, time since surgery, and body image variables were significantly associated with psychosocial outcomes. A clear subset of participants expressed dissatisfaction with care received about body image issues and/or indicated they would have liked additional resources to help them cope with body image changes.

CONCLUSIONS

These data provide useful information to document wide-ranging body image difficulties for this population and provide important targets for the development of relevant psychosocial interventions.

The nature and extent of body image concerns among surgically treated patients with head and neck cancer

BACKGROUND

The purpose of this study was to describe body image concerns for surgically treated patients with head and neck cancer and evaluate the relationship between body image concerns and quality of life outcomes.

METHODS

Data were obtained from 280 patients undergoing surgical treatment for head and neck cancer. We used a cross-sectional design and obtained data from individuals at different time points relative to initiation of surgical treatment. Participants completed the Body Image Scale, the Functional Assessment of Cancer Therapy Scale-Head and Neck Version, and a survey designed for this study to evaluate disease-specific body image issues, satisfaction with care regarding body image issues, and interest in psychosocial intervention.

RESULTS

Body image concerns were prevalent in the majority of participants with 75% acknowledging concerns or embarrassment about one or more types of bodily changes at some point during treatment. Significant associations were found between body image concerns and all major domains of quality of life. Age, gender, cancer type, time since surgery, and body image variables were significantly associated with psychosocial outcomes. A clear subset of participants expressed dissatisfaction with care received about body image issues and/or indicated they would have liked additional resources to help them cope with body image changes.

CONCLUSIONS

These data provide useful information to document wide-ranging body image difficulties for this population and provide important targets for the development of relevant psychosocial interventions.

Identifying appearance-related concerns in routine follow-up clinics following treatment for oral and oropharyngeal cancer

Facial disfigurement can be a consequence of treatment for oral or oropharyngeal cancer. Patients' concerns about appearance and the impact this has on quality of life are very important, but are often not recognised in a busy outpatient clinic. We aimed to assess concerns about appearance using the University of Washington Quality of Life questionnaire version 4 (UW-QoL) and the Patient Concerns Inventory (PCI), a self-administered questionnaire that allows patients to choose what they would like to discuss in their consultation. Prospective data were collected from 204 patients who attended routine follow-up clinics from August 2007 to mid-July 2009. Fifty-seven percent were male, 68% had cancer of the oral cavity, 78% had clinical T1-T2 tumours, 19% had node positive tumours, 44% had had radiotherapy since diagnosis, and 48% had had free-flap reconstructive surgery. They all completed the questionnaires using touch-screen computer technology at 454 clinic appointments. Appearance was raised on the inventory at 9% (42/454) of clinics, and at 10% (47/454) it was indicated as a serious problem on the UW-QoL questionnaire. Concerns about appearance were raised on the inventory or were shown to be a serious problem on the UW-QoL in 14% (64/454) of patients. The main factors associated with those who reported concerns about appearance were age (younger patients), sex (female), T stage (III and IV), and site (oropharynx). Patients who choose concerns about appearance for discussion on the UW-QoL questionnaire and not on the PCI risk being missed if only the PCI is completed. Both tools compliment the screening of patients who have problems with facial disfigurement; failure to identify them can have serious clinical and psychosocial implications.

"I'm still who I was" creating meaning through engagement in art: The experiences of two breast cancer survivors

PURPOSE

The aim of this feasibility study was two-fold: i) develop lifelike torsos of two breast cancer survivors using innovative sculpting material and; ii) shed light on the meaning women give to the experience of breast cancer after viewing their sculpted torsos.

METHODS

This collaborative initiative between nurse researchers and artists was situated within phenomenological inquiry. Two breast cancer survivors shared their bodies, as models, and stories of their cancer journey and the experience of modeling to create life-sized torsos of their bodies.

KEY RESULTS

The participants articulated embodied knowing as each shared experiences of connectedness and relationship which culminated in the emergence of four core themes: The Landscape of Breast in Cancer; Red Shoes: The Re-claiming of Self; Liberation: towards an embodied self; and, Scars: Re-authoring Life.

CONCLUSIONS

Active engagement in art through the use of one's body has the potential to open the door to healing, the generation of meaning and a reaffirmation of self.

Women's motives to opt for either implant or DIEP-flap breast reconstruction

OBJECTIVE

Understanding women's motives concerning breast reconstructive surgery will contribute to a better counselling and care for the increasing number of women choosing post-mastectomy breast reconstruction (BR).

METHODS

We interviewed 31 women who opted for implant or deep inferior epigastric perforator (DIEP)-flap BR after therapeutic or prophylactic mastectomy. Motives for BR in general and for the selected type of BR were investigated following a phenomenological qualitative research approach.

RESULTS

Women opting for implant BR were concerned with surgery-related issues, such as recovery time, number of scars and impact of surgery. They wanted to return to their daily life and restore their body image as soon as possible. Patients choosing DIEP-flap BR were more focussed on regaining a natural breast and wanted to benefit from the advantages of autologous tissue. Women scheduled for prophylactic mastectomy saw BR as an integral part of their treatment. Patients opting for BR after therapeutic mastectomy wanted to regain a complete body image with BR.

CONCLUSIONS

Patients' motives for implant BR were primarily related to surgical issues, whereas women who chose DIEP-flap BR especially focussed on regaining a breast that resembles their own lost breast as well as possible. Clinical variables (such as therapeutic or prophylactic mastectomy, breast irradiation, and waiting lists) need to be taken into account when considering a certain type of BR, as these can be of great importance in the decision-making process.

A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients

OBJECTIVES

One of the most common acute side effects of breast cancer radiotherapy is treatment-induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on QOL.

METHODS

Semistructured interviews were conducted with 20 women (Stage 0-III breast cancer), during their last week of external beam radiotherapy. Each interview was transcribed verbatim, and thematic analysis was performed.

RESULTS

Three themes were identified based on the interview responses: First, skin changes affect multiple dimensions of QOL. They cause physical discomfort, body image disturbance, emotional distress, and impair both day-to-day functioning and satisfaction with radiation treatment. Second, individual differences affect women's experiences. Generally African American women, younger women, women who are not currently in a relationship, women who are being treated during the summer, and women who are more invested in their appearance are more distressed by skin toxicity. Third, women use a variety of symptom management strategies including self-medication, complementary/alternative medicine approaches, and psychological strategies.

CONCLUSIONS

Implications of results are as follows: (1) skin toxicity affects numerous dimensions of QOL, and assessment approaches and psychosocial interventions should address this; (2) individual differences may affect the experience of skin toxicity and should be considered in treatment and education approaches; and (3) participants' own creativity and problem-solving should be used to improve the treatment experience.

Individual and dyadic predictors of body image in women with breast cancer

OBJECTIVE

Previous studies examining the body image among breast cancer (BC) patients have primarily focused on their psychosocial adjustment or on the predictive value of body image on quality of life. Little is known about predictors of body image.

METHODS

The present study investigated how much body image in women with BC is determined by individual factors (surgery type, medical treatments, disease stage, women's age, depressive symptoms) and by dyadic variables (relationship satisfaction and duration, dyadic coping). Furthermore, two different aspects of women's body image were assessed: self- acceptance and perceptions of partners' acceptance. Ninety-eight German women with early stage BC and their partners participated.

RESULTS

Individual and dyadic aspects of body image were differentially related to body image. Women's depressive symptoms and men's marital satisfaction predicted women's self-acceptance, but not women's perceptions of their partners' acceptance of their appearance. Female's relationship satisfaction and perspective on common dyadic coping predicted women's perceptions of their partner's acceptance of their appearance.

CONCLUSIONS

The findings suggest interventions that include strategies to reduce women's depressive symptoms and build relationship satisfaction, might reduce body image difficulties in women after BC.

Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress

BACKGROUND

Cultural perceptions and norms affect individuals' psychological reactions to cancer and quality of life, but very few studies have assessed reactions to breast cancer in specific cultural groups. Such assessments are especially rare for Arab women with breast cancer.

AIMS

To assess the effect of spousal support, sharing household tasks, and body image in relation to emotional distress in Arab breast cancer survivors compared with matched healthy controls.

METHOD

Fifty-six Israeli Arab breast cancer survivors (stages I-III), and 66 age- and education-matched women answered Brief Symptoms Inventory-18, Perceived Body Image, Perceived Spousal Support and Division of Household Labor scale questionnaires.

RESULTS

Breast cancer patients experienced higher psychological distress, especially anxiety and somatization. They reported receiving more support from their spouses and higher sharing of household tasks than did matched healthy controls, but were not different regarding body image. Twenty-eight percent of the variance of psychological distress was explained, with group, perceived support, and group × body image interaction. Thus, higher psychological distress was more likely to occur in participants receiving lower support and in breast cancer survivors with lower body image.

CONCLUSIONS

The study described the effects of breast cancer on Arab women compared to healthy women. It highlights the need for culture-sensitive care for Arab breast cancer patients, as well as other patients from minority groups residing in other Western countries.

Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer

BACKGROUND

Body image is a critical psychosocial issue for patients facing treatment for oral cancer, yet there is limited research conducted in this area. This study uses a multidimensional approach to body image assessment and evaluates relationships between body image, demographic, health, and psychosocial variables.

METHODS

Newly diagnosed patients with oral cancer completed self-report questionnaires and a structured clinical interview.

RESULTS

Most participants identified current and/or future body image concerns primarily related to impending surgery. Adequate psychometric properties were demonstrated on a range of body image measures. Depression was the strongest and most consistent predictor of body image outcomes.

CONCLUSIONS

Preliminary evidence supports the importance of evaluating body image concerns in oral cancer patients prior to surgical intervention. Our findings have implications for developing validated body image tools and can be used to guide psychosocial interventions targeting body image disturbance.

Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation

BACKGROUND

Traditionally, physicians have believed that limb-salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb-salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups.

PROCEDURE

Participants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome.

RESULTS

Fifty-seven patients participated in this study (33 who underwent limb-salvage surgery and 24 who underwent amputation). Participants had gone 12-24 years since diagnosis and were 16-52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self-esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (P < 0.001), whereas surgery type did not impact this relationship. Body image was rated significantly worse by those who underwent late amputation, amputation after failed limb salvage, than by those who did not.

CONCLUSIONS

Participants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb-salvage surgery.

"The healthy me appears": palliative cancer patients' experiences of participation in a physical group exercise program

OBJECTIVE

Tentative results from a pilot study showed that patients with advanced cancer were willing and able to take part in a group exercise intervention. Limited knowledge exists, though, about the meaning and significance of such programs. The purpose of the present study was to understand the meaning of such an intervention for the individual participant and thereby to provide knowledge for shaping future clinical practice.

METHODS

Thirty-four palliative cancer patients with a life expectancy of less than 1 year completed a 6-week group exercise program. Five randomly selected individuals were interviewed 7 months after completion. Results from a self-report evaluation questionnaire identified relevant themes that formed the basis of an interview guide. These were addressed in a semistructured interview. Verbatim transcripts were analyzed with a phenomenological-hermeneutical approach.

RESULTS

Two main themes emerged from the interviews: (1) perceptions of the group and (2) a secure and caring setting for the group. Themes identified regarding perception of the group were a sense of belonging and commitment. Themes identified regarding a secure and caring setting for the group were a life-empowering group as a setting for enhancing coping, the qualifications of those who led the group, and a public gym as an unsuitable setting.

SIGNIFICANCE OF RESULTS

Our study indicates that an individually adjusted group exercise program, with competent leaders, can provide a setting to enhance psychological well-being in cancer patients with life expectancy below 1 year. Small sample size, however, limits the possibility to generalize the findings.

Altered Sexuality and Body Image after Gynecological Cancer Treatment: How Can Psychologists Help?

Once medical treatment for gynecological cancer is completed, what happens to patients' sexuality and body image? Due to the delicate nature of the cancer site, treating this cancer typically affects sexual functioning and body image adversely, making it critical to identify the concerns of these patients and do so in a manner less restrictive than paper-and-pencil assessment. To gain a deeper understanding of the phenomenological experiences in question, we interviewed nine gynecological cancer patients and seven cancer-free women. After implementing a relaxation protocol, we asked each woman to describe her feelings and thoughts on her sexuality and body image in one-on-one interviews. A variety of themes emerged on patients' attitudes and perspectives concerning sexuality and body image following diagnosis and treatment of the cancer. The themes that were considerably different from those of the cancer-free women included decreased sexual functioning and body image, abrupt shifts in self-identity due to loss of physical integrity, and distancing in intimate relationships. Several implications of these findings for clinical practice are discussed, as well as the need to train medical professionals to properly assess these patients' alterations in sexuality.

The Portuguese version of the body image scale (BIS) - psychometric properties in a sample of breast cancer patients

PURPOSE

The aim of this study was to analyse the psychometric properties of the Portuguese version of the body image scale (BIS; Hopwood, P., Fletcher, I., Lee, A., Al Ghazal, S., 2001. A body image scale for use with cancer patients. European Journal of Cancer, 37, 189-197). This is a brief and psychometric robust measure of body image for use with cancer patients, independently of age, cancer type, treatment or stage of the disease and it was developed in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group.

METHOD

The sample is comprised of 173 Portuguese postoperative breast cancer patients that completed a battery of measures that included the BIS and other scales of body image and quality of life, in order to explore its construct validity.

RESULTS

The Portuguese version of BIS confirmed the original unidimensional structure and demonstrated adequate internal consistency, both in the global sample (alpha=.93) as in surgical subgroups (mastectomy=.92 and breast-conserving surgery=.93). Evidence for the construct validity was provided through moderate to largely sized correlations between the BIS and other related measures. In further support of its discriminant validity, significant differences in BIS scores were found between women who underwent mastectomy and those who underwent breast-conserving surgery, with the former presenting higher scores. Age and time since diagnosis were not associated with BIS scores.

CONCLUSIONS

The Portuguese BIS proved to be a reliable and valid measure of body image concerns in a sample of breast cancer patients, allowing a brief and comprehensive assessment, both on clinical and research settings.

Sexual Adjustment and Body Image Scale (SABIS): a new measure for breast cancer patients

The purpose of this study was to develop and validate a self-report measure of body image and sexual adjustment in breast cancer patients: the Sexual Adjustment and Body Image Scale (SABIS). Three hundred and fifty three women diagnosed with primary breast cancer that had completed initial surgical treatment completed the SABIS and five measures of psychological, psychosocial, and sexual functioning. Psychometric properties of the SABIS were examined and it was found to be a reliable and valid means of assessing body image and sexuality in breast cancer patients following surgery.

Body image of children and adolescents with cancer: A systematic review

We report a systematic literature review to identify (1) differences in body image (BI) between children and adolescents with cancer and healthy controls; (2) relationships between BI and demographic or medical variables; (3) implications of BI for psychological adjustment; and (4) relationship between BI and social support. Thirty-two studies were identified from computerized databases including BNI (1985-March, 2008), CINAHL (1982-March, 2008), MEDLINE (1950-March, 2008), PsychInfo (1806-March, 2008), and PubMed (1950-March, 2008). There was no consistent evidence regarding BI differences between children and adolescents with cancer and healthy controls. Relations between BI and gender, disease characteristics, and psychological adjustment were found. Changes in BI have adverse implications for self-esteem and adjustment, but can be moderated by social support. Future research should also adopt broader definitions of BI, and cancer-specific age-appropriate BI measures are needed to increase sensitivity of this work.

The association of perceived partner-related social support with self-reported outcomes in women post-mastectomy

Marital satisfaction is an important indicator of adaptation in patients with cancer; however, its relationship to medium-to-long-term health-related outcomes is less well understood. Married women (N = 152) at least six months post-mastectomy were surveyed to determine whether marital satisfaction predicted non-weight-related body image distress (BID), pain impact, and mood, or whether the directionality of this association operated in reverse. Structural equation modeling indicated that the model predicting medium-to-long-term health-related outcomes from satisfaction better fit the data and that time influences mood.

Body image issues in women with breast cancer

Diagnosis and treatment of breast cancer affects women physically as well as psychologically. There are many obvious and real factors that are related to psychological distress in women coping with breast cancer, such as facing a life-threatening illness, painful and impairing treatments, and significant role changes. Although these factors are clearly important, issues related to body image in women faced with breast cancer can also add to psychological distress. Women, in general, are concerned with their appearance, their weight, and their body, with recent studies suggesting 89% of women reported concerns with weight. Such premorbid concerns are often deeply ingrained and can contribute to psychological distress in women treated for breast cancer. The present article is a summary of the literature that has examined body image issues and related psychological adjustment in women with breast cancer. Implications for clinical practice and recommendations for future investigations are discussed.

Effectiveness of cosmetic rehabilitation on the body image of oral cancer patients in Taiwan

GOALS OF THE WORK

Oral tumors and their treatment cause obvious changes in disfigurement and functions of cancer patients. Therefore, some kind of strategy to improve personal appearance is important in nursing care. This prospective study intended to verify the effects of a cosmetic rehabilitation program on the body image of oral cancer patients.

MATERIALS AND METHODS

A single-blind quasi-experimental design with repeated-measures design was used in this study. The experimental group received instruction on cosmetic rehabilitation, whereas the control group received regular nursing care. The experimental group and control group each had 22 subjects who were requested to complete the questionnaires throughout the regular follow-up (during admission, after 6 weeks, and after 12 weeks). The Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) was selected for data collection.

MAIN RESULTS

The results showed that subjects in both experimental and control groups reported similar levels of body image in each subscale of MBSRQ-AS before conducting cosmetic rehabilitation. The appearance evaluation subscale was the only one that changed significantly in both the experimental and control groups during the research period. Nevertheless, results of item comparison showed that cosmetic rehabilitation had improved the scores of "I like the way I am," "most people think that I am good looking," "body weight," and "face" in the experimental group.

CONCLUSION

Present study confirmed that cosmetic rehabilitation had similar effects on the body image of oral cancer patients. Integration of cosmetic program into the routine nursing care for oral cancer patients is highly recommended.

Women's Experiences of an Altered Appearance during Chemotherapy

This study explores breast cancer patients' experiences of chemotherapy treatment, with a focus on the impact of an altered appearance during this time. We present two key themes from the thematic analysis of interviews with 19 women: anxiety that chemotherapy will render them identifiable as a `person-with-cancer'; and problematic interactions with others. We discuss how changes in appearance can reveal disease status to others, demonstrate the personal impact of temporary changes to appearance, relate these findings to literature on psychosocial aspects of disfigurement and consider the provision of psychosocial care for women experiencing an altered appearance during chemotherapy.

Breast Reconstruction following Mastectomy for Breast Cancer: The Decisions of Sexual Minority Women

BACKGROUND

Prior research on decision-making for reconstructive surgery after mastectomy has not addressed the specific considerations of sexual minority women (women who partner with women, and lesbian or bisexual identified women). The purpose of this study is to explore which issues sexual minority women considered when making decisions on reconstructive surgery and to understand the influence and perspectives of these women's most important support persons.

METHODS

Study participants were recruited through targeted community-based sampling. The authors conducted individual semistructured interviews with 15 sexual minority women who had been treated with mastectomy after breast cancer diagnosis and 12 support persons who were identified by these women as their most important source of support. Using qualitative data analysis software, transcribed interviews were analyzed. Through constant comparison methods, themes related to the decision on and experiences and satisfaction with reconstructive choice were identified from the narrative data.

RESULTS

The considerations of women who decided for or against reconstruction are rooted in a value system and body image shaped by their sexual minority identity. Women who chose reconstruction experienced difficulties and regrets, whereas women without reconstruction adjusted well after time. Partners of sexual minority women matched the level of satisfaction with reconstructive choice achieved by the women themselves.

CONCLUSION

Providers who treat sexual minority women might benefit from knowing about issues important to this population to provide more comprehensive care.