Body image dimensions and cancer: a heuristic cognitive behavioural model

The influence of body image on psychological symptomatology in breast cancer women undergoing intervention: a pre-post study

Introduction

Body image concerns related to breast cancer surgery may challenge patients' quality of life and their treatment outcomes, thus representing a key aspect to be assessed in the psycho-oncological settings. The present longitudinal study is aimed to (1) investigate the association between preoperative body image and postoperative psychological symptoms in breast cancer patients; (2) explore the impact of pre-/post-surgery variation in body image on psychological symptomatology.

Methods

N = 72 women undergoing breast cancer surgery were preoperatively screened (T1) using the Body Uneasiness Test (BUT) and were assessed postoperatively (T2) using the Symptom Checklist-90 Revised (SCL-90-R) and re-administered the BUT. Spearman's correlation was used to investigate the relationship between age, preoperative body image and postoperative psychological symptoms, and variation in body image. To predict post-surgical psychological symptomatology, two separated multiple regression models were used to evaluate preoperative body image and its variation after surgery controlling for covariates (i.e., education; intervention type). P significance was set as 0.05 for all analyses and adjusted for multiple comparisons.

Results

At T1, anxiety in relation to body image scores emerged as the most frequently experienced psychological symptomatology after surgery (all adjusted p < 0.05). Significant correlations were observed between all SCL-90-R scores at T2 and avoidance behaviors and depersonalization scores at T1. The associations were most significantly strong for somatization, depression, anxiety, and hostility (all adjusted p < 0.05). However, change in body image between pre- and post-intervention was not associated with psychological symptomatology at T2 (all adjusted p > 0.05). Pre-surgery body avoidance was significantly associated with post-intervention psychological symptoms (SOMβ = 0.453, p = 0.0001; DEPβ = 0.507, p = 0.0001; AXβ = 0.459, p = 0.0001; HOSβ = 0.410, p=. 0001). However, increased weight phobia between pre- and post-surgery was statistically associated with increased somatization, anxiety, depression and hostility at T2 (βSOM = 0.439, p = 0.0001; βDEP = 0.454, p = 0.0001; βANX = 0.471, p = 0.0001).

Discussion

Overall, pre-/post-intervention body concerns were significantly associated with primary psychological symptoms in breast cancer patients undergoing surgery. Higher levels of body avoidance and weight phobia were significantly associated with the primary psychological dimensions assessed. As body concerns might act as quality-of-life predictors, their evaluation is crucial in fostering patients' well-being and treatment adherence.

The mediating effect of personal mastery and perceived social support between emotional intelligence and social alienation among patients receiving peritoneal dialysis

Aim

This study aims to assess the extent of social alienation in patients undergoing peritoneal dialysis and examine how personal mastery and perceived social support mediate the association between emotional intelligence and social alienation in this patient population.

Methods

This study adopts a cross-sectional survey design. A total of 192 patients were recruited from a tertiary hospital located in Henan Province, China, using a convenience sampling method. We have developed a structural equation model to investigate the mediating influence of personal mastery and perceived social support on the emotional intelligence and social alienation of patients undergoing Peritoneal dialysis.

Results

Peritoneal patients exhibited an social alienation score of 42.01 ± 3.15. Elevated EI levels (coefficient = -0.616, p < 0.001) were significantly correlated with reduced social alienation. The mediation model demonstrated that personal mastery and perceived social support fully mediated the impact of emotional intelligence on social alienation.

Conclusion

The social alienation of peritoneal dialysis patients is serious, and healthcare professionals should pay attention to patients' social alienation, improve patients' emotional intelligence through relevant interventions, increase personal mastery and perceived social support, and finally reduce social alienation.

Loneliness and Perceived Social Support in Endometriosis: The Roles of Body Image Disturbance and Anticipated Stigma

BACKGROUND

Research has identified that living with the chronic inflammatory disease endometriosis adversely impacts social functioning and interpersonal relationships, specifically, feelings of loneliness and a lack of perceived social support. Commonly experienced body image disturbance (BID), combined with the anticipation of endometriosis-related stigma from others, may result in further social withdrawal. This study aimed to quantitatively investigate the association between BID and social functioning (loneliness and diminished perceived social support), and the potential moderating effect of anticipated stigma on these associations.

METHOD

Participants (N = 212) with a self-reported endometriosis diagnosis completed an online questionnaire measuring social and emotional loneliness, perceived social support, BID, anticipated stigma and demographic and medical characteristics.

RESULTS

Mean scores indicated high levels of BID, emotional loneliness and diminished perceived social support. Bootstrapped multivariable regression analyses indicated that BID was significantly associated with greater emotional loneliness and lower perceived social support. BID was also associated bivariately with greater social loneliness. Anticipated stigma from healthcare workers moderated the association of BID with perceived social support, such that poorer perceived support was reported when anticipated stigma was high, despite the presence of minimal BID.

CONCLUSION

These findings highlight the psychological challenges of living with endometriosis in terms of highly prevalent BID, in the context of feeling lonely and poorly supported. The further negative impact of anticipated stigma suggests that psychosocial interventions may benefit from additionally targeting these perceptions of stigma.

Role performance and factors affecting quality of life in bladder cancer survivors with ileal orthotopic neobladder

Objective

Bladder cancer survivors with neobladder experience changes in role performance and quality of life (QoL) due to various symptoms and problems, but related studies are limited. Therefore, this study attempted to explore the QoL and factors influencing it in bladder cancer survivors with neobladder.

Methods

A cross-sectional descriptive design was used. Data were collected from 100 bladder cancer survivors with a neobladder using the European Organisation for Research and Treatment of Cancer QLQ-C30 and Muscle-Invasive Bladder Cancer Module, the Patient Activation Measure 13, the Enforced Social Dependency Scale, and the Multidimensional Scale of Perceived Social Support. Factors affecting the QoL were identified using multiple regression analysis.

Results

QoL significantly differed by daily pad usage, need for clean intermittent catheterization, and role performance. QoL was correlated with urinary symptoms and problems, future perspective, abdominal bloating and flatulence, body image, role performance, and social support. Role performance, body image, and the need for clean intermittent catheterization were identified as the factors affecting QoL.

Conclusions

The study highlights the importance of bladder cancer survivors continuing their roles at home, at work, and in society after neobladder reconstruction. Specifically, continuing recreational and social activity positively affects QoL, even if the activity range is modified. To help with their role performance, institutional support and changes in social perception are needed. Additionally, education and interventions, including body image enhancement, symptom management, and self-care, should be developed and applied to improve their QoL.

The marked body: Exploring experiences of post-mastectomy scarring, body image and change through artistic tattooing

Breast cancer has become the most prevalent cancer globally, predominantly affecting women, with mastectomy surgery a frequent treatment. Women often experience a discrepancy between their post-mastectomy body, and their former sense of self, affecting negatively on wellbeing. The narratives of eight women who chose to artistically tattoo over their mastectomy scars were explored in this study, through semi-structured interviews and Interpretative Phenomenological Analysis (IPA). Seven master themes are presented. These themes follow the women from a state of disruption (of body image and gender identity) and surgical scarring as the first marking of the body, to the second marking of the body through artistic tattooing, bringing with it transformation, acceptance, feeling heard and connection with the artist, closure and control and the creation of significance and meaning. Viewed through Self-Discrepancy Theory, the findings of this study has implications for psycho-oncology and wellbeing support for women following mastectomy surgery.

Cross-Cultural Adaptation and Validation of the Korean Version of the Body Image After Mastectomy Scale

OBJECTIVE

This study aimed to evaluate the psychometric properties and validity of the Korean version of the Body Image After Mastectomy Scale (K-BIMS).

METHODS

This validation study was divided into two phases. Phase 1 included the translation of the K-BIMS according to the World Health Organization recommendations, investigation of content validity by five experts, and a pilot study involving 10 participants for the final list of K-BIMS items. The study participants included 156 women who met the inclusion and exclusion criteria to verify the validity-reliability of the K-BIMS. Phase 2 included a validity-reliability analysis of the K-BIMS. This included convergent validity, known-group validity, construct validity assessed by confirmatory factor analysis, and item-total score correlation. We assessed internal consistency using the Cronbach α.

RESULTS

The K-BIMS confirmatory factor analysis demonstrated good fitness of indices and validity including content validity, convergent validity, and known-group validity was satisfactory. Internal consistency reliability was satisfying with a Cronbach α reliability of .89.

CONCLUSIONS

The results revealed that the K-BIMS is a valid and reliable instrument for assessing appearance-based behaviors and beliefs about body image distress among women who underwent reconstructive surgery after mastectomy.

IMPLICATIONS FOR NURSING PRACTICE

To identify individuals who exhibit maladaptive symptoms and are at risk of developing long-term body image problems, the K-BIMS can be used as a point-of-care screening tool. Therefore, the K-BIMS can be used as an early screening tool to proactively offer accessible and affordable solutions.

Mechanism underlying a brief cognitive behavioral treatment for head and neck cancer survivors with body image distress

PURPOSE

Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT.

METHODS

In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive five weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the Inventory to Measure and Assess imaGe disturbancE-Head and Neck (IMAGE-HN). Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores.

RESULTS

Among 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month resulted in decreases in IMAGE-HN scores from baseline to 3 months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3 months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039).

CONCLUSIONS

This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03831100 .

The mediation effect of social support between stigma and social alienation in patients with stroke

Background

Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation.

Methods

A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model.

Results

The results showed that stigma has a negative effect on social support (β = -0.503, p<0.001); stigma has a positive effect on social alienation (β = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect.

Conclusion

Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.

Mechanism Underlying a Brief Cognitive Behavioral Treatment for Head and Neck Cancer Survivors with Body Image Distress

Purpose

Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT.

Methods

In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive 5 weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the IMAGE-HN. Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores.

Results

Among 44 HNC survivors with BID, mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month decreased IMAGE-HN scores from baseline to 3-months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3-months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039).

Conclusions

This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors.

Trial Registration

This trial was registered on ClinicalTrials.gov identifier NCT03831100 on February 5, 2019.

Efficacy of a brief cognitive behavioral therapy for head and neck cancer survivors with body image distress: secondary outcomes from the BRIGHT pilot randomized clinical trial

PURPOSE

Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

METHODS

In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose and delivery-matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1 and 3-month post-intervention.

RESULTS

Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1).

CONCLUSIONS

In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03831100 .

IMPLICATIONS FOR CANCER SURVIVORS

These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

Efficacy of a Brief Cognitive Behavioral Therapy for Head and Neck Cancer Survivors with Body Image Distress: Secondary Outcomes from the BRIGHT Pilot Randomized Clinical Trial

Purpose: Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT ( B uilding a R enewed I ma G e after H ead & neck cancer T reatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Methods: In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1- and 3-months post-intervention. Results: Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1). Conclusions: In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID. Implications for Cancer Survivors: These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Trial Registration: ClinicalTrials.gov identifier: NCT03831100.

Psychosexual development, sexual functioning and sexual satisfaction in long-term childhood cancer survivors: DCCSS-LATER 2 sexuality substudy

OBJECTIVES

Childhood cancer may negatively impact childhood cancer survivors' (CCS) sexuality. However, this is an understudied research area. We aimed to describe the psychosexual development, sexual functioning and sexual satisfaction of CCS, and identify determinants for these outcomes. Secondarily, we compared the outcomes of a subsample of emerging adult CCS to the Dutch general population.

METHODS

From the Dutch Childhood Cancer Survivor Study LATER cohort (diagnosed 1963-2001), 1912 CCS (18-71 years, 50.8% male) completed questions on sexuality, psychosocial development, body perception, mental and physical health. Multivariable linear regressions were used to identify determinants. Sexuality of CCS age 18-24 (N = 243) was compared to same-aged references using binomial tests and t-tests.

RESULTS

One third of all CCS reported hindered sexuality due to childhood cancer, with insecure body the most often reported reason (44.8%). Older age at study, lower education, surviving central nervous system cancer, poorer mental health and negative body perception were identified as determinants for later sexual debut, worse sexual functioning and/or sexual satisfaction. CCS age 18-24 showed significantly less experience with kissing (p = 0.014), petting under clothes (p = 0.002), oral (p = 0.016) and anal sex (p = 0.032) when compared to references. No significant differences with references were found for sexual functioning and sexual satisfaction, neither among female CCS nor male CCS age 18-24.

CONCLUSIONS

Emerging adult CCS reported less experience with psychosexual development, but similar sexual functioning and sexual satisfaction compared to references. We identified determinants for sexuality, which could be integrated in clinical interventions for CCS at risk for reduced sexuality.

How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes

BACKGROUND

In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL.

METHODS

EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time.

RESULTS

BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101).

CONCLUSIONS

Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.

Body image concerns in long-term head and neck cancer survivors: prevalence and role of clinical factors and patient-reported late effects

PURPOSE

Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns.

METHODS

This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates.

RESULTS

A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems.

CONCLUSIONS

Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients' daily functioning and symptoms.

IMPLICATIONS FOR CANCER SURVIVORS

Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need.

The German version of the body image scale: Validation and item response analysis in cancer patients

OBJECTIVE

To translate the cancer-specific Body Image Scale (BIS) into German and assess its psychometric properties.

METHODS

The BIS was translated in accordance with current guidelines. In a prospective, cross-sectional two center study (psychosocial counselling center for cancer patients Leipzig, oncological inpatient ward Berlin), we assessed composite reliability and factor structure using confirmatory factor analysis. Additional item response theory (IRT) modelling was performed. Convergent validity was assessed via correlation with the Body Appreciation Scale (BAS) as well as psychological symptom burden (PHQ-9, GAD-2 and Distress Thermometer). Discriminant validity was assessed via demographic and clinical group comparisons.

RESULTS

677 patients participated (response rate 78%). Composite reliability was 0.95 and the one-factor structure was confirmed (standardized root mean square residual = 0.051, average variance extracted ≥50%, no indications of local dependence). In IRT models, all items had a discriminating power above the established threshold of b = 0.5 and relatively high "difficulty" parameters (b = 0.89-2.06). The BIS was negatively correlated with the BAS (rho = -0.62, p < 0.001) and positively with psychological symptom burden (e.g. PHQ-9: rho = 0.49, p < 0.001). Patients who were younger, female, had undergone chemotherapy, radiotherapy or surgery and those who were distressed by fatigue, their appearance or sexual problems had significantly higher BIS scores.

CONCLUSION

The German version of the BIS is a valid tool to assess BID in patients with cancer that is now available for clinical or research contexts.

Sexual dysfunction in female patients with anal cancer treated with curative intent: A systematic review of the literature

BACKGROUND AND PURPOSE

Patients with anal squamous cell carcinoma (SCC) are treated with sphincter-preserving radiation therapy and concurrent chemotherapy, achieving excellent oncologic outcomes. Patients, however, may experience treatment-related morbidity including sexual dysfunction. The objective of this systematic review was to review the literature on sexual dysfunction in female patients treated for anal cancer and to identify knowledge gaps.

MATERIALS AND METHODS

This systematic review was registered in PROSPERO prior to initiation. Databases searched included MEDLINE, Embase, PubMed, Cochrane, and Google Scholar. There were no restrictions on the study time period. Studies were limited to English. All study designs were included except review articles, letters to the editor, and case reports with less than ten patients.

RESULTS

In total, 1801 studies were retrieved and 19 met the inclusion criteria, including: 13 cross-sectional surveys, 3 prospective studies, 1 longitudinal intervention study, 1 retrospective chart review, 1 case control study. Sexual function was assessed using the female sexual functioning index (FSFI), EORTC-QLQ-CR30 and -CR38; response rates were low (<50 % in most studies). Sexual dysfunction was reported by up to 85 % of women; the most common symptoms being dyspareunia (17-65 %), vaginal dryness (22-88 %), and loss of libido (38-95 %). Gastrointestinal issues, such as bowel problems, and body image concerns additionally affected sexual function and quality of life.

CONCLUSION

Sexual dysfunction is a common issue affecting most female patients treated for anal cancer and there is a paucity of evidence on the management of this important survivorship issue. There is additionally a lack of ethnic, economic, and educational diversity and there are no studies addressing the unique needs of LGBTQ individuals - future studies should make a concerted effort to include a diverse patient population.

Body image and depression in endometriosis: Examining self-esteem and rumination as mediators

Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.

Social isolation in adults with cancer: An evolutionary concept analysis

Background

In extant literature, the concept of social isolation has been explored primarily in the context of older adults. However, people with cancer may also experience social isolation, and there is a need for increased clarity regarding this phenomenon in this population.

Objective

To conceptualize social isolation in adult cancer care.

Methods

PubMed, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database were systematically searched using the key terms “cancer,” “social isolation,” “social alienation,” and “social exclusion” for studies (from the earliest date available to June 2022). The main disciplines involved were psychology, nursing, medicine, and public health. Rodgers’ evolutionary concept analysis was employed to clarify the antecedents, attributes, and consequences of social isolation in adults with cancer.

Results

A total of 60 eligible articles were reviewed entirely and the main findings were categorized into antecedents, attributes, and consequences. The antecedents of social isolation were classified into six categories: cancer-related physiological changes, cognitive beliefs, psychological wellbeing, unsatisfactory social supports or relationships, restrictions associated with receiving treatments, and social-level barriers. Attributes were characterized according to behavior or social avoidance and negative affective experiences, while consequences were attributed to low therapeutic compliance, poor health conditions and mental health problems, and low quality of life. White’s heuristic model is a potential theoretical context applicable to social isolation in adults with cancer.

Conclusion

This concept analysis provides a basis for developing multidimensional assessment tools and measures to alleviate social isolation in adults with cancer, a complex and varied phenomenon. However, while this review contributes to the current knowledge on social isolation in people with cancer, studies should further investigate the relationships among attributes associated with social isolation.

Exploring the validity of the body image scale with survivors of breast cancer: A cognitive interview approach

OBJECTIVE

The aim of this study is to explore the construct validity of the Body Image Scale for Cancer Questionnaire (BIS) using cognitive interviews.

METHODS

Twelve breast cancer survivors participated in a cognitive interview while completing the BIS. Each participant was asked to think-out-loud while answering items, and an interviewer asked probing questions relating to the participants' comprehension, example retrieval, certainty of answer and other decision-making factors. Interviews were audio recorded and transcribed, and the data were analysed deductively and inductively.

RESULTS

The participants' interpretations of the questions varied significantly. Several participants perceived the phrasing of some questions to be leading. The participants were able to provide examples of how their physical, physiological and body function affected their body image. The participants expressed positive attitudes towards, and gratitude for their body, which was not captured by the questionnaire. At times, the participants felt uncertain in how to respond appropriately to specific items, and the participants found some items challenging to answer. Finally, the BIS included sensitive questions that elicited emotional reactions and discomfort for some participants.

CONCLUSION

The findings of this study provide insight into, and suggestions for potential questionnaire revisions that may enhance the validity and relevance of the BIS for use with breast cancer survivors.

Probiotic effects on sexual function in women with polycystic ovary syndrome: a double blinded randomized controlled trial

Background

Considering the presence of sexual dysfunction in patients with polycystic ovary syndrome, our aim was to provide scientific evidence studying effect of oral probiotic on sexual function in patients with PCOS treated with letrozole in an Iranian population.

Methods

This study was a double blind randomized clinical trial. Eligible women were allocated to Lactofem plus letrozole (n = 20) or letrozole (n = 20). Folic acid was prescribed to all participants in two groups during the study. In group A, Lactofem capsule was administered daily for the first month. In the second month, letrozole (2.5 mg daily from the third day of the menstrual cycle for 5 days) plus Lactofem capsule same as previous month were prescribed. In group B, letrozole administered 2.5 days from the third day of the menstrual cycle for 5 days in the second month. All questionnaires were completed by patients after the intervention (two months after the start of treatment). The Female Sexual Function Index (FSFI) and Body Image Concern Inventory (BICI) were used to assess sexual function and body satisfaction, respectively.

Results

There is statistically significant increase in chemical pregnancy rate (10% vs. 0%; p = 0.05) and clinical pregnancy (10% vs. 0%; p = 0.05) in Probiotic plus letrozole group compared to letrozole group after intervention. Based on our results, there was a statistically significant difference in each domain and sum score of sexual function of before and after the intervention between group (P < 0.05). Our findings have been shown, after eight weeks, the probiotic plus letrozole group had a significant improvement in the FSFI domains and sum score compared to letrozole alone group. Moreover, there are a significant improvement in mean (IQR) of body image score in probiotic group [30 (4.99) vs. 40 (4.36); P < 0.01].

Conclusion

The results of the current study suggests that eight weeks of administration of probiotic may improve chemical and clinical pregnancy rate, sexual function and body satisfaction in women with PCOS.

Body image in women diagnosed with breast cancer: A grounded theory study

Using a Straussian grounded theory methodology, we explored the meaning women attribute to body image and how they understand their breast cancer experience as influencing their body image to develop a grounded theory of body image for women diagnosed with breast cancer. Interviews were conducted with 27 women who had completed treatment for breast cancer in Canada. Data were analyzed through a process of open, axial, and selective coding using constant comparison techniques and memo-writing. A grounded theory of body image for women diagnosed with breast cancer was developed around the core category of body image: what it means to women, which was underpinned by six themes and 17 subthemes. This theory explains how women diagnosed with breast cancer define body image and illustrates intrapersonal and interpersonal factors that can undermine or support their body image, along with strategies they used to manage their body image. This theory can guide research and practice aimed at enhancing body image and minimizing its consequences for women diagnosed with breast cancer.

The role of psychosocial factors in patients' recollections of breast reconstruction options discussed with their surgeons

A patient's comprehension and memory of conversations with their providers plays an important role in their healthcare. Adult breast cancer patients whose legal sex was female and who underwent treatment at the Center for Reconstructive Surgery at The University of Texas MD Anderson Cancer Center were asked to indicate which breast reconstruction procedures they discussed with their surgeon. We focused on the three most frequent responses: (a) participants who remembered discussing implant-based, tissue-based, and combination procedures; (b) participants who remembered only an implant-based option being discussed; and (c) participants who remember only a tissue-based option being discussed. We used multinomial logistic regression models to explore the psychosocial factors associated with patients' recollections of their breast reconstruction options after discussions with their reconstructive surgeons, controlling for medical factors that impact surgical decision-making. Our analyses identified body mass index, body image investment, and body image as statistically significantly associated with the reconstructive options that a participant recalls discussing with their surgeon. Our findings highlight body image investment and body image as important psychological factors that may influence what patients remember from consultations about breast reconstruction options.

Dyadic Profiles of Couples Coping With Body Image Concerns After Breast Cancer: Preliminary Results of a Cluster Analysis

Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at (1) exploring rates of body image concerns among breast cancer patients, and (2) identifying dyadic profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners (n = 32) were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics (BFQ-2), psychological distress (HADS), coping flexibility (PACT), dyadic coping (DCQ), and closeness (IOS). Body image (BIS) and adjustment to cancer (Mini-MAC) measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” (cluster-1) reported low rates of body image concerns (p < 0.001), anxious preoccupation, negative dyadic coping, and self-oriented stress communication (p < 0.05), compared to “worried patients” (cluster-2). “Comfortable partners” (cluster-1) reported lower anxiety and depression (p < 0.001), self-oriented negative dyadic coping and closeness (p < 0.05) than “uncomfortable partners” (cluster-2). Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations (p < 0.05) by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions.

Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study

Objective

Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse.

Methods

Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.

Results

Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.

Conclusion

This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.

Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China

Background

Breast cancer survivors experience altered body image and quality of life (QoL) due to the disease and its treatment. The multidimensional nature of body image and QoL makes their relationships complex. This study aimed to examine the associations between the two concepts in Chinese breast cancer survivors and test whether these associations are moderated by rural–urban residence.

Methods

A cross-sectional design was adopted. Breast cancer survivors were recruited via a convenience sampling method. Two validated questionnaires (the Body Image Self-Rating Questionnaire for Breast Cancer and 36-item Short-Form Health Survey) and questions assessing demographic and clinical covariates were administered. Multiple linear regressions were used to assess the relationship between body image and QoL domains and to examine the moderating effect of rural–urban residence.

Results

In our sample of 354 breast cancer survivors, half (50.28%) lived in rural areas. After adjusting for demographic and clinical variables, better perception of body image-related sexual activity change, role change, and psychological change was significantly associated with better physical (β ranged from − 0.15 to − 0.11, p < 0.05) and mental (β ranged from − 0.46 to − 0.34, p < 0.001) well-being. Better perception of body image-related social and behavior change was significantly associated only with better mental well-being (β ranged from − 0.40 to − 0.33, p < 0.001). The association between body image and mental well-being was much stronger in urban subjects (b = − 0.38, p < 0.001) than in rural subjects (b = − 0.20, p < 0.001).

Conclusions

Our findings suggest that multidimensional body image is associated with physical and mental well-being in Chinese breast cancer survivors. Body image appears to play a larger role in urban breast cancer survivors’ mental well-being. Our results indicate that incorporating interventions that address body image issues would be advantageous for survivorship care to enhance QoL in breast cancer survivors. Furthermore, rural–urban differences should be considered in the strategic design of survivorship care programs in rural and urban settings.

Appearance investment, coping strategies, and psychosocial adjustment in male patients with head and neck cancer

Background: This study examined the interrelationships among two facets of appearance investment (self-evaluative salience and motivational salience), appearance-related coping strategies, and psychosocial adjustment in male patients with head and neck cancer following physical appearance changes.Methods: It adopted a cross-sectional design; 136 male patients with stage I-III head and neck cancer were recruited. Self-reported scales were used to assess physical appearance changes due to cancer surgery and treatment, appearance investment, coping strategies, psychological distress, and disease-specific quality of life. Data were analyzed using path analysis.Results: Results showed that self-evaluative salience was directly and negatively associated with psychosocial adjustment, and motivational salience was indirectly and positively associated with psychosocial adjustment through coping strategies of less avoidance and greater positive rational acceptance.Discussion: This study also provides important information regarding the possible pathways of appearance investment and coping strategies in the psychosocial adjustment of male patients with head and neck cancer.

Testing the Associations Between Body Image, Social Support, and Physical Activity Among Adolescents and Young Adults Diagnosed With Cancer

Physical activity (PA) is important for managing the side effects and long-term outcomes of cancer treatment, yet many adolescents and young adults diagnosed with cancer (AYAs) are not meeting PA guidelines. Body image and social support are two factors that can influence PA behavior and require further attention in this population. The purpose of this study was to examine the associations between body image, social support, and PA among AYAs. An online cross-sectional survey administered through the Research Electronic Data Capture platform was used to assess self-reported body image (body-related self-conscious emotions of appearance and fitness shame, guilt, authentic pride, and hubristic pride), social support (general and cancer-specific), and PA (mild, moderate-to-vigorous, and resistance exercise) in AYAs (N = 119; M age = 34.5 ± 5.5 years). Based on findings from path analyses, body image and social support were directly associated with PA (R 2 = 0.09-0.33). Social support was also directly associated with body image. However, there were no indirect effects. These findings provide preliminary support for the influential role of appearance and fitness body-related emotions and cancer-specific social support on PA. The results have important implications for the development of targeted strategies aimed at improving body image (e.g., cognitive dissonance and compassion-focused interventions) and social support (e.g., facilitating the provision of cancer-specific support), with the overall goal of increasing AYAs' PA.

Aesthetic monitoring-based assessment of oncological safety of oncoplastic management of breast cancer: a multi-center research study

BACKGROUND

Oncoplastic Breast surgeries (OBS) in breast cancer have evolved to preserve the cancerous breast rather than its amputation to improve postoperative cosmetic results. The lack of evidence to support the oncological safety and benefits of OBS is questionable. In this study, we evaluate various aspects of oncoplastic surgeries with a focused monitoring of aesthetic results and oncological safety.

METHODS

This was a multi-center observational study focused on the statistics of data collected from cases who underwent oncoplastic surgeries from the cohort of breast cancer candidates at Mansoura University Hospitals/Egypt and King Faisal Medical Complex/KSA from January 2015 to June 2018. All data were analyzed carefully using SPSS v-26.

RESULTS

Eighty cases who underwent different oncoplastic surgeries were included and reviewed for the aesthetic outcome and oncological safety. The recurrence rate was found to be 2.5%. The breast impact treatment scale assessment method was used to analyze the aesthetic outcomes, and average scores were accepted in 90% of patients.

CONCLUSIONS

The oncoplastic breast surgeries are feasible and they had a high rate of oncological safety with the maintenance of good aesthetic outcomes and patient satisfaction.

[From the dream body to the real body, a clinical look at body image]

As the object of care in medical treatment, the body is apprehended and invested in by patients from the point of view of the subject. The social, cultural and historical background of the subjects shapes their relationship with their body and regulates the possible impact of its transformations. These elements are important to take into account in the identification of body image disturbances and access to dedicated care. The experience of carers in dealing with these "marked" bodies must also be taken into account.

The effect of mobile health educational intervention on body image and fatigue in breast cancer survivors: a randomized controlled trial

BACKGROUND

Cancer-related fatigue, physical changes, and pain are among the most troublesome symptoms caused by breast cancer treatment and influence the patients' quality of life. The aim of the present study was to examine the effect of mobile health educational intervention on body image and fatigue in breast cancer survivors.

METHODS

The present clinical trial study conducted on 38 women with breast cancer referred to Golestan and Shahid Baghaei 2 hospitals, Ahvaz, south west Iran in 2018-2019. Patients were randomly assigned into two intervention group, and control groups on 1:1 basis. Data collection tool included three parts: cancer fatigue scale, body image concern inventory, and demographic information. Text messages sent to intervention group via WhatsApp messenger for 7 weeks on a daily schedule. The control group did not receive any messages. Data were analyzed using SPSS Version 23.0.

RESULTS

The mean age of participants was 46.34 ± 9.96. The mean score of cancer fatigue scale after the intervention in the intervention group was decreased significantly (p = 0.005), but no statistically significant difference was observed in the control group. There was a significant difference in the mean score of body image concern inventory in the intervention group (p = 0.002) after the intervention compared with the control group.

CONCLUSION

Mobile health educational intervention improved cancer-related fatigue and body image among women breast cancer survivors. The integration of education for the management of fatigue and body image disturbance as part of routine care among breast cancer survivors is recommended.

Body image among adolescents and young adults diagnosed with cancer: A scoping review

OBJECTIVE

Cancer and treatment can produce temporary or permanent body changes, which may affect the body image (BI) of adolescents and young adults diagnosed with cancer (AYAs). This evidence has not been comprehensively summarized. A scoping review was conducted to explore the available evidence on BI among AYAs and identify the definitions, theories, models, frameworks, measures, and methods used to assess BI.

METHODS

Databases MEDLINE, EMBASE, PsycINFO (via Ovid) and CINAHL and Gender Studies (via EBSCO) were searched to identify published studies from 1 January 2000 to 25 November 2019. Inclusion criteria were: qualitative, quantitative, or mixed methodology; at least one BI-related measure or theme; published in English; and majority of the sample between 13 and 39 years at diagnosis and a mean age at diagnosis between 13 and 39 years. Two authors screened the titles, abstracts, and full-text articles and data were extracted and summarized.

RESULTS

The search yielded 11,347 articles and 82 met inclusion criteria. Articles included 45 quantitative, 33 qualitative, and four mixed-methods studies. The majority of studies used cross-sectional designs, while BI definitions, theories, models, frameworks, and measures were varied. Studies explored descriptive, psychological, physical, coping, and social factors, with BI being described most often as an outcome rather than a predictor.

CONCLUSIONS

Theory-based research that employs a holistic BI definition and uses longitudinal or intervention study designs or a qualitative methodology is needed to better understand the BI experience of AYAs and inform the development of strategies and programs to reduce BI concerns and increase positive body experiences.

M, Belaid A, Gargouri W, Nasr C. Évaluation de l’image du corps chez des femmes traitées pour un cancer utérin

Introduction : À l’heure actuelle, le retentissement des cancers utérins, ainsi que leur traitement sur l’image du corps, demeure un sujet peu étudié en Tunisie et souvent négligé aussi bien par les praticiens, les malades et leurs partenaires.

Méthodes : Il s’agit d’une étude transversale descriptive colligeant 100 patientes tunisiennes suivies à l’institut Salah- Azaïez pour un cancer de l’endomètre ou du col utérin confirmés histologiquement et non métastatiques, avec un recul supérieur à six mois. Nous avons utilisé l’échelle Body Image Scale (BIS) et Female Sexual Function Index (FSFI). Nous avons collecté les antécédents personnels et familiaux, et différentes données sociodémographiques des patientes.

Résultats : Dans notre étude, 40 % des patientes ont des troubles de l’image du corps. La moyenne du score BIS était de 12,03 avec des extrêmes allant de 0 à 30 avec un écarttype de 7,88. En analyse univariée, l’absence du soutien familial, l’altération de la relation de couple et de la relation sexuelle, la mauvaise tolérance de la chirurgie et la curiethérapie utérovaginale étaient significativement associées à l’altération de l’image corporelle. En analyse multivariée, le bas niveau socio-économique était le facteur indépendant protecteur du trouble de l’image du corps, et la dysfonction sexuelle était le facteur indépendant prédicteur de ce trouble.

Conclusions : Le manque de communication des patientes avec leur conjoint et avec l’équipe de soin constitue l’un des principaux obstacles lorsqu’il s’agit de reconnaître et de traiter ce problème. Des stratégies préventives visant à maintenir une image corporelle positive chez ces femmes devraient être entreprises.

From breast cancer surgery to survivorship: Insecure attachment tendencies predict negative psychological outcomes

Little is known about the variables explaining individual variability in the long-term adaptation of breast cancer survivors. Attachment tendencies have, however, been shown to explain negative psychological outcomes in the postsurgical period. The present study aimed to assess the continuing influence of attachment tendencies in the survivorship period. A sample of 28 women were surveyed 2 weeks, 3 months, 12 months, and 5 to 7 years after surgery. Attachment tendencies and psychological outcomes (distress, body image, sexuality) were assessed through questionnaires, and medical and sociodemographic data collected. Results show that insecure attachment tendencies predict negative body image and elevated distress.

Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients: results from a psychiatric oncology clinic

PURPOSE

Adequate adjustment to bodily changes during various phases of cancer treatment is important to patients' emotional well-being. The Body Image Scale (BIS) is a widely used tool for assessment of body image concerns in different cancer types. However, a cut point score indicative of clinically relevant body image concerns has not been established. The purpose of our study was to evaluate whether the previously suggested, but not validated, BIS cut point score of ≥ 10 is an adequate indicator of psychological distress.

METHODS

In a prospective cross-sectional study, 590 adult patients were recruited from a psychiatric oncology clinic (November 2017-March 2018). Patient-reported body image concerns, depression, anxiety, and emotional distress were assessed with the BIS, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and National Comprehensive Cancer Network Distress Thermometer, respectively.

RESULTS

Almost half of the patients had a BIS score ≥ 10; these were more likely to be younger, female, Hispanic, and to have breast cancer than patients with a score < 10. BIS scores were positively associated with depression, anxiety, and distress scores. A BIS score ≥ 10 was a significant predictor of moderate depression and anxiety (odds ratios = 3.555 [95% CI 2.478-5.102] and 3.655 [2.493-5.358]; p < 0.001 for both).

CONCLUSION

To our knowledge, this is the first study to have assessed the validity of the previously suggested clinically relevant BIS cut point score of ≥ 10 as an indicator of psychological distress. Our results suggest that a BIS score of ≥ 10 or higher should lead to follow-up on body image concerns and/or appropriate referral.

The role of body image in treatment decision-making and post-treatment regret following prostatectomy

Three main treatments are offered to men with localised prostate cancer: active monitoring, radiotherapy and prostatectomy. The aim of this research was to explore the role of body image in treatment decision-making and post-treatment regret following prostatectomy for localised prostate cancer. Data were collected via nine semi-structured interviews. Interviews underwent thematic analysis and four themes emerged: need to prolong life, loss of function and self, post-surgery effects on body image and confidence, and coping strategies. Participants revealed that loss of erectile function following surgery resulted in reduced self-confidence, and changes in their perception of their body.

Resistance Exercise and Art Therapy on Body Image in Breast Cancer: A Scoping Review

Background: Treatments for breast cancer are invasive, causing visible changes such as loss of the breast, body weight change, and hair loss. These changes in conjunction with the pressure for women to conform to societal beauty standards may lead to body image disturbance in breast cancer survivors (BCS). The aims of this scoping review were to explore the nature, characteristics, and extent of the literature examining resistance exercise or art therapy on body image in BCS; and examine how body image is defined and measured across the studies.

Methods: We searched the literature up to January 2020, which included conducting electronic searches of three major databases and checking references of screened articles.

Results: Ninety-three articles were identified, 28 underwent full-text screening, with 8 studies eligible for inclusion in the review. Five randomized control trials, one hybrid effectiveness-implementation trial, and two single group studies were found. All studies showed significant within-group difference in body image scores, with two studies showing a between-group difference in favor of resistance exercise. No studies were found combining resistance exercise and art therapy. None of the studies defined the aspect of body image they wished to measure, and only one used theory to inform their research.

Discussion: Preliminary evidence supports the benefit of resistance exercise and art therapy as single interventions to improve body image perception among BCS. Findings suggest the need for closer attention to the delivery format of interventions. Future research is needed that is theory-informed, with a clear definition of the aspect of body image of interest, and with body image as the primary outcome.

Body image distress in head and neck cancer patients: what are we looking at?

PURPOSE

The aim of the present study is to investigate the prevalence of body image distress among head and neck cancer (HNC) patients after treatment and to examine its association with sociodemographic and clinical factors, health-related quality of life (HRQOL), HNC symptoms, sexuality, self-compassion, and psychological distress. Second, we aim to explore daily life experiences of HNC patients regarding body image.

METHODS

A cross-sectional survey among HNC patients investigated the prevalence of body image distress based on the Body Image Scale. Multivariable logistic regression analysis was applied to study associations with sociodemographic and clinical factors, HRQOL (EORTC QLQ-C30), HNC symptoms (QLQ-HN43), sexuality (FSFI-6; IIEF-5), self-compassion (SCS-SF), and psychological distress (HADS). Qualitative data from a body image writing intervention was used to explore experiences in daily life related to body image.

RESULTS

Body image distress was prevalent in 13-20% (depending on cut-off scores) of 233 HNC patients. Symptoms of depression (p < 0.001), younger age (p < 0.001), problems with social contact (p = 0.001), problems with wound healing (p = 0.013), and larger extent of surgery (p = 0.014) were associated with having body image distress. This model explained 67% of variance. Writing interventions of 40 HNC patients showed that negative body image experiences were related to appearance and function, with social functioning problems described most often.

CONCLUSION

Prevalence of body image distress in HNC patients, using different cut-off scores, is 13-20%. Younger patients, patients after extensive surgery, and patients who had wound healing problems are most at risk. There is a significant association between body image distress and depressive symptoms and social functioning.

The prevalence of altered body image in patients with primary brain tumors: an understudied population

Purpose

Body image (BI) is an important issue for cancer patients, as patients with BI concerns are susceptible to depression, anxiety, difficulty coping, and poor quality of life (QoL). While this concern has been documented in patients with other malignancies, no data exists of this QoL issue in patients with primary brain tumors (PBT).

Methods

A cross-sectional survey of 100 PBT patients was conducted on an IRB approved prospective protocol using structured questionnaires. Participants completed the body image scale (BIS), Appearance Scheme Inventory Revised (ASI-R), MD Anderson Symptom Inventory Brain Tumor (MDASI-BT), and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Psychosocial Impact Positive measures.

Results

The prevalence of clinically significant body image dissatisfaction (BIS ≥ 10) was 28% (95% CI 19–37%), median BIS score was 5 (range 0–27). The median ASI-R composite score was 2.9 (range 1.5–4.7). BIS was significantly correlated with the ASI-R (r = 0.53, 95% CI 0.37 to 0.65). The mean PROMIS Depression score was 48.4 (SD = 8.9), PROMIS Anxiety score was 49.4 (SD = 9.9), and PROMIS Psychosocial Illness Impact Positive score was 48.9 (SD = 9.7). BIS was significantly correlated with age, and trended with BMI and sex. The PROMIS Psychosocial Illness Impact Positive and PROMIS Anxiety scores were the most strongly related to BIS.

Conclusions

This study, the first to explore altered body image in PBT patients, revealed clinically significant body image dissatisfaction in nearly 1/3 of patients, similar to other malignancies. These findings underscore the potential contribution of disease and treatment-related body image concerns on psychosocial wellbeing in patients with PBT.

Electronic supplementary material

The online version of this article (10.1007/s11060-020-03433-8) contains supplementary material, which is available to authorized users.

Body image in older breast cancer survivors: A systematic review

OBJECTIVE

Breast cancer is the most common cancer among women world-wide. In North America survival rates are >80%, resulting in a large population of survivors. The goal of this review was to systematically explore the literature to identify the status of body image and factors that can impact the body image of older breast cancer survivors.

METHODS

A systematic review of the literature was conducted and registered with PROSPERO (CRD42019133617). EMBASE and PubMed were searched for articles including terms related to "body image" and "breast cancer." Duplicates were removed and the remaining 322 abstracts were screened. Articles published before 2000, were off-topic, or those that were non-primary research articles were excluded. Sixty-nine remaining full-length articles were screened for language, gender and location. Seven articles underwent quality assessment of which five passed and were reviewed in depth. The remaining two articles were briefly discussed.

RESULTS

The literature review suggests that body image is considered important in older BCS and that body image may impact or be impacted by several factors including age, menopausal status, mental health, treatment modality and exercise. Additionally, themes of dealing with physical changes and the length of time women are impacted following treatment were explored.

CONCLUSION

Our findings highlight that older women may be at an advantage in terms of being post-menopausal, however concerns surrounding physical and emotional changes affecting body image are indeed present. Future studies on breast cancer survivorship should consider the inclusion of body image as an outcome measure in addition to including individuals representing a wide range of ages.

Restoring body image after cancer (ReBIC): A group therapy intervention

OBJECTIVES

Body image (BI) remains a significant survivorship challenge among breast cancer (BC) survivors. We describe an 8-week group intervention-restoring body image after cancer (ReBIC)-developed to target BI distress for BC survivors.

METHODS

The intervention was informed by interviews with BC survivors and by a descriptive, exploratory approach which adapted guided imagery exercises to address BI. Educational material was selected to address sociocultural factors that may contribute to BI distress and affect adjustment. Videotape reviews and content analyses further refined the intervention.

RESULTS

The intervention incorporates three active components: psychotherapeutic group principles; guided imagery exercises to address BI; and psychoeducation on relevant socialization factors and gender-based messages internalized by women in Western society. The therapeutic group was a supportive and effective way to assist BC survivors to gain insight on BI impacts, their histories, and relevant sociocultural factors contributing to BI distress. The group also facilitated the working through of grief over multiple losses. Guided imagery was well-received, and appeared to help survivors identify negative and emerging self-schema, as well as facilitate new self-views. Specific themes included negative emotions associated with an altered body and self, grief and loss, isolation, difficulties with sexual intimacy, relationship challenges, and uncertainty around sense of self and future.

CONCLUSION

An empirically tested group therapy intervention is described and has implications for survivorship programs to help address BI-related challenges. Future work could consider testing a similar approach tailored for other cancer populations.

Psychological Aspects of Breast Reconstruction after Breast Cancer

Even though breast cancer mortality is declining, the diagnosis still poses a huge threat for the affected woman and her close family. Breast cancer surgery, which often includes reconstructive procedures, can help restoring a satisfactory body image. The decision on the type of surgery should always be made together with the patient and should focus on her psychosocial needs. This review describes the psychological aspects of breast cancer for the patient and her social environment and offers ideas for a patient-oriented treatment plan.

A systematic review of body image measures for people diagnosed with head and neck cancer (HNC)

PURPOSE

Head and neck cancer (HNC) is a relatively common cancer which causes a significant health burden, impacting individuals physically and psychologically. HNC treatment may result in facial disfigurement, eating and communication difficulties, and body image disturbances. We aimed to (1) identify HNC-specific patient-reported outcome measures (PROMs) used to assess body image, (2) evaluate their conceptual coverage, (3) appraise their development process and psychometric properties, and (4) determine appropriate body image PROM(s) for use in the HNC setting.

METHODS

Online databases were searched (July 2007-July 2017) for studies that assessed body image in patients with HNC. Studies were screened for eligibility. In addition, we searched three PROM databases for relevant PROMs. From available body image frameworks, we compiled a conceptual schema consisting of 18 clinically relevant body image issues important in the HNC setting, against which PROMs were assessed. Selected measures were appraised for psychometric characteristics, content, and readability.

RESULTS

A total of 245 records were retrieved. 18 studies with PROMs met our inclusion criteria, reporting eight PROMs. The PROM databases searched yielded 62 measures. After screening, eleven measures were short-listed and appraised. The Derriford Appearance Scale (DAS)-59, DAS-24, and body image scale (BIS) cover > 55% of issues within the body image conceptual schema; were developed based on literature, patient interviews, and clinician opinions; and have evidence of internal consistency (Cronbach alpha > 0.7), validity, and responsiveness.

CONCLUSIONS

We recommend the DAS-24 and BIS as having adequate coverage of HNC-related issues, and suitable for use in future research.

Enhancing self-compassion in individuals with visible skin conditions: randomised pilot of the 'My Changed Body' self-compassion writing intervention

Background: Abnormalities in the appearance of skin are commonly associated with compromised self-body perceptions, arising from physical manifestations of the skin condition that deviate from the individual's idealised body image. These body image concerns are associated with a range of psychological issues including anxiety, depression, fear of negative evaluation, and suicidal ideation. Unfortunately, stigma and embarrassment associated with these body image concerns mean that these issues are rarely discussed in clinical medical consultations. There is thus a need for highly accessible and acceptable interventions to address skin-related body image concerns. We have previously demonstrated that a web-based self-compassion focused therapeutic writing approach, the 'My Changed Body' intervention, is efficacious in addressing body image concerns of women in the breast cancer context. The aim of this experimental pilot study was to investigate the feasibility of applying the My Changed Body intervention to address visible skin-related body image concerns. Methods: Participants (N = 50) with a range of visible skin conditions provided online informed consent, then completed measures of demographic and medical history, body image disturbance, self-compassion and positive and negative affect. They were then randomly allocated either to an active control expressive writing condition (n = 25) or to the My Changed Body writing condition (n = 25). Participants were blind to their condition allocation. Immediately after completing their allocated writing exercise, participants completed self-compassion and affect measures. Results: Controlling for pre-writing body image disturbance, repeated measures ANCOVAs with fixed effects revealed that self-compassion and negative affect significantly improved after the My Changed Body writing exercise, compared to the control condition. There was no between groups difference at follow-up in positive affect. Conclusions: This study suggests that the My Changed Body writing intervention may provide benefit to individuals with visible skin conditions. A randomised controlled trial is needed to further confirm these results.

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.