Body image in older breast cancer survivors: A systematic review

Body image and social appearance anxiety in patients with cancer undergoing radiotherapy: Across-sectional study

BACKGROUND

The body image of patients with cancer can be negatively affected due to treatment toxicities. Changes in body image may cause patients to experience social appearance anxiety. This study aimed to evaluate the body image and social appearance anxiety of patients with cancer undergoing radiotherapy.

METHODS

The cross-sectional study was conducted with 153 patients with cancer undergoing radiotherapy in a university hospital. The data were collected with a Patient Information Form, the Body Image Scale, and the Social Appearance Anxiety Scale and the Radiation Therapy Oncology Group Skin Toxicity Criteria.

RESULTS

Patients' mean body image score was 15.18 ± 8.26 (min = 0, max = 30), mean social appearance anxiety score was 45.29 ± 14.50 (min = 16, max = 80). Patients with low education levels and low-income levels had higher body image and social appearance anxiety scores (p < 0.01). Body image and social appearance anxiety scores were found to be higher in patients with advanced cancer, grade III-IV skin toxicity, pain, fatigue, and constipation (p < 0.05).

CONCLUSIONS

Radiotherapy may negatively affect body image and social appearance anxiety. Assessments of body image and social appearance anxiety regularly before, during, and after treatment are essential. Psychosocial support should be provided to patients to reduce body image and social appearance anxiety and increase their well-being. Patients with cancer especially those who have low income and education levels, advanced cancer stage and skin toxicity, and suffer from pain, fatigue, constipation, etc. should be supported by methods such as counseling and social support groups.

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 effect of appearance and functionality concerns, and weight status, on negative body image mental health literacy in women

Few studies have investigated community knowledge and beliefs about negative body image. Yet, low rates of recognition and help-seeking for body image concerns have been reported. Given the prevalence of body image problems and associated mental health risks in women, the current online study investigated negative body image mental health literacy in 260 women aged 18 to 64 years recruited via Prolific. The mental health literacy paradigm was employed in a 2 × 2 experimental design in which the effect of a target's domain of body image concern (appearance versus body functionality) and weight status ("normal weight" versus "overweight") was assessed on problem recognition, beliefs, and help-seeking recommendations. Overall, low symptom recognition was observed, and ratings for beliefs and help-seeking suggested low levels of stigma. However, significantly greater sympathy and lifestyle support recommendations were observed in the overweight compared to normal weight condition, and a domain × weight interaction suggested significantly fewer negative emotional reactions in the appearance overweight condition compared to appearance normal weight, and functionality overweight, conditions. The findings suggest a need for education about body image independent of weight status in women. Future research would benefit from examining diverse samples, broader functionality concerns, and stigma.

'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors

OBJECTIVE AND DESIGN

Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb.

SETTING

A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods.

PARTICIPANTS

32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female).

RESULTS

Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies.

CONCLUSIONS

This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.

Feasibility and acceptability of study methods and psychosocial interventions for body image among women diagnosed with breast cancer: A systematic review and narrative synthesis

OBJECTIVE

This systematic review aimed to summarize evidence for the feasibility and acceptability of psychosocial interventions for body image among women diagnosed with breast cancer and the study methods used to evaluate the interventions in question.

METHODS

Articles were identified via MEDLINE, CINAHL, CENTRAL, PsychINFO, and EMBASE. Inclusion criteria were: (1) peer-reviewed publication in English from 2000 onward with accessible full-text, (2) reported data on the feasibility and/or acceptability of psychosocial interventions and/or study methods, (3) included at least one measure of body image or reported a body-related theme, and (4) sample comprised women diagnosed with breast cancer. All study designs were eligible. Two reviewers independently performed study selection, data extraction, and quality assessment.

RESULTS

Sixty-two articles were included. Participants and comparator groups varied as did interventions. Feasibility and acceptability of the interventions and study methods were inconsistently operationalized and reported across studies. Evidence of feasibility and acceptability was heterogeneous within and across studies, though mostly positive.

CONCLUSION

Published psychosocial interventions for body image and study methods are generally feasible and acceptable. Findings should be used to advance the development, implementation, and evaluation of interventions designed to improve outcomes (body image or otherwise) for women diagnosed with breast cancer.

SYSTEMATIC REVIEW REGISTRATION

This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42021269062, 11 September 2021).

Consumer experiences of shame in clinical encounters for breast cancer treatment. "Who do you think you are- Angelina Jolie?"

BACKGROUND

Shame is a powerful negative emotion that has the potential to affect health. Due to the intimate nature of breast cancer treatment and its impact on body image, it is hypothesised that shame may be experienced during treatment. The aim of this study was to explore shame experiences related to clinical encounters for breast cancer treatment.

METHODS

People with a lived experience of breast cancer were invited to anonymously share their stories of shame through an online survey. Using qualitative methodology, the stories were examined, and themes identified.

PARTICIPANTS

Participants were members of the consumer organisation Breast Cancer Network Australia.

RESULTS

Stories were contributed by 38 participants. Most (n = 28, 73.7 %) were >5 years post-diagnosis. Shame was experienced in a range of clinical settings (consulting rooms, wards, operating theatres, radiotherapy departments). They involved a different health professionals (oncologists, surgeons, nurses, radiation therapists, psychologists.) Five themes were identified: (1) Body shame (sub-themes: Naked/vulnerable and Weight), (2) Communication (subthemes: Lack of compassion/impersonal manner and Not listening), (3) Being blamed (subthemes: diagnosis and complications), (4) Feeling unworthy (subthemes: Burden to staff and Unworthy of care), (5) Judgement for treatment choices.

CONCLUSIONS

Shame can be experienced in a range of situations, from scrutiny of the naked body to comments from health professionals. The impact of these experiences is profound, and the feelings of shame are carried for many years. These findings can inform strategies to support consumers and educate health professionals with the aim of reducing harm related to cancer treatment.

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

PURPOSE

The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice.

METHODS

A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted.

RESULTS

Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health.

CONCLUSION

Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.

Efficacy of breast reconstruction in elderly women (>60 years) using deep inferior epigastric perforator flaps: A comparative study

BACKGROUND

The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue.

METHODS

This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others.

RESULTS

We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%.

CONCLUSIONS

Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.

"Who am I?" A qualitative meta-synthesis of Chemotherapy-induced alopecia and body image perception in breast cancer patients

BACKGROUND

Since alopecia may be the first physical evidence and sign of cancer diagnosis and treatment, it may have a more serious and challenging effect on a woman than the loss of breast tissue.

OBJECTIVE

The purpose of this study was to summarize the current qualitative research which explores the body image perceptions of breast cancer patients with chemotherapy-induced alopecia.

MATERIAL AND METHODS

We searched three electronic databases and reviewed studies from December 2011 to December 2021 for qualitative results analysing the experiences of women with breast cancer and chemotherapy-induced alopecia. The Joanna Briggs Institute critical (JBI) appraisal tool was used to assess the quality of the targeted studies. The Meta-synthesis process developed by Sandelowski and Barroso was used to collect and analyse the data.

RESULTS

We discovered two main and five sub-themes from the meta-synthesis findings of 11 qualitative studies involving 225 women. The main themes were "I am not comfortable in this body" and "Who am I?". The first main theme revealed patients' intense reactions to their hair loss: "I'm in emotional chaos", "I am looking for a place to hide" and "I knew it and now I'm experiencing it".The second main theme of "Who am I?" contained two sub-themes: "What did my hair take from my femininity when it was gone?" and "Will I lose my partner after my hair?".

CONCLUSION

Meta-synthesis provided an up-to-date and integrated interpretation of scientific results about the experiences of women with breast cancer, alopecia, and their body image perceptions. This interpretation will facilitate a more comprehensive understanding of the alopecia-body image relationship. Thus, the aim of the meta-synthesis results is that these will contribute to nurses' understanding of how alopecia, although a temporary symptom, affects women's perceptions of body image.

Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors

Body image (BI) and self-esteem (SE) are two fundamental aspects in the evolution of breast cancer (BC), mainly due to surgery, treatment, and the patient's conception of BI. A dissatisfaction with BI and low SE decreases the subject's quality of life and increases the risk of recurrence and mortality by BC. The aim of this study is to find out if there is any degree of association between the sociodemographic data of the sample and their BI and SE. A cross-sectional, descriptive study was conducted with 198 women diagnosed with BC, aged 30-80 years, in Mexico. Women's BI and SE were assessed using two questionnaires, Hopwood Body Image Scale (S-BIS) and Rosenberg Self-Esteem Scale (RSES). The results show significant differences in several items when the variable sense of humor is taken into account, indicating that women with a sense of humor report higher satisfaction with their BI and higher SE. The age also indicates a significantly better BI in women over 50 years of age, as well as the education level variable, where those women who had studied up to secondary reported higher satisfaction with their BI; the family history shows that those women without a family history report better SE. All these data are supported by stepwise regression, which shows that educational level and sense of humor are predictors of BI, and family history along with breast reconstruction and sense of humor are predictors as of SE. In conclusion, it is important to take into account the characteristics of women with BC, particularly age and sense of humor, in order to reduce the impact of the disease on their BI and SE with the help of a multidisciplinary team.

Body image experience of women with breast cancer: A meta-synthesis

BACKGROUND

Body image is a multidimensional concept that involves the mental image of the human body and the feeling of being oneself throughout existence. Treatment for breast cancer causes several bodily changes that affect women's body image.

AIMS

This meta-synthesis aims to synthesise and interpret primary qualitative studies on the experience of body image in women undergoing treatment for breast cancer.

METHODS

A qualitative meta-synthesis was conducted employing systematic searches in six databases (PubMed, CINAHL, SCOPUS, Web of Science, PsycINFO, and LILACS). Data analysis was performed according to thematic synthesis.

RESULTS

Forty studies were included. Five descriptive themes were identified: (1) actively saying goodbye to body image; (2) the rupture of body image; (3) the sacrifice of body image in exchange for life; (4) body image as a vehicle for social expression; and (5) resignation of the alterated body image. These themes were understood through one analytical theme: Half-woman: body image of the woman with breast cancer.

CONCLUSION

The experience of body image in the context of breast cancer is a dynamic phenomenon, which involves dismissal, rupture, and resignation and occurs mediated by interpersonal contact.

Tornar-se Mulher com Câncer: Repercussões do Câncer de Mama no Papel de Mulher

O desenvolvimento do papel de mulher se dá de maneira processual e plurideterminada, bem como o processo de significar e experienciar o câncer de mama. O objetivo principal deste trabalho foi conhecer as repercussões do câncer de mama no papel de mulher de pessoas em tratamento oncológico. Para tanto, foi realizado um estudo qualitativo do tipo prospectivo exploratório, de orientação teórico-metodológica do fotovoz. As quatro participantes eram mulheres em tratamento oncológico na UNACON/HUB, maiores de 18 anos e diagnosticadas com câncer de mama (CID: C50). A partir da aplicação da análise temática, construíram-se seis temas: relação imagem corporal e adoecimento por câncer de mama; maternidade e câncer; envelhecimento e câncer; trabalho feminino e câncer; comunicação e representação social em torno do adoecimento por câncer; e escutem as mulheres! Os resultados apontam para a relevância da oferta de atenção integral à saúde das mulheres com câncer de mama, centrada nas experiências e protagonizada por elas.

Effectiveness of cognitive-based interventions for improving body image of breast cancer patients: A systematic review and meta-analysis

Objective

Breast cancer patients often suffer from body image disturbance due to impairment of their body/appearance resulting from surgeries, other cancer treatments, and/or their complications. Cognitive-based interventions (CBIs) have recently been adopted for patients having breast cancer but their effects on improving body image are uncertain. This systematic review aimed to examine the effects of CBIs on body image in these patients, identify the optimal dose, characteristics, and/or component(s) of an effective intervention for these patients to inform future research and practice.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ten online databases and five search engines were used to search for eligible studies. Quality appraisal of included studies and meta-analysis results were conducted using Rob 2 and Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool, respectively. RevMan and comprehensive meta-analysis software were used to perform data analysis and synthesis.

Results

Eleven eligible randomized controlled trials (RCTs) examining the effects of cognitive behavioral, acceptance and commitment, mindfulness, and self-compassion therapies were reviewed. Results of the meta-analysis showed that CBIs significantly reduced negative body image perception (Standardised Mean Difference, SMD ​= ​-0.49, 95% confidence interval [CI], [-0.87, -0.11], I ²  ​= ​81%, 6 RCTs, 758 participants), when compared to the control groups (mainly usual care) at immediately post-intervention; in which, CBT-based (SMD ​= ​-0.37, 95% CI (-0.60, -0.13), I ²  ​= ​0%) and group-based (SMD ​= ​-0.38, 95% CI (-0.62, -0.13), I ²  ​= ​0%) programs had more consistent and significant effects.

Conclusions

In view of the highly heterogeneous and limited RCTs identified, high-quality controlled trials of CBIs for improving the body image of patients having breast cancer are suggested.

Systematic review registration

PROSPERO, CRD42021259173.

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.

How do Body Practices Affect the Psychological Aspects of Survivors Women Undergoing Treatment for Breast Cancer? Systematic Literature Review

Introduction: Body practices can bring physical, psychological benefits and social rehabilitation and may be an alternative treatment for breast cancer. Objective: To analyze the evidence of the results of body practices over the psychological aspects of survivors women undergoing treatment for breast cancer. Method: Systematic blind and independent review from September to December 2021 following the PRISMA guidelines, carried out in the databases: Embase Elsevier; PubMed Central; ScienceDirect; Scopus Elsevier and Web of Science – Core Collection. Results: Of 1,372 studies identified, 22 were included in this systematic review. Among the practices that stood out are meditation and Yoga, with anxiety being the most investigated variable by the studies. It is clear that body practices are options for non-pharmacological clinical treatments utilized in clinical practice by different health professionals in women who have survived breast cancer. Conclusion: Body practices proved to be beneficial in the treatment and psychological health of women who survived breast cancer. This evidence may help to implement body practices as a therapeutic resource to be used in the clinical practice of health professionals. However, more randomized clinical trials that follow study protocols more rigorously are suggested, so that the effectiveness of this approach can be evaluated in different clinical outcomes.

The correlation between posttraumatic growth and social support in people with breast cancer: A meta-analysis

Posttraumatic growth (PTG) is consistently reported to be associated with social support among people with breast cancer. But so far there is no consensus on the size and direction to which social support are related to PTG in people with breast cancer. Thus, a meta-analysis was performed by us to quantitatively synthesize the previous results. This meta-analysis followed the PRISMA 2020 guidelines. We searched PubMed, PsycINFO, Web of Science, Embase, Chongqing VIP Information Co., Ltd. (VIP), China National Knowledge Infrastructure (CNKI), and WANFANG DATA databases prior to 1 June 2022. A random effects model of Stata software (version 17.0) was employed to compute the pooled association coefficient and examine a series of moderating factors: economic level, publication type, region, year of publication, participants' age, and social support measurement tools. Ultimately, 31 studies including 6,380 breast cancer patients were identified. This meta-analysis offers evidence of a highly positive correlation between PTG and social support among people with breast cancer (r = 0.425). Economic level, region, and social support measurement tools moderated the link between PTG and social support among people with breast cancer. Whether variables such as disease stage, time since diagnosis, and disease treatment moderate the link between PTG and social support among people with breast cancer can be further investigated in the future.

Unpacking the psychological and physical well-being of Ghanaian patients with breast cancer

This study explored the psychological and physical well-being of 12 Ghanaian women diagnosed with breast cancer, aged between 22 and 69 years. Individual in-depth interviews were conducted with participants to understand their lived experiences following their diagnosis and treatment. Reflexive thematic analysis was used to analyse the transcripts. Findings revealed that patients' psychological and physical well-being relative to breast cancer diagnosis and treatment are marked by (a) persistent pain, (b) concerns with physical appearance, (c) a willingness to lose a breast for survival, (d) positive religious coping, and (e) posttraumatic growth (i.e., positive psychological changes in the aftermath of diagnosis or treatment). The findings suggest that recognising patients' concerns with pain, physical changes, and the will to lose a breast to survive in the care continuum may yield public health dividends. Moreover, the findings highlight the need for individualised psychotherapeutic interventions to assist the patients to deal with the disease in the aftermath of their diagnosis and treatment.

Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors

PURPOSE

It is important to monitor disease-specific health-related quality of life (HRQoL) in breast cancer (BC) survivors to identify potential unmet supportive care needs. However, previous studies were characterized by small samples of mostly short-term survivors and were limited to certain age ranges, stages and/or treatments.

METHODS

We used data from 3045 long-term BC survivors (5-15 years post-diagnosis) recruited in a German multi-regional population-based study. We assessed disease-specific HRQoL with the EORTC QLQ-BR23, scoring from 0 to 100. Differences in functioning and symptoms according to age at survey, self-reported treatments, stage, and disease status (disease-free vs. active disease) were assessed with multiple regression. Active disease was defined as any self-report of recurrence, metastasis or second primary cancer after the index cancer.

RESULTS

Older BC survivors reported a higher body image and a better future perspective, but lower sexual functioning. Survivors aged 30-49 years who had breast-conserving therapy or mastectomy with breast reconstruction reported a better body image compared to those who had mastectomy only. We also found differences in symptoms according to treatments in some age groups. Stage at diagnosis was not associated with HRQoL overall and in most age subgroups. Disease-free BC survivors aged 30-79 years reported a better future perspective and less systemic therapy side effects than those with active disease.

CONCLUSION

Several treatment-associated symptoms and functioning detriments were found 5-15 years after diagnosis. The results emphasize the need of a comprehensive, individualized survivorship care, recognizing differential needs of long-term BC survivors according to age, treatment modalities, and disease status.

Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study

(1) Background: Patients and survivors of head and neck cancer (HNC) are at a high risk of developing body image concerns. Despite the prevalence of body image concerns in patients with HNC, there is a lack of longitudinal research exploring the wide array of its associated determinants. The current longitudinal study examined the determinants and longitudinal course of body image dissatisfaction in patients with HNC. (2) Methods: Patients participated in Structured Clinical Interviews and self-administered questionnaires at four time-points: (T1) upon cancer diagnosis, (T2) at 3 months post-diagnosis, (T3) at 6 months post-diagnosis, and (T4) at 12 months post-diagnosis. They also underwent a disfigurement rating on an objective scale. (3) Results: Two hundred and twenty-four patients participated in our study. Fourteen percent to twenty-eight percent of patients reported at least moderate body image concerns across time points, with the lowest rates at baseline and the highest at 3 months (T1). It was found that patients more predisposed to developing higher levels of body image concerns presented physical markers (i.e., advanced cancer stage, lower physical functioning, higher disfigurement), psychosocial markers (i.e., higher depression, higher anxiety, and higher levels of coping with denial), and health disparities (i.e., younger age, female sex, French language, and marital status, with divorced and widowers most affected). (4) Conclusions: The findings of this study highlight the multifaceted nature of body image concerns in patients with HNC and its biopsychosocial determinants. Clinicians should pay specific attention to these biopsychosocial markers in their clinics to predict high levels of body image concerns and tailor communication/refer for support accordingly.

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.

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.

Challenges of Survivorship for Older Adults Diagnosed with Cancer

Purpose of Review

The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research.

Recent Findings

The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship.

Summary

There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

The psychosocial needs of underserved breast cancer survivors and perspectives of their clinicians and support providers

PURPOSE

Breast cancer survivors (BrCS) experience many psychosocial difficulties following treatment, leading to an increased risk of psychological distress compared to the general population. This is especially true for underserved BrCS whose unmet supportive care needs can result in worse physical and mental health outcomes. This qualitative study compared healthcare and support providers' perceptions of BrCS' needs to survivors' perceptions of their own needs.

METHODS

Semi-structured in-depth interviews were conducted with 25 underserved BrCS and 20 cancer survivorship stakeholders identified using purposeful sampling. Using the constant comparison method and content analysis, data were analyzed via an iterative process of coding and discussion. Data were summarized according to three intermediate and proximal themes mentioned by both stakeholders and survivors: (1) psychosocial needs of cancer survivors, (2) support, and (3) benefit finding/positive feelings about cancer. Demographic data were analyzed by calculating descriptive statistics.

RESULTS

There was consistency in providers' and survivors' perceptions of post-treatment mood changes, financial burden, familial stress, and physical changes. Providers and survivors differed in perceptions of BrCS' preferred sources of care and support, effects of cancer treatment on body image, the effects of fear of cancer recurrence on follow-up care, and benefit finding.

CONCLUSIONS

This study provides valuable insight into areas in which healthcare and support providers' perceptions may differ from underserved BrCS' lived experiences. Results from this study can be used to develop interventions and inform healthcare and support providers on how to provide high-quality care to underserved BrCS.

Feasibility and acceptability of study methods and psychosocial interventions for body image targeting women diagnosed with breast cancer: a protocol for a systematic review

INTRODUCTION

Improving body image may help to enhance the quality of life of women diagnosed with breast cancer. Although evidence suggests psychosocial interventions can effectively improve body image in this population, no review to date has assessed their feasibility or acceptability. This manuscript reports the protocol for a review summarising current evidence for the feasibility and acceptability of psychosocial interventions for body image targeting women diagnosed with breast cancer and the study methods used to evaluate the interventions in question to provide recommendations to optimise the success and sustainability of psychosocial interventions for body image and future studies. Results will also help to identify gaps in the existing evidence to provide direction for future research.

METHODS AND ANALYSIS

We searched the following databases for articles published in the English language from January 2000 to June 2021 using a systematic search strategy: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, PsychINFO and EMBASE. This search will be supplemented with a manual search of reference lists from relevant systematic reviews and included articles. Eligible studies will include peer-reviewed publications reporting on feasibility and acceptability in the evaluation of psychosocial interventions for body image targeting women diagnosed with breast cancer. All study designs are eligible, although articles are required to have reported on an intervention evaluation. Two reviewers will independently carry out study selection, extraction of quantitative and qualitative data and quality assessment. Data will be summarised in a narrative review and thematic analysis.

ETHICS AND DISSEMINATION

No ethical approval is required because this is a protocol for a systematic review. On completion, results will be submitted for publication in a peer-reviewed scientific journal and for presentation at a relevant conference.

TRIAL REGISTRATION

This protocol has been registered in the Prospective Register of Systematic Reviews international registry (ID: CRD42021269062, 11 September 2021).

Body image in patients with different types of cancer

BACKGROUND

Cancer can cause physical changes and affect satisfaction with a persons' physical appearance, which in turn can affect overall quality of life. Previous studies have primarily focused on women with breast cancer and few is known about body image in patients with other cancers and especially men. The present study compares satisfaction with body image of patients with different types of cancer with the general population and across sexes and identifies risk factors for diminished body image. Additionally, patients that were diagnosed within the last year and those living with cancer for longer are compared.

METHODS

In this cross-sectional study, N = 531 cancer patients answered the German Self-Image Scale to assess body image. One sample t-tests are utilized to compare the body image of cancer patients with the general population. Stepwise regression analyses were used to identify factors associated with body image and ANOVAs with posthoc tests as well as t-tests were used to examine group differences.

RESULTS

Cancer patients showed diminished body image compared to the general population. For men, higher relationship satisfaction and lower cancer-specific distress were associated with more positive body self-acceptance (SA), whereas younger age, higher relationship satisfaction, and lower cancer-specific distress resulted in better perceived partner-acceptance of one's body (PA). In women, higher education, lower anxiety and cancer-specific distress were associated with more positive SA. Female cancer patients with breast/gynecological cancer reported better SA than those with visceral cancers. Higher relationship satisfaction and lower cancer-specific distress were found to be associated with more satisfactory PA in females. Time since diagnosis did not affect body image in this study.

CONCLUSIONS

Results indicate that cancer patients regardless of sex tend to have decreased body image satisfaction. Future research directions include examination of additional entities of cancer, deeper research in men and the role of time since diagnosis.

Physical activity domains are differently related with quality of life in breast cancer survivors: a cross-sectional study

OBJECTIVES

Treatments for breast cancer (BC) can lead to physical and mental impairments which may affect quality of life (QoL). Physical activity (PA) is highly recommended for this population due to its protective effect against BC relapse and its ability to reduce the health impact of treatment. However, it is not clear whether the different domains of PA are associated with better QoL of BC survivors. The current study aimed to verify the relationship between different PA domains with QoL of BC survivors.

METHODS

The sample consisted of 128 women BC survivors, with a mean age of 58.2 ± 9.7 years. QoL was assessed using the Short-Form Health Survey questionnaire (SF-36) and PA was verified through the Baecke questionnaire, in domains of occupation, sports practice, and leisure time/commuting. The relationship between QoL and different PA domains was verified by linear regression, adjusted by age, marital status, and socioeconomic condition.

RESULTS

Occupational PA was negatively related to physical limitations [β= -15.36 (-29.04 to -1.68] and body pain [β=-6.61 (-14.53 to 1.31) marginal association]. Sports practice was positively related to functional capacity [β= 4.24 (0.60 to 7.88)]. Leisure time/commuting PA was positively related to functional capacity [β = 7.17 (3.09 to 11.26)], vitality [β = 4.30 (0.39 to 8.22)], social aspects [β= 5.47 (0.80 to 10.15)], and mental health [β = 4.08 (0.40 to 7.75)].

CONCLUSIONS

Sports practice and leisure time/commuting PA were positively related to QoL in BC survivors, while occupational PA was negatively related to QoL, independently of age, marital status, and socioeconomic condition.

Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study

INTRODUCTION

The better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR.

MATERIAL AND METHODS

A multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders.

RESULTS

In total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women.

CONCLUSIONS

Long-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.

Body image concerns in individuals diagnosed with benign gynaecological conditions: scoping review and meta-synthesis

Background

Benign gynaecological conditions (BCGs) and body image-related concerns are commonly experienced by reproductive-aged female-identified individuals. Qualitative evidence from cancer populations identifies a link between diseases of the sexual organs and body image distress encompassing appearance, sensory and functional aspects. Most BCGs and the impacts on body image have been studied separately. However, commonalities exist between these conditions including chronicity, diagnostic delays, and menstrual-related social stigma. This systematic scoping review and meta-synthesis aimed to compare and contrast the experience of body image in the benign conditions of endometriosis, polycystic ovarian cysts, uterine fibroids, and vulvar intraepithelial neoplasia.

Method

Electronic databases (MEDLINE, PsycINFO, Scopus, CINAHL, Embase, and Allied and Complementary Medicine) were searched in February 2020 and relevant articles were examined to identify papers that qualitatively explored the relationship between body image and BCGs. Meta-synthesis was used to analyse the 17 papers that met the inclusion criteria.

Results

Six main themes evolved from this iterative analysis: loss of control; regained control; silence – menstrual concealment; cultural differences; feeling abnormal, and functional impairment. Body image concerns were widespread although impacts on individual’s lives were dependent on the unique symptom profile of each disease which interacted with socio-cultural factors, daily functioning, and feminine identity. Body image concerns were a common, but hidden, experience rarely screened in routine clinical settings despite causing significant distress.

Conclusions

The chronicity and severity of individuals unique symptom profile often determined the intensity and type of body image concerns individuals described. Across conditions, body image concerns were often left untreated, were concealed, and were associated with reduced quality of life.

Body image, physical activity and psychological health in older female cancer survivors

OBJECTIVES

To determine the association of physical activity and body image with psychological health outcomes and whether body image mediates the association of physical activity with psychological health among older female cancer survivors.

MATERIALS AND METHODS

Data from the Women's Health Initiative (WHI) Life and Longevity after Cancer (LILAC) Study were used. Surveys assessed body image (appearance, attractiveness, scars), moderate-strenuous physical activity (min/week), and psychological health (depression, anxiety, distress). A mediation analysis was conducted to estimate the percentage of the total effect of physical activity on psychological health mediated by body image concerns.

RESULTS

Among 4567 female cancer survivors aged 66-98 years, the average time since cancer diagnosis was 9.2 years. Approximately 50% reported no moderate-strenuous physical activity; 15% reported depressive symptoms, 6% reported anxiety, and 5% reported psychological distress; 3% had concerns with appearance, 20% had concerns with attractiveness, and 21% had concerns with scars. When unadjusted for body image concerns, every 30 min/week increase in physical activity was associated with lower risk of depressive symptoms (RR = 0.93, 95%CI: 0.90-0.96), anxiety (RR = 0.92, 95%CI: 0.87-0.97), and distress (RR = 0.92, 95%CI: 0.87-0.98). Body image concerns with appearance mediated 7%, 8.8%, and 14.5% of the association between physical activity and depressive symptoms, anxiety, and distress, respectively.

CONCLUSION

Older female cancer survivors reported body image concerns, which were associated with both physical activity and psychological health. Our findings suggest that interventions designed to address body image concerns in older female cancer survivors could serve to improve the benefit of physical activity on psychological health.

Current Resources for Evidence-Based Practice, March 2021

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of men's experiences of pregnancy loss and commentaries on reviews focused on the effects of perineal massage on perineal trauma and air pollution and heat exposure on birth outcomes.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

A scoping review of measures used to assess body image in women with breast cancer

OBJECTIVE

The emergence of body image studies in the oncology setting has led to the use of numerous measures to assess different dimensions of body image. The present study is a scoping review of the literature on body image in women with breast cancer to describe: measures used to assess body image in women with breast cancer, dimensions the measures used tap into, and gaps and issues needing attention going forward.

METHODS

Three databases were searched for peer-reviewed original studies that had: (1) full-texts available in English; (2) focused on women with breast cancer; and (3) assessed body image.

RESULTS

The search yielded 3,729 peer-reviewed articles; after screening, 562 articles met inclusion criteria. Of the 88 measures used, 28 were used in more than two studies and analyzed herein. The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire constituted the most frequently used measure. Most measures used focused on the affective dimension of body image (n = 24/28, 85.7%), followed by the cognitive (n = 20/28, 71.4%), behavioral (n = 13/28, 46.4%), and perceptual dimensions (n = 13/28, 46.4%).

CONCLUSIONS

This review provides a current summary of measures used to assess body image in women with breast cancer. Although some further development and refinement of body image measures could benefit the field, depending on the questions researchers or clinicians seek to answer, there are many available for use. Future research should use these measures to assess the effectiveness of interventions aimed at improving body image in women with breast cancer across the lifespan.

Exploring primary care providers' understandings of body image in patient care

Research has shown that healthcare providers lack confidence in having the knowledge needed to have conversations about body image with their patients. No research to date has explicitly explored how providers in primary healthcare understand body image, including its definition and how it impacts plans for care. Accordingly, the current study explored how primary healthcare providers define body image and how they see the concept of body image manifest in their practice. A total of 21 participants were interviewed, including 3 registered dietitians, 6 occupational therapists, 4 physiotherapists, 1 registered massage therapist, 1 kinesiologist, 4 family physicians, 1 nurse, and 1 social worker. Using thematic analysis, it was found that gaps in knowledge about body image were quite apparent as participants' understanding of body image was slippery (e.g., they struggled to articulate specifics about the concept within care and recognized body image is not something associated with a clinical guideline that would bring form to the concept). However, healthcare providers believed in the importance of body image in their patients' care in broad and far reaching ways. Future directions for bridging the knowledge gap with respect to body image among primary healthcare providers are discussed.