Body image screening for cancer patients undergoing reconstructive surgery

The psychological impact of diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers: a systematic review

Objective

High risk of degraded quality of life and psychological distress is observed in patients diagnosed with sinonasal, nasopharyngeal, and laryngeal cancers, which could be caused by exposure to carcinogens in workplaces. This review aimed to investigate the psychological impact of diagnosis associated with the possible occupational etiology of such neoplasms and to explore the instruments that evaluate the quality of life (QoL), anxiety, and depression in these patients.

Methods

Studies were considered for the review only if they described aspects of the psychological impact of the diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers and reported results distinguished by the tumor site. The psychological impact was assessed in terms of health-related QoL, anxiety, and depression using reliable psychometric questionnaires administered at the time of diagnosis and 1 year later.

Results

In more than 5,900 records identified, 442 studies fulfilled the eligibility criteria and 436 were excluded after full-text screening, resulting in six studies to be finally included in the review. The EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC QLQ-H&N35, and Functional Assessment of Cancer Therapy (FACT) were used to evaluate the QoL, whereas the Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were employed to assess anxiety and depression. QoL scores were similar to those of the general population at the time of diagnosis and remained unchanged or slightly improved at 1 year since diagnosis. In contrast, a higher prevalence of anxiety and depression was observed compared with the general population, although the results were inconsistent across the very few studies identified. No study investigating the association between the potential occupational etiology and QoL or distress was found.

Conclusion

Exploring the existing scientific literature on emotional distress in sinonasal, nasopharyngeal, and laryngeal cancer patients was prompted by concerns over the disfiguring nature of treatment and the additional emotional burden resulting from their occupational etiology. Unfortunately, neither a crucial element nor other risk factors (lifestyle, smoking, drinking, etc.) were examined in any study. Patients' employment history should be considered in order to assess the possible impact of believing they are affected by an occupational exposure disease in the evaluation of their psychological distress. This history would support evidence-based recommendations about dedicated psychological interventions.

Optimizing presurgical education for patients with head and neck cancer receiving laryngectomy and free flap surgery: A qualitative study

BACKGROUND

There has been limited study of oncology professionals' perspectives on optimizing delivery of presurgical education for individuals with head and neck cancer (HNC). Therefore, we assessed oncology professionals' perspectives about presurgical education for laryngectomy and free flap surgeries, which have a significant impact on patients' quality of life.

METHODS

Interviews were conducted with 27 oncology professionals from an NCI-designated Comprehensive Cancer Center and a community oncology setting.

RESULTS

Participants identified six recommendations to improve presurgical education: (1) establishing preoperative consultations with allied health professionals; (2) educating patients and providers on the concept of team-based care; (3) optimizing education through multimodal strategies; (4) connecting patients with other HNC surgical patients; (5) preparing caregivers for their role; and (6) educating patients on insurance navigation.

CONCLUSIONS

Study findings demonstrate gaps in the timing, content, and mode of delivery for presurgical education and suggest strategies for further evaluation in future studies.

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 .

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.

Optimizing Function and Appearance After Head and Neck Reconstruction: Measurement and Intervention

Approximately 50% of head and neck cancer (HNC) survivors are left with dysphagia as a result of treatment sequele, and 25% of survivors experience clinically significant body image distress (BID). Both dysphagia and BID adversely affect quality of life and should be tracked using validated clinician- and patient-reported outcome measures such as the Performance Status Scale for Head and Neck Cancer, MD Anderson Dysphagia Inventory, and Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN). Subjective and objective evaluation measures are critical to dysphagia workup and management. Building a renewed image after head and neck cancer treatment, a brief telemedicine-based cognitive behavioral therapy, has become the first evidence-based treatment for BID among HNC survivors.

The effect of implant loss after immediate breast reconstruction on patient satisfaction with outcome and quality of life after five years - a case-control study

Several advantages have been suggested for immediate breast reconstruction (IBR); however, there is little scientific high-quality evidence confirming those advantages. Disadvantages of IBR, compared to delayed breast reconstruction (DBR), include an increased risk for complications, such as implant loss (prevalence 5-10% vs. 1%). Little is known on how women experience implant loss and how it affects patients' long-term satisfaction and quality of life (QoL). The primary aim of our study was to compare patient satisfaction and QoL of women with implant loss after IBR, with that of women with a successful IBR. Breast-Q, Body Esteem Scale for Adults and Adolescents (BESAA) and Hospital Anxiety and Depression Scale (HADS) were sent to women who had experienced implant loss during the last 10 years. Women of a similar age who were reconstructed, without complications, during the same period were controls. The results suggest that there might be a more permanent negative effect on satisfaction and QoL following implant loss. The proportion of possible cases of depression was higher among patients who had experienced implant loss. The findings could indicate that in patients with an elevated risk for implant loss, the possible benefits with IBR should be carefully balanced against the effects of implant loss.

Addressing Body Image After Reconstructive Surgery in Adult Patients with Cancer

Body image or how a person views their body and the way it functions ultimately influences their quality of life and functional well-being in their daily environments. The changes to appearance or to body structures and functions that occur as a result of cancer and its treatment can cause individuals to become dissatisfied with their body image where maladaptive emotions, thought processes, and behaviors develop and may lead to deleterious consequences including social avoidance and isolation. Although reconstructive surgery is restorative in nature, it does not guarantee the mitigation of body image dissatisfaction when treating adults with cancer. The majority of adults who undergo reconstructive surgery for the treatment of cancer demonstrate some level of body image dissatisfaction during or after the reconstructive process. Therefore, a need exists for nurses and other oncological team members to recognize and address body image dissatisfaction and the detrimental emotional and behavioral consequences associated with it. This article provides guidance for nurses to address body image by understanding the effects of cancer and its treatment on body image, by recognizing the impact of reconstructive surgery on body image when treating cancer in adults, and by integrating body image assessment and interventions into practice.

Prospective examination of psychological risk and maintenance factors for body image distress after mastectomy with immediate breast reconstruction

Reconstructive breast surgery aims to improve body image following mastectomy, yet many women experience ongoing body image distress (BID). The relationship between the esthetic outcome of reconstructive surgery with BID has been underexplored in mastectomy. This study aimed to assess whether reconstruction outcome following mastectomy is associated with post-surgery BID, and to examine potential psychological risk and maintenance factors for BID above reconstruction outcome. In 49 women undergoing mastectomy with immediate breast reconstruction, we prospectively assessed hypothesized pre-surgery psychological risk factors and post-surgery maintenance factors for post-surgery BID. Reconstruction outcome was assessed via blind surgeon ratings of post-surgery photographs. Surgeon-rated reconstruction outcome was uncorrelated with BID, or with patients' ratings of surgical outcome. Higher pre-surgery depressive symptoms and lower pre-surgery patient expectations for reconstruction predicted greater post-surgery BID, above reconstruction outcome. Post-surgery body checking also predicted greater BID, above reconstruction outcome. Results suggest that the medical team cannot assume their perception of reconstruction outcome matches the patient's view or degree of BID. If replicated, results point to potential psychological risk and maintenance factors that are stronger predictors of post-reconstruction BID, highlighting opportunities for light-touch prevention and intervention to reduce BID after mastectomy with breast reconstruction.

Prevalence of Body Dysmorphic Disorder in an Otolaryngology-Head and Neck Surgery Clinic

OBJECTIVE

To analyze the prevalence of body dysmorphic disorder (BDD) in a general otolaryngology population presenting to an outpatient clinic.

STUDY DESIGN

Prospective prevalence study.

SETTING

Single tertiary academic otolaryngology clinic.

SUBJECT AND METHODS

New patients over 18 years of age who presented to an academic otolaryngology clinic between August 2018 and May 2021 completed a questionnaire including demographic questions and the validated Body Dysmorphic Disorder Questionnaire (BDDQ). Data collected from the questionnaires were analyzed to assess demographics and prevalence of BDD in an otolaryngology clinic.

RESULTS

Of the 242 patients queried, 15 patients screened positive for BDD. The screened prevalence of BDD was determined to be 6.2%. None of the patients had previously been diagnosed with BDD. The prevalence of prior mental health diagnoses was 34.3%. These patients had initially presented for a variety of otolaryngologic concerns and had pre-existing diagnoses of anxiety, depression, obsessive-compulsive, bipolar and eating disorders.

CONCLUSION

The prevalence of BDD in our population of new patients presenting to an academic otolaryngology practice (6.2%) is higher than that of the general population (1.9%).

The psychometric properties of the Turkish version of the pectus carinatum body image quality of life questionnaire

PURPOSE

The present study aimed to evaluate the psychometric properties of the Turkish version of the Pectus Carinatum Body Image Quality of Life Questionnaire (PeCBI-QOL), which was originally created in American English in patients with pectus carinatum (PC).

METHODS

The study included 52 volunteer patients with PC, aged 10-18 years. Cronbach α was used to assess internal consistency. Intraclass correlation coefficient (ICC) was used to estimate the test-retest reliability. Construct validity was analyzed with the Pectus Excavatum Evaluation Questionnaire (PEEQ).

RESULTS

The reliability of the Turkish version of the PeCBI-QOL was found to have acceptable to excellent internal consistency (Cronbach's α coefficient = 0.701-950). Test-retest reliability calculated for investigating the reliability of the questionnaire over time was found to be excellent (ICC = 0.817-0.983). Construct validity of the PeCBI-QOL (child and parent form) was found to be correlated with all subscales in the PEEQ questionnaire (r = - 0.425 to 897, p < 0.001) except the treatment motivation subscale (r = 0.033-0.111, p = 0.439-0.816).

CONCLUSION

We determined that the Turkish version of the PeCBI-QOL questionnaire was valid and reliable for the assessment of body image and quality of life in Turkish patients with PC. PeCBI-QOL questionnaire, a self-assessment one, will assist Turkish clinicians who wish to assess body image and quality of life of patients with PC.

Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.

Body Image After Mastectomy Scale: A New Measure of Body Image Behaviors and Beliefs in Women Following Mastectomy

Background: Body image distress is frequently reported by women after mastectomy and is associated with negative health outcomes, such as reduced quality of life, elevated depression and anxiety symptoms, and impaired sexual functioning. To reduce body image distress after mastectomy, we must first understand the factors that contribute to its development and maintenance. We therefore developed a new measure, the Body Image after Mastectomy Scale (BIMS), to comprehensively assess maladaptive appearance-related beliefs and behaviors (e.g., avoidance and rituals) that may trigger and maintain body image distress after mastectomy. Materials and Methods: Forty-seven female patients undergoing mastectomy with breast reconstruction completed the BIMS and other measures 3 months after breast reconstruction. Results: Evaluation of the BIMS' initial psychometric properties showed that the overall scale has good internal consistency and strong construct validity. Domain-specific subscales ranged in reliability from good to poor. Conclusions: The BIMS can be used clinically to identify cognitive and behavioral psychotherapy targets to reduce body image distress resulting from mastectomy. It can also be used in research to identify factors that contribute to the development and maintenance of body image distress after mastectomy. ClinicalTrials.gov identifier: NCT03428399.

Addressing Body Image After Reconstructive Surgery in Adult Patients with Cancer

Body image or how a person views their body and the way it functions ultimately influences their quality of life and functional well-being in their daily environments. The changes to appearance or to body structures and functions that occur as a result of cancer and its treatment can cause individuals to become dissatisfied with their body image where maladaptive emotions, thought processes, and behaviors develop and may lead to deleterious consequences including social avoidance and isolation. Although reconstructive surgery is restorative in nature, it does not guarantee the mitigation of body image dissatisfaction when treating adults with cancer. The majority of adults who undergo reconstructive surgery for the treatment of cancer demonstrate some level of body image dissatisfaction during or after the reconstructive process. Therefore, a need exists for nurses and other oncological team members to recognize and address body image dissatisfaction and the detrimental emotional and behavioral consequences associated with it. This article provides guidance for nurses to address body image by understanding the effects of cancer and its treatment on body image, by recognizing the impact of reconstructive surgery on body image when treating cancer in adults, and by integrating body image assessment and interventions into practice.

'I Didn't Even Recognise Myself': Survivors' Experiences of Altered Appearance and Body Image Distress during and after Treatment for Head and Neck Cancer

Simple Summary

In interview data collected from 21 people diagnosed with head and neck cancer in the previous six years, participants reported adequate procedural preparation but little or no preparation related to appearance. Body image distress contributed to psychosocial issues for many people, negatively impacting their adaptation to altered appearance. The main themes included; Preparation (sub-themes: Decision-making; and Preparation for Altered Appearance); Altered Appearance (sub-themes: Weight Loss; Face, Skin and Hair Changes; and Reconstructive Surgery); and Consequences (sub-themes Reactions from Others; Adapting to Altered Appearance). Current practice provides information pre-treatment about many aspects of coping; however, the subject of appearance is not routinely addressed. Communication skills training for health professionals that improves their comfort and sensitivity in discussing and conveying compassion around issues of altered appearance, body image, and trauma, is needed to decrease suffering for survivors, support healthy adaptation to living with altered appearance, and increase patient satisfaction with health care.

Abstract

Purpose: Preparation for head and neck cancer treatment is focused on practicalities of treatment. Little or no time is spent prior to treatment discussing aesthetic results of treatment or the psychosocial impact of living with an altered appearance after treatment. The objective of this study was to explore the experiences of survivors of head and neck cancers, with a focus on the psychosocial impact of altered appearance. Methods: A qualitative research approach based on social constructionist theory was used. Twenty-one semi-structured interviews were conducted with survivors of head and neck cancer who had been diagnosed in the previous six years. Thematic analysis was used to identify themes. Results: People diagnosed with HNC reported feeling rushed into treatment, with adequate procedural preparation but little or no preparation related to appearance. The main themes included: Preparation (sub-themes: Decision-making; and Preparation for Altered Appearance); Altered Appearance (sub-themes: Weight Loss; Face, Skin and Hair Changes; and Reconstructive Surgery); and Consequences (sub-themes Reactions from Others; Adapting to Altered Appearance). Conclusions: Body image distress related to altered appearance, contributed to psychosocial issues for many people diagnosed with head and neck cancer. Current practice provides information pre-treatment about many aspects of coping; however, the subject of appearance is not routinely addressed. Communication skills training for health professionals that improves their comfort and sensitivity in discussing and conveying compassion around issues of altered appearance, body image, and trauma, is needed to decrease suffering for survivors, support healthy adaptation to living with altered appearance, and increase their satisfaction with health care.

Body image in colorectal cancer patients: A longitudinal study

OBJECTIVE

To assess changes in body image distress (BID) over time, identify factors associated with BID, and explore the mediating role of body image on the longitudinal association between stoma status (permanent stoma, temporary stoma, or nonstoma) and psychological distress in postoperative colorectal cancer (CRC) patients in China.

METHODS

Participants (N = 255) 1-2 weeks postsurgery completed self-report questionnaires assessing BID (Body Image Scale) and psychosocial distress (Distress Thermometer, Hospital Anxiety and Depression Scale); 212 (83%) completed 6-month follow-up surveys. Generalized estimating equations were used to identify factors associated with BID for longitudinal data analysis.

RESULTS

A total of 46.7% of participants reported BID at follow-up. Prevalence of BID and BID scores did not significantly change over time in the total sample. Body image scores decreased in patients whose temporary stoma was removed during follow-up (p < 0.05). Prevalence of BID decreased in nonstoma patients at follow-up (p < 0.05). There were significant decreases in the prevalence and scores of distress, anxiety, and depression between baseline and follow-up (p < 0.001). Stoma presence, later clinical stages, greater distress, anxiety, and depression were risk factors for poorer body image. Body image had partial mediating effects on the longitudinal association between stoma status and distress.

CONCLUSIONS

Our findings indicate that BID remains stable even as psychological distress decreases. BID should be addressed early postoperation to avoid persistent impairment in CRC patients.

Couples Facing Skin Cancer in Old Age: A Dyadic Investigation of Partner Support and Quality of Life

This study investigated perceived support received by partners and its association with quality of life (QOL) in older couples facing skin cancer. Thirty couples (n = 60; M _Age = 70) in which one partner had a skin cancer diagnosis (PwSC) completed either online or paper surveys about their skin cancer diagnosis, perceived partner support, and overall QOL. Actor-partner interdependence models revealed that when PwSCs reported overprotection from their healthy partners (HPs), they were more likely to report lower QOL. Protective buffering received by HPs was negatively associated with their QOL as well as their PwSCs QOL. Active engagement support, however, was not associated with either partner's QOL. While couples may use all three styles of relationship-focused support, protective buffering and overprotection affected each partner's QOL. Implications of the study findings for interventions for couples facing illnesses like skin cancer are discussed.

Development and validation of the Pectus Carinatum Body Image Quality of Life (PeCBI-QOL) questionnaire

INTRODUCTION

While body image disturbances and quality of life in persons with pectus excavatum (PE) have been well documented, very little has been done to systematically measure and document the same in patients with pectus carinatum (PC). Because of this, the current study aimed to develop and validate an instrument to assess body image related quality of life in patients with PC and their parents.

METHOD

Participants: Two waves of data collection took place. The development phase enrolled 78 PC patients and 76 matched parents. The validation phase enrolled 50 PC patients and 50 parents. Mean age at the initiation of treatment was 15.14 (SD = 2.54). Participants were mostly boys (85.9%) and White or Caucasian (89.7%). Instrument development, refinement, and validation: A group of 5 experts in chest wall deformities used existing measures of body image disturbances in PE, combined with the broader body image literature, to develop larger item pools for patients and their parents. Item analysis from this phase was used to remove poorly performing or statistically redundant items. In the validation phase, refined patient and parent instruments were examined using exploratory principal components factor analysis (EFA) with parallel analysis for factor retention, followed by Varimax rotation to identify a final factor solution.

RESULTS/DISCUSSION

This development and refinement process yielded a final questionnaire for patients (18 items) and parents (15 items). The patient questionnaire includes four subscales, each with good internal consistency: Body Image Disturbance; Treatment Motivation/Engagement; Physical Limitations; and Social Disadvantage. The parent questionnaire includes 3 subscales: Body Image Disturbance; Treatment Motivation/Engagement; Physical Limitations. Patient and parent scales showed moderate correlations. Among patients with measures pre- and posttreatment, there was a significant improvement in overall PeCBI-QOL score. We demonstrate, in this study, that body image and related quality of life can be reliably and validly assessed with the PeCBI-QOL, which has implications for more comprehensively documenting the negative psychological and functional consequences of pectus carinatum.

TYPE OF STUDY/LEVEL OF EVIDENCE

Study of diagnostic test/III.

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.

Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Patient-Centered Approach

OBJECTIVE

To promote patient-centered oncology care through an in-depth analysis of the patient experience of body image disturbance (BID) following surgery for head and neck cancer (HNC).

STUDY DESIGN

Qualitative methods approach using semistructured key informant interviews.

SETTING

Academic medical center.

SUBJECTS AND METHODS

Participants with surgically treated HNC underwent semistructured key informant interviews and completed a sociodemographic survey. Recorded interviews were transcribed, coded, and analyzed using template analysis to inform creation of a conceptual model.

RESULTS

Twenty-two participants with surgically treated HNC were included, of whom 16 had advanced stage disease and 15 underwent free tissue transfer. Five key themes emerged characterizing the participants' lived experiences with BID following HNC treatment: personal dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance. The participant's perceived BID severity was modified by preoperative patient expectations, social support, and positive rational acceptance. These 5 key themes and 3 experiential modifiers form the basis of a novel, patient-centered conceptual model for understanding BID in HNC survivors.

CONCLUSION

A patient-centered approach to HNC care reveals that dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance are key conceptual domains characterizing HNC-related BID. Recognition of these psychosocial dimensions of BID in HNC patients can inform development of HNC-specific BID patient-reported outcome measures to facilitate quantitative assessment of BID as well as the development of novel preventative and therapeutic strategies for those at risk for, or suffering from, BID.

Development and validation of the McGill body image concerns scale for use in head and neck oncology (MBIS-HNC): A mixed-methods approach

OBJECTIVE

The aim of this study was to develop and validate a patient-reported outcome measure to evaluate body image concerns in head and neck cancer (HNC) patients.

METHODS

Items were created using a combination of deductive (eg, US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (eg, subject matter experts, HNC patients). Items were translated for use in both Canadian English and Canadian French using back-translation. A two-step empirical validation process using the Classical Test Theory (CTT) and Rasch Measurement Theory (RMT) was conducted with 224 and 258 HNC patients, respectively, having undergone disfiguring surgery within the past 3 years.

RESULTS

Analyses suggest two subscales for MBIS-HNC: social discomfort (10 items) and negative self-image (11 items). The McGill Body Image Concerns Scale-Head and Neck Cancer (MBIS-HNC) is reliable with high internal consistency (0.98), high test-retest reliability over a two-week period (ICC = 0.88), moderate to high convergent validity (range r = 0.43-0.81), and divergent validity (range r = 0.12-0.15). RMT was used in addition to CTT. Disordered thresholds led to the modification of the number of response options, and items were deleted based on differential item functioning and high local dependency. Unidimensionality of both subscales and supporting a total score was confirmed. The measure was however characterized by the presence of an important floor effect, confirmed with poor targeting as demonstrated by the person-item threshold distribution.

CONCLUSION

Evidence gathered from our theory-driven validation study using CTT and RMT provides practitioners and researchers with a useful and easy to use self-report measure.

The impact and incidence of altered body image in patients with head and neck tumors: a systematic review

Body image dissatisfaction is a common issue among patients with cancer and is associated with difficulty coping, anxiety, and depression. Patients with tumors involving the head and neck are at increased risk of body image dissatisfaction due to the visible disfigurement that can occur from their illness and its treatment. Patients with primary central nervous system (CNS) malignancies often face similar tumor-related and treatment-related effects, yet there is limited research conducted in this population. Our aim was to perform a systematic review of the literature on body image in patients with tumors of the head and neck, and identify factors associated with body image alterations during treatment, with the intention of applying these approaches to those with CNS disease. A systematic search of PubMed and EMBASE was performed using predefined criteria. Nine studies met the inclusion criteria and were selected for review. The literature collected showed a relationship between body image and age, depressive symptoms, and tumor grade or stage. In addition, body image disturbance had an impact on patients' daily functioning and psychosocial indices including anxiety, coping, and body reintegration. Evaluation of the impact of body image alterations in patients with CNS tumors is needed to direct clinical care, explore research opportunities, and improve patient quality of life.

A systematic review of the measurement properties of the Body Image Scale (BIS) in cancer patients

INTRODUCTION

Body image is acknowledged as an important aspect of health-related quality of life in cancer patients. The Body Image Scale (BIS) is a patient-reported outcome measure (PROM) to evaluate body image in cancer patients. The aim of this study was to systematically review measurement properties of the BIS among cancer patients.

METHODS

A search in Embase, MEDLINE, PsycINFO, and Web of Science was performed to identify studies that investigated measurement properties of the BIS (Prospero ID 42017057237). Study quality was assessed (excellent, good, fair, poor), and data were extracted and analyzed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology on structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, and responsiveness. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate.

RESULTS

Nine studies were included. Evidence was sufficient for structural validity (one factor solution), internal consistency (α = 0.86-0.96), and reliability (r > 0.70); indeterminate for measurement error (information on minimal important change lacked) and responsiveness (increasing body image disturbance in only one study); and inconsistent for hypothesis testing (conflicting results). Quality of the evidence was moderate to low. No studies reported on cross-cultural validity.

CONCLUSION

The BIS is a PROM with good structural validity, internal consistency, and test-retest reliability, but good quality studies on the other measurement properties are needed to optimize evidence. It is recommended to include a wider variety of cancer diagnoses and treatment modalities in these future studies.

Body consciousness of people with intestinal stomach: A phenomenological study

ABSTRACT Objective: to describe the bodily awareness of people with stomies. Method: a descriptive study with a qualitative approach, carried out in the Ostomized Association of the State of Ceará, through semi-structured interviews with ten people with intestinal stomies, according to Merleau-Ponty's phenomenological thinking. Results: two categories of analysis emerged: The body that I have, in which the sensations of deficiency, imperfection and bad odor add to the feeling of strangeness towards one's own body, affecting the way of being in the world of each deponent; and The body that others perceive, in which the stoma is seen as an embarrassing and complex experience, since it hampers daily activities and conviviality with other people. Final considerations: The corporeal consciousness of Being-Stomp-in-the-world requires the movement to reconstruct the senses of the body from the body I have and from that which others perceive.

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.

Suitability of the Patient Concerns Inventory as a holistic screening tool in routine head and neck cancer follow-up clinics

In patients with cancer of the head and neck, efficient screening for problems can improve care and the management of resources. We explored use of the Patient Concerns Inventory (PCI-HN) as a holistic screening tool in the follow up of these patients. Between August 2007 and January 2013, 464 patients completed the PCI-HN and the University of Washington Quality of Life questionnaire version 4 (UWQoL) immediately before their routine follow-up consultations. The median (IQR) number of items selected on the inventory was 3 (1-6). This was associated (p<0.001) with the number of serious problems (dysfunction) in the 12 UWQoL domains (Spearman's correlation, rs=0.51), overall QoL (rs=-0.41), and the 2 UWQoL subscale scores of physical (rs=-0.46) and social-emotional (rs=-0.53) function. Binary regression to predict an overall outcome of "less than good" indicated that use of the PCI could be better than just recording clinical characteristics. Some patients however, chose few PCI items and had numerous problems. The inventory may have a role in the screening of patients with cancer of the head and neck, particularly in relation to social-emotional function and overall QoL, and may have added value when used with the UWQoL-v4. The total number of PCI items selected is a useful predictor of QoL. Further research is required to confirm suitable limits, and to find out whether additional support and repeated use of the inventory over time improve QoL.

Evaluation of Social Support, Quality of Life, and Body Image in Women with Breast Cancer

BACKGROUND

This study was aimed at comparing the quality of life, body image, and perceived social support in women with breast cancer surgery.

PATIENTS AND METHODS

Patients receiving breast-conserving surgery (BCS) (n = 72), mastectomy alone (n = 44), and mastectomy with breast reconstruction (n = 41) were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Breast Cancer Module (QLQ-BR23), the Body Image Scale (BIS) and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

The results indicated that the BCS group had a better body image compared with the other 2 groups and better role functioning compared with the mastectomy-alone group. In the reconstruction group, body image correlated with perceived social support, especially from family and significant others.

CONCLUSION

These results suggest that a positive perception of a supportive social network can help women with breast reconstruction to better cope with the psychological effects of surgery on their body image.

Platelet-rich plasma in the treatment of subcutaneous venous access device scars: a head-to-head patient survey

Introduction. Platelet-rich plasma (PRP) is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular (i.e., joint-injections) or direct introduction onto the wound surface. Methods. Between the years of 2012 and 2014 a questionnaire evaluating surgical outcome after port (venous access device) removal was answered by 100 patients in the control group and 20 patients in a PRP group, leading to a total of 120 patients in this single center, retrospective, subjective outcome evaluation. Results. No statistical difference was shown in postsurgical complication rates, postsurgical pain, decreased mobility, and overall quality of life. A significant difference was shown in overall patient satisfaction and the desire to further improve port area scarring. Results differed significantly in favor of the PRP group. Interestingly, approximately 40.2% of patients are dissatisfied with the surgical outcome after port removal in the control group. This result, though surprising, may be improved to 10% dissatisfaction when a PRP product is used. Conclusion. PRP products such as Arthrex ACP are safe to use and present an additional option in improving surgical outcome.

Body Image in Adult Women: Moving Beyond the Younger Years

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

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

SUMMARY 

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