1
|
Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Mechanism underlying a brief cognitive behavioral treatment for head and neck cancer survivors with body image distress. Support Care Cancer 2023; 32:32. [PMID: 38102496 PMCID: PMC10798060 DOI: 10.1007/s00520-023-08248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
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 .
Collapse
Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Emily Kistner-Griffin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy M Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Detroit, MI, USA
| | - Lynne Padgett
- Veteran Affairs Office of Research and Development, Washington, DC, USA
| | - Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Brad Johnson
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Taylor McLeod
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Hollings Cancer Center, MUSC, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| |
Collapse
|
2
|
Cai Y, Zhang Y, Cao W, Guo VY, Deng Y, Luo L, Shen J, Zhu Y, Chen X, Yang X, Hou F, Li J. Preliminary Validation of the Revised Illness Perception Questionnaire for Patients with Nasopharyngeal Carcinoma in China. Healthcare (Basel) 2023; 11:2469. [PMID: 37761666 PMCID: PMC10530590 DOI: 10.3390/healthcare11182469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/15/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Nasopharyngeal carcinoma is a common and highly malignant cancer in southern China. It is important to accurately assess the illness perception of nasopharyngeal carcinoma according to the common-sense model of self-regulation. The purpose was to validate the Chinese version of the Revised Illness Perception Questionnaire for patients with Nasopharyngeal carcinoma. A cross-sectional survey of 631 patients with Nasopharyngeal carcinoma was conducted in Guangzhou, China. The reliability of the scale was evaluated using Cronbach's alpha. The factor structure was assessed using exploratory factor analysis (EFA) of each dimension. The EFA revealed that the 29-item self-rated scale has a seven-factor structure consistent with the original scale and explained 67.3% of the variance after extraction and rotation. The scale showed satisfactory reliability. The item-total correlations ranged from -0.16 to 0.64 (p < 0.05). The item-subscale correlations ranged from 0.46 to 0.91 (p < 0.05). The item-other subscale correlations ranged from -0.38 to 0.51 and from -0.21 to 0.56 (p < 0.05). Significant correlations were found between the timeline (acute/chronic) (r = 0.224, r = 0.166), consequences (r = 0.415, r = 0.338), timeline cyclical (r = 0.366, r = 0.284), emotional representations (r = 0.497, r = 0.465), personal control (r = -0.122, r = -0.134), treatment control (r = -0.135, r = -0.148), and illness coherence (r = -0.261, r = -0.213) subscales, and depression, anxiety (p < 0.05). The scale revealed acceptable reliability, factorial validity, and construct validity. It could be used to assess the illness representations of Chinese patients with nasopharyngeal carcinoma.
Collapse
Affiliation(s)
- Yuqi Cai
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510080, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100871, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Liying Luo
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Jianling Shen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yang Zhu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Xiaoting Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Xiao Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Fengsu Hou
- Shenzhen Kangning Hospital/Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| |
Collapse
|
3
|
Wang H, Nicklaus K, Jewett E, Rehani E, Chen TA, Engelmann J, Bordes MC, Chopra D, Reece GP, Lee ZH, Markey MK. Assessing saliency models of observers' visual attention on acquired facial differences. J Med Imaging (Bellingham) 2023; 10:S11908. [PMID: 37091297 PMCID: PMC10118307 DOI: 10.1117/1.jmi.10.s1.s11908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose Saliency models that predict observers' visual attention to facial differences could enable psychosocial interventions to help patients and their families anticipate staring behaviors. The purpose of this study was to assess the ability of existing saliency models to predict observers' visual attention to acquired facial differences arising from head and neck cancer and its treatment. Approach Saliency maps predicted by graph-based visual saliency (GBVS), an artificial neural network (ANN), and a face-specific model were compared to observer fixation maps generated from eye-tracking of lay observers presented with clinical facial photographs of patients with a visible or functional impairment manifesting in the head and neck region. We used a linear mixed-effects model to investigate observer and stimulus factors associated with the saliency models' accuracy. Results The GBVS model predicted many irrelevant regions (e.g., shirt collars) as being salient. The ANN model underestimated observers' attention to facial differences relative to the central region of the face. Compared with GBVS and ANN, the face-specific saliency model was more accurate on this task; however, the face-specific model underestimated the saliency of deviations from the typical structure of human faces. The linear mixed-effects model revealed that the location of the facial difference (midface versus periphery) was significantly associated with saliency model performance. Model performance was also significantly impacted by interobserver variability. Conclusions Existing saliency models are not adequate for predicting observers' visual attention to facial differences. Extensions of face-specific saliency models are needed to accurately predict the saliency of acquired facial differences arising from head and neck cancer and its treatment.
Collapse
Affiliation(s)
- Haoqi Wang
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Krista Nicklaus
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Eloise Jewett
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
| | - Eeshaan Rehani
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
| | - Tzuan A. Chen
- University of Houston, HEALTH Research Institute, Houston, Texas, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, Texas, United States
| | - Jeff Engelmann
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States
| | - Mary Catherine Bordes
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Deepti Chopra
- The University of Texas MD Anderson Cancer Center, Department of Psychiatry, Houston, Texas, United States
| | - Gregory P. Reece
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Z-Hye Lee
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Mia K. Markey
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, Texas, United States
| |
Collapse
|
4
|
Reynolds LM, Harris L. Stigma in the face of cancer disfigurement: A systematic review and research agenda. Eur J Cancer Care (Engl) 2020; 30:e13327. [PMID: 32896036 DOI: 10.1111/ecc.13327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION An emerging body of work has reported on the psychological impact of disfigurement on cancer patients; however, the extent of research focusing on stigmatisation in this context is unclear. This review aimed to evaluate how stigma associated with disfigurement impacts on cancer patients. METHODS A systematic review of literature was conducted using SCOPUS, Web of Science, MEDLINE and PubMed databases. Articles were included if they described a qualitative or quantitative study that investigated the impact of stigma and disfigurement on individuals with cancer and/or their families. Included studies were appraised for methodology and narratively synthesised. RESULTS Of the 16 studies which met the inclusion criteria, ten were qualitative and six were quantitative. Publication dates ranged from 1994 to 2020. Results highlighted the varying impact of felt and enacted stigma in people with cancer disfigurement. While individuals cope with stigma in different ways and outcomes can sometimes be positive, most articles documented a negative impact to well-being including emotions such as disgust and shame. CONCLUSION This review identified negative and (sometimes) positive consequences of disfigurement and stigma on cancer patients; however, the main finding is that relevant research is in its infancy. Several areas of future research are warranted.
Collapse
Affiliation(s)
- Lisa M Reynolds
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Lauren Harris
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Jarry JL, Dignard NAL, O'Driscoll LM. Appearance investment: The construct that changed the field of body image. Body Image 2019; 31:221-244. [PMID: 31653567 DOI: 10.1016/j.bodyim.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/14/2019] [Indexed: 01/07/2023]
Abstract
In the mid-1990s, Thomas F. Cash developed the construct of appearance investment and an instrument to measure it, the Appearance Schemas Inventory (ASI). This was followed by a significant revision of this measure, the ASI-R. This instrument distinguished two dimensions to appearance investment, one referring to engagement in behaviours meant to improve appearance esthetics, and one referring to the importance of appearance for self-definition. The construct of appearance investment and its measurement gave rise to a new area of research that widened our understanding of body image beyond the ubiquitous construct of satisfaction. In this paper, we review the literature on appearance investment and offer conclusions based on the different study designs in which either the ASI or ASI-R were used. This is followed by general conclusions about the current state of the research on appearance investment, and future directions to improve our understanding of the factors contributing to the development of excessive investment in appearance.
Collapse
|
6
|
Bonomo P, Paderno A, Mattavelli D, Zenda S, Cavalieri S, Bossi P. Quality Assessment in Supportive Care in Head and Neck Cancer. Front Oncol 2019; 9:926. [PMID: 31620372 PMCID: PMC6759470 DOI: 10.3389/fonc.2019.00926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023] Open
Abstract
Quality assessment is a key issue in every clinical intervention, to be periodically performed so to measure the adherence to standard and to possibly implement strategies to improve its performance. This topic is rarely discussed for what concerns supportive care; however, it is necessary to verify the quality of the supportive measures; “supportive care makes excellent cancer care possible,” as stated by the Multinational Association of Supportive Care in Cancer (MASCC). In this regard, the quality of supportive care in head and neck cancer patients is a crucial topic, both to allow administration of treatments according to planned dose intensity or surgical indications and to maintain or improve patients' quality of life. This paper aims to provide insight on state of the art supportive care and its future developments for locally advanced and recurrent/metastatic head and neck cancer, with a focus on quality assessment in relation to surgery, radiotherapy, and systemic therapy.
Collapse
Affiliation(s)
- Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical Oncology, ASST Spedali Civili di Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
7
|
Ellis MA, Sterba KR, Day TA, Marsh CH, Maurer S, Hill EG, Graboyes EM. Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Patient-Centered Approach. Otolaryngol Head Neck Surg 2019; 161:278-287. [PMID: 30961419 DOI: 10.1177/0194599819837621] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mark A Ellis
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Courtney H Marsh
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacy Maurer
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,4 Department of Psychiatry and Behavioral Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth G Hill
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|