Body image issues in women with breast cancer

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.

Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer

PURPOSE

Automated scalp cooling (ASC) is available to patients undergoing chemotherapy for breast cancer to decrease chemotherapy-induced alopecia. This study sought to elucidate patient and chemotherapy nursing perspectives on the ASC experience.

METHODS

This is a survey-based study of chemotherapy nursing staff and patients with breast cancer regarding perceived efficacy, side effects, administration, support, and overall opinions of ASC. Chemotherapy nurses across a large, multi-regional tertiary healthcare system completed a one-time survey regarding their experiences in administering ASC. Breast cancer patients who utilized ASC were surveyed along with a control group who underwent alopecia-inducing chemotherapy without ASC use for comparison.

RESULTS

The majority of nursing responses reported inadequate technical support, an increased burden of administering ASC compared to other clinical duties, and that they would not recommend ASC to a family member or friend. Patients who underwent ASC reported significantly less hair loss and were significantly less likely to shave their heads or wear a wig, but this did not translate into significant differences in body image or psychosocial wellbeing responses. Time investment was the most significant burden related to ASC.

CONCLUSION

Patients using ASC reported significantly less hair loss compared to those not using ASC during alopecia-inducing breast cancer chemotherapy, but this did not translate to improved body image. The majority of chemotherapy nurses reported they lacked adequate support in administering ASC and would not recommend it. Enhanced nursing support may provide a means for improving the ASC experience for both nursing staff and patients.

[RECOMA study: Evaluation of quality of life and satisfaction after immediate or delayed breast reconstruction]

OBJECTIVE

Breast reconstruction after mastectomy, whether immediate or delayed, is an integral part of the overall management of breast cancer. However, up to 40 % of reconstructed patients are not satisfied with the aesthetic result. The primary objective of the study was to evaluate satisfaction and quality of life according to the reconstruction techniques used in our center. The secondary objectives were to identify the parameters that could influence satisfaction and quality of life after surgery, to list the main complications, and the number of operations required to consider the reconstruction process as completed.

METHOD

A retrospective monocentric study, RECOMA, was carried out at the CHRU Minjoz in Besançon. All patients who underwent immediate or delayed breast reconstruction between 2010 and 2021 were contacted by post or e-mail and asked to complete the standardized BREAST-Q postoperative module.

RESULTS

Of 508 patients contacted, 149 were included. Reconstructed patients reported satisfaction, but also "average" quality of physical and psychological sexual life. Only the surgeon's assessment was rated as "good". There was no significant difference in satisfaction and quality of life depending on the reconstruction method chosen. On the other hand, patients who underwent nipple areolar complex (NAC) reconstruction had a significantly higher psychic quality of life score (P=0.02). In addition, a significant decrease in physical satisfaction was observed over time(P=0.049). An average of 2.4 operations was required to consider breast reconstruction complete.

CONCLUSION

In our opinion, breast reconstruction is an essential procedure to be considered as soon as the indication for mastectomy is given, but it is a process that requires the patient to be prepared for a result that may be weaker than expected, may require several operations, and may be complicated.

Women Who Experience More Affectionate Touch Report Better Body Satisfaction and Relationship Outcomes

Affectionate touch (e.g. hugging, handholding) is an essential component of many intimate relationships and is a primary contributor to overall relationship satisfaction as well as sexual satisfaction. Affectionate touch is understood to be a form of non-verbal communication in which the giver is expressing positive feelings toward the receiver. Here, we propose that affectionate touch also positively impacts receivers' body satisfaction, because affectionate touch is a positive message communicated toward the receiver's body. In a cross-sectional sample of romantically partnered women (N = 1,156), we assessed the association between affectionate touch frequency and body satisfaction. We also investigated whether affectionate touch is associated with relationship/sexual satisfaction in part because touch helps to improve women's evaluations of their own bodies. Our results showed that body satisfaction was a significant, partial mediator and a valid path through which affectionate touch shapes relationship quality. Receiving affectionate touch could bolster relationship satisfaction and self-perceptions among women. Given the prevalence of body dissatisfaction amongst women, these results suggest that the underexplored associations between affectionate touch and body satisfaction may have significant impacts on a wide array of future empirical and applied research trajectories.

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

(1) Importance of problem: Breast cancer accounted for 685,000 deaths globally in 2020, and half of all cases occur in women with no specific risk factor besides gender and age group. During the last four decades, we have seen a 40% reduction in age-standardized breast cancer mortality and have also witnessed a reduction in the medium age at diagnosis, which in turn means that the number of mastectomies performed for younger women increased, raising the need for adequate breast reconstructive surgery. Advances in oncological treatment have made it possible to limit the extent of what represents radical surgery for breast cancer, yet in the past decade, we have seen a marked trend toward mastectomies in breast-conserving surgery-eligible patients. Prophylactic mastectomies have also registered an upward trend. This trend together with new uses for breast reconstruction like chest feminization in transgender patients has increased the need for breast reconstruction surgery. (2) Purpose: The purpose of this study is to analyze the types of reconstructive procedures, their indications, their limitations, their functional results, and their safety profiles when used during the integrated treatment plan of the oncologic patient. (3) Methods: We conducted an extensive literature review of the main reconstructive techniques, especially the autologous procedures; summarized the findings; and presented a few cases from our own experience for exemplification of the usage of breast reconstruction in oncologic patients. (4) Conclusions: Breast reconstruction has become a necessary step in the treatment of most breast cancers, and many reconstructive techniques are now routinely practiced. Microsurgical techniques are considered the "gold standard", but they are not accessible to all services, from a technical or financial point of view, so pediculated flaps remain the safe and reliable option, along with alloplastic procedures, to improve the quality of life of these patients.

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).

Epigenetic Silencing of p16INK4a gene in Sporadic Breast Cancer

Epigenetic alterations of tumor suppressor genes (TSG) involved in the onset and progression of Breast Cancer (BC) may serve as biomarkers for early detection and prediction of disease prognosis. We have herein tried to determine the methylation status of TSG, p16INK4a, in our 50 BC patients and their association with clinicopathological parameters. The methylation status of the p16INK4a gene in fresh tissue samples from 50 patients with BC was assessed by methylation-specific polymerase chain reaction (MS-PCR). The mean age of BC patients was 49.30 ± 9.75 years. Of 50 BC samples tested, 21 (42%) had methylated p16INK4a gene. p16INK4a gene hypermethylation was significantly associated with age ≤ 50 years, premenopausal status and advanced BC stage. Multivariate analysis revealed a strong association between advanced BC stage (Stage III and Stage IV) and p16INK4a hypermethylation (P = 0.008, RR = 5.996, 95% CI = 1.581-22.739). p16INK4a methylation was significantly associated with Triple Negative BC (TNBC) (P = 0.045, OR = 4.181, 95% CI = 1.030-16.981). These findings indicate that p16INK4a hypermethylation frequently occurs in BC. Hypermethylation of p16INK4a in young, premenopausal, TNBC and with advance stage in BC patients suggests its association with aggressive BC.

Information and oncosexological management in breast cancer patients

OBJECTIVES

Breast cancer treatment is a particularly high-risk situation for the deterioration of sexual health, leading to an alteration in body image and physical deteriorations such as vaginal trophicity. The aim of this study was to evaluate the information received by patients concerning this alteration of their sexual health in relation to their treatment, and to identify their expectations and needs in terms of oncosexual management.

STUDY DESIGN

A bicentric qualitative retrospective study was conducted, involving women aged 18 to 80, treated for breast cancer by total or partial mastectomy after 2014 and having had a follow-up consultation between July and December 2019. Data were collected using medical files and a de-identified questionnaire sent by post or e-mail after obtaining consent. The main outcome measures were the proportion of patients who received informations about oncosexology and those who felt impact on their sexual health.

RESULTS

Of the 274 patients included in the study, 60% said they had received no information about the sexological side effects of their disease or treatment. Of these, 62.5% dared not talk about it during consultation. Patients were keen to receive oncosexological advice or treatment from a specialized nurse or doctor. In 76.1% of cases, patients declared that they had been sexually active in the year prior to their cancer diagnosis, compared with 54.94% after treatment. They reported a loss of femininity in 24% of cases, and 40.5% had no sexual desire.

CONCLUSION

Women treated for breast cancer report a lasting alteration in their body image and sexual activity. Information on the impact of the disease and its treatment on sexual health is inadequate, even though patients are keen to receive specialized care with professional sexology consultations. The impact of breast cancer on sexual health should systematically explained to the patients, especially as treatment options exist and can be offered.

The Use of Natural Language Processing for Computer-Aided Diagnostics and Monitoring of Body Image Perception in Patients with Cancers

BACKGROUND

Head and neck cancers (H&NCs) constitute a significant part of all cancer cases. H&NC patients experience unintentional weight loss, poor nutritional status, or speech disorders. Medical interventions affect appearance and interfere with patients' self-perception of their bodies. Psychological consultations are not affordable due to limited time.

METHODS

We used NLP to analyze the basic emotion intensity, sentiment about one's body, characteristic vocabulary, and potential areas of difficulty in free notes. The emotion intensity research uses the extended NAWL dictionary developed using word embedding. The sentiment analysis used a hybrid approach: a sentiment dictionary and a deep recursive network. The part-of-speech tagging and domain rules defined by a psycho-oncologist determine the distinct language traits. Potential areas of difficulty were analyzed using the dictionaries method with word polarity to define a given area and the presentation of a note using bag-of-words. Here, we applied the LSA method using SVD to reduce dimensionality. A total of 50 cancer patients requiring enteral nutrition participated in the study.

RESULTS

The results confirmed the complexity of emotions in patients with H&NC in relation to their body image. A negative attitude towards body image was detected in most of the patients. The method presented in the study appeared to be effective in assessing body image perception disturbances, but it cannot be used as the sole indicator of body image perception issues.

LIMITATIONS

The main problem in the research was the fairly wide age range of participants, which explains the potential diversity of vocabulary.

CONCLUSIONS

The combination of the attributes of a patient's condition, possible to determine using the method for a specific patient, can indicate the direction of support for the patient, relatives, direct medical personnel, and psycho-oncologists.

Sexual health outcomes among adolescent and young adult cancer patients: a systematic review and meta-analysis

BACKGROUND

Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages 15-39) affected by cancer. The objective of this systematic review and meta-analysis is to summarize the current literature and evaluate AYA cancer impact on SHO.

METHODS

EMBASE and MEDLINE were searched from January 1, 2000 to September 28, 2022 to identify epidemiologic studies that used an analytic observational design, included individuals with AYA cancer and non-cancer control participants, and evaluated SHO. Odds ratios and prevalence ratios were calculated; random effects models were used to obtain pooled measures where possible.

RESULTS

Of 2621 articles, 8 were included that investigated 23 SHO in 9038 AYA cancer patients. Based on the sexual response cycle, outcomes were categorized as those occurring among males (desire = 1, arousal = 1, orgasm = 4, other = 3) and females (desire = 2, arousal = 1, orgasm = 2, pain = 6, other = 3). It was feasible to conduct meta-analysis for 3 female SHO and 5 male SHO. There were associations between AYA cancer and 3 SHO: vaginal dryness (pooled odds ratio = 3.94; 95% confidence interval (CI) = 2.02 to 7.70), ejaculatory dysfunction (pooled odds ratio = 3.66; 95% CI = 2.20 to 6.08), and testosterone level (pooled mean difference = -2.56 nmol/liter; 95% CI = -3.46 to -1.66; P = .00001).

CONCLUSION

This study found increased ejaculatory dysfunction and reduced testosterone levels in male AYA cancer patients and increased vaginal dryness in female AYA cancer patients, highlighting the need for sexual health resources in this population.

Dermatological Side Effects of Cancer Treatment: Psychosocial Implications-A Systematic Review of the Literature

Cancer is a leading cause of mortality and morbidity all over the world and the second major cause of death in Portugal. Dermatological side effects resulting from cancer treatment have a psychosocial impact on patients' lives, such as quality of life (QoL), body image, cognitive fusion and social inhibition. This systematic review aimed to explore and synthesize the psychosocial impact of dermatological side effects of cancer treatment, answering the following research objectives: (i) Do the dermatological side effects of the cancer treatment present any psychosocial impact for the patients? (ii) How does the psychosocial impact of the dermatological toxicities of the cancer treatment manifest in patients' lives? Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and guided a systematic search through the PubMed, Cochrane Library and PyscNet databases. The considered studies correlate dermatological side effects of cancer treatments and their psychological/psychosocial outcomes. The studies found were all published in peer-reviewed journals. The results obtained established that cancer treatment causes the most varied skin changes, consequently reducing self-esteem and QoL; disturbing body image; and contributing to cases of stress, depression and anxiety. There is still limited literature that profoundly investigates the experience of living with these skin toxicities. The development of research lines to improve knowledge in this field will allow for significant improvements in healthcare for patients undergoing cancer treatment who need to focus more on the psychosocial implications of skin toxicities. The novelty of this review lies in adding knowledge summarizing the psychosocial implications of dermatological side effects of cancer treatment to support healthcare providers in the development of integrative therapeutic strategies for these patients in their clinical practice.

Perceived support, social and marital challenges in the lives of breast cancer survivors after illness: a self-administered cross-sectional survey

Background

Breast cancer (BC) is a traumatic illness. BC is the leading female cancer in Palestine. Complex socio-political dynamics impact patients' lives, resulting in an increasing need for social support to develop resilience after illness.

Methods

Data was collected through a cross-sectional survey targeting women living in the Gaza Strip who had been diagnosed with BC. The survey was self-administered and distributed to 350 women between 1 March and 30 May 2021. Descriptive statistics and multinomial logistic regression analysis (SPSS, version 28.0) were used to explore perceived support, post-illness social and marital changes and the association between these changes and socio-demographic, illness-related and support-related variables.

Findings

About four-fifth of the women with BC felt supported after illness, either fully or partially, mainly by family members, non-governmental organisations, spouses, and peers. Nevertheless, nearly half of the women perceived negative social changes after illness, and about 40% of married or formerly married women perceived negative changes in their marital life. Survivors' lived experiences varied by age, marital status, motherhood, prescribed treatment (specifically mastectomy), and the absence of informal support in social life and lack of partner support amongst married or formerly married women.

Conclusion

This study shows how BC undermines the social status of women and further exacerbates existing social vulnerabilities. Nevertheless, it is possible to manage and potentially overturn this circumstance by enveloping patients with social support. Guiding partners, families, and friends on providing emotional and instrumental support will help survivors to cope better during recovery.

PRO Hair Safe Study: The Patient's Perspective on the Effects of Scalp Cooling on Hair Preservation

Purpose

Alopecia has been reported a distressing side-effect of chemotherapy for breast cancer patients (BCP) that is highly relevant for quality of life during treatment. For the prevention of chemotherapy-induced alopecia, scalp cooling (SC) has been reported to be an effective and safe intervention. However, data on the patient's perspective on effectiveness and applicability of SC in a clinical routine setting are scarce. In this comparative study, we aimed at a longitudinal assessment of patient-reported outcome (PRO) data on the effect of SC on alopecia and its effect on symptoms and functional health when applied in clinical routine in BCP receiving taxane or anthracycline-based chemotherapy.

Patients and Methods

Study participants were allocated either to the intervention group receiving SC or to the control group based on patient preference (non-randomized study). All patients completed PRO-measures on hair preservation (EORTC Item Library items on hair loss), symptom and functional health measures (EORTC QLQ-C30 and -BR23) and the Body Image Scale (BIS). Outcomes were assessed at chemotherapy start (baseline), mid-chemotherapy, last chemotherapy cycle, 3 months follow-up and 6-9 months follow-up.

Results

Overall, we included 113 patients: 75 patients underwent SC (mean age = 51.3 years, 52.7% premenopausal); 38 patients standard care (mean age = 55.6 years, 39.5% premenopausal). A total of 53 patients (70.7%) discontinued SC, with 39 patients (73.5%) stating alopecia as the primary reason. On average, BCP stayed on treatment with the cooling cap for 40.2% of the duration of their chemotherapy (SD 25.3%). In an intention-to-treat analysis, we found no difference between the SC group and the control group with regard to their patient-reported hair loss (p=0.831) across the observation period, overall QOL (p=0.627), emotional functioning (p=0.737), social functioning (p=0.635) and body image (p=0.463) did not differ between groups.

Conclusion

We found a high rate of SC-decliners and no beneficial effects of SC for patient-reported hair loss, symptoms and functional health. The efficacy and tolerability of SC applied in a clinical routine setting hence appeared to be limited. The further determination and up-front definition of criteria prognostic for effectiveness of SC may be helpful to identify patient subgroups that may experience a treatment benefit.

The Unmet Needs of Breast Cancer Navigation Services: Reconciling Clinical Care With the Emotional and Logistical Challenges Experienced by Younger Women with Breast Cancer in a Healthcare Delivery System

This study explores the experience of the breast cancer journey for younger women receiving patient navigation services in a healthcare delivery system and any remaining challenges that navigation services may leave unaddressed. In this qualitative analysis, we used a purposeful sampling approach to conduct a semistructured in-person interview with 19 younger women (under 50 years at the time of diagnosis) at various stages of breast cancer treatment and receiving care that included some form of patient navigation services/within the Sutter Health system. Thematic analysis was performed using an inductive grounded theory approach. The patient experience revealed that women receiving navigation services throughout their cancer journey had little concern related to clinical decision-making and treatment. Rather, emotional, and logistical challenges dominate their experience and perceptions of the cancer journey. Managing day-to-day life and the emotional aspects of a cancer diagnosis cannot be disentangled from clinical care. Navigating the emotional and logistical aspects of the cancer journey is an ongoing unmet need for women under age 50, and navigation services can potentially be enhanced to help address these specific needs. Women with breast cancer may benefit from navigation programs focused not only on clinically related challenges but also on recognizing the daily needs of younger women and guiding them through family and job-related obstacles encountered while navigating cancer care. Health systems could enhance existing nurse navigation programs and redesign other aspects of care to focus on meeting these needs.

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.

Energy balance in cancer survivors at risk of weight gain: a review

PURPOSE

The study of energy balance [i.e., energy intake (EI) and energy expenditure (EE)] is a powerful tool for understanding body weight regulation and may contribute to our understanding of rapid weight gain risk in certain cancer survivors post-diagnosis. The purpose of this review was to summarize studies that assessed longitudinal, prospective changes in components of energy balance from diagnosis/start of treatment to any duration of follow-up in cancer survivors with prior evidence of weight gain (breast, prostate, thyroid, gynecologic, testicular, and acute lymphoblastic leukemia) RESULTS: The available literature suggests that energy balance components may be altered in cancer survivors who have a heightened risk of weight gain post-diagnosis. The evidence for EI was overall inconsistent. Conversely, decreases in resting and physical activity EE during the active phases of treatment (e.g., chemotherapy, hypothyroid state) were commonly noted, which then slowly rebounded towards baseline levels at the end of treatment and during follow-up assessments. Much of this evidence is based on data collected from breast cancer survivors, which highlights a paucity of data currently available on other cancer types.

CONCLUSIONS

While there is growing acknowledgement that weight management interventions in cancer survivors are needed, it is important to recognize that changes in both behavioral (EI, physical activity EE) and passive (resting EE, thermic effect of food) components of energy balance may occur post-diagnosis. This information can help to inform weight management interventions which often entail modifications in diet and/or physical activity.

Quality of Life and Its Association with Androgenetic Alopecia Patients in Shanghai: A Cross-Sectional Study

Background

Health-related quality of life (HRQoL) of androgenetic alopecia patients has become increasingly important, but the influencing factors associated with the different domains are poorly understood.

Objective

This study aimed to investigate the influencing factors in HRQoL of androgenetic alopecia patients and identify its strongly associated domains.

Patients and Methods

We enrolled 170 androgenetic alopecia patients. HRQoL was measured using the World Health Organization Quality of Life Brief Version (WHO-BREF), and Hairdex.

Results

HRQoL was significantly impaired in patients <30 years, (WHO-BREF: P=0.022, Hairdex: P=0.004), less educated (WHO-BREF: P=0.021, Hairdex: P=0.003), single patients (Hairdex: P=0.023), and urban residence (Hairdex: P=0.043). By domains, those <30 years were impaired by physical health (P=0.038) and psychological (P=0.030) by WHO-BREF, and symptoms (P=0.002) and emotions (P=0.002) by Hairdex. Singles were impaired by symptoms (P=0.020), and emotions (P=0.009) by Hairdex. Less-educated individuals had impaired all domains in the WHO-BREF and Hairdex, except for physical health. Women had impaired symptoms (P=0.013) and stigmatization (P=0.041) in Hairdex.

Conclusion

Androgenetic alopecia is associated with significantly reduced HRQoL in young, less educated, and single patients. Dermatologists should inquire about Quality of Life and appropriately support androgenetic alopecia patients.

How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis

BACKGROUND

Acknowledging the popularity of TikTok, how quickly medical information can spread, and how users seek support on social media, there is a clear lack of research on breast cancer conversations on TikTok. There is a paucity of information on how these videos can advocate for those impacted by breast cancer as a means to provide support and information as well as raise awareness.

OBJECTIVE

The purpose of this cross-sectional content analysis was to describe the content of videos from the hashtag #breastcancer on TikTok. Content related to breast cancer support and coping, cancer education, and heightening the awareness of breast cancer early detection, prevention, and treatment was evaluated.

METHODS

This study included 100 of the most viewed TikTok videos related to breast cancer through June 30, 2022. Videos were excluded if they were not in the English language or relevant to the topic being studied. Content was deductively coded into categories related to video characteristics and content topics using a screener based on expert breast cancer information sheets. Univariable analyses were conducted to evaluate differences in video characteristics and content when stratified as advocating or not advocating for breast cancer (yes or no) support, education, and awareness.

RESULTS

The cumulative number of views of the videos included in this study was 369,504,590. The majority (n=81, 81%) of videos were created by patients and loved ones of individuals with breast cancer, and the most commonly discussed topic was breast cancer support (n=88, 88%), followed by coping with the myriad issues surrounding breast cancer (n=79, 79%). Overall, <50% of the videos addressed important issues such as body image (n=48, 48%), surgery (n=46, 46%), medication and therapy (n=41, 41%), or the stigma associated with a breast cancer diagnosis (n=44, 44%); however, in videos that were advocacy oriented, body image (40/62, 64% vs 8/38, 21%; P<.001), stigma associated with breast cancer (33/62, 53% vs 11/38, 29%; P=.02), and breast cancer surgery (36/62, 58% vs 10/38, 26%; P=.002) were discussed significantly more often than in videos that did not specifically advocate for breast cancer.

CONCLUSIONS

The use of videos to display health journeys can facilitate engagement by patients, family members, and loved ones interested in information about challenging conditions. Collectively, these findings highlight the level of peer-to-peer involvement on TikTok and may provide insights for designing breast cancer educational campaigns.

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.

The associations between photo-editing and body concerns among females: A systematic review

Emerging research has raised concerns about the growing prevalence of photo-editing behaviour and how this may negatively interact with body-related concerns among females. This review aimed to systematically examine the current evidence relating to the associations between photo-editing behaviour and female body concerns, including body image, body dissatisfaction and body modification. Six databases were searched for studies investigating associations between photo-editing and body concerns in female social media users. Empirical studies published in English were included if they quantitatively measured the association between photo-editing and at least one of the body-related outcomes, and included female participants. A narrative synthesis of the 22 studies meeting these specific criteria was completed. This review revealed mixed findings in relation to the associations between photo-editing and body concerns. The findings indicate there may be a more complex relationship between both concepts that is influenced by alternative factors. The findings also revealed considerable heterogeneity in measurement approaches for both photo-editing behaviour and body-related outcomes. Future research should focus on developing a gold-standard approach to the measurement of various body-related concerns and conducting in-depth analyses in order to further understand the complex relationship between photo-editing and female social media users' body concerns.

Gender Socialization as a Predictor of Psychosocial Well-Being in Young Women with Breast Cancer

This study aimed to explore the relationship between gender socialization and psychosocial well-being among young women diagnosed with and treated for breast cancer. A total of 113 women between the ages of 18-49 completed a one-time questionnaire package. Four key measures of gender socialization were included: Gender Role Socialization Scale (GRSS), Objectified Body Consciousness Scale (OBCS), Mental Freedom Scale (MFS), and Silencing the Self Scale (SSS). Two measures of psychosocial well-being were included: Functional Assessment of Cancer Therapy-Breast (FACT-B) and Experience of Embodiment Scale (EES). Correlational and regression analyses were conducted to assess the relationship between gender socialization variables and well-being. In multiple regression models, GRSS and MFS added significant increments to the prediction of variance of the FACT-B (R² = 23.0%). In contrast, the OBCS and MFS added significant increments to the prediction of variance of the EES (R² = 47.0%). Findings suggested that women with greater endorsements to proscribed gender socialization were associated with poor well-being scores. Women who endorsed a critical stance, resisting traditional gender-role expectations, objectification pressures, and other social discourses, were associated with greater well-being scores. Future studies are needed to examine the impact of gender socialization on the well-being of young people with breast cancer.

Healthcare providers’ perspectives of the supportive care needs of women with advanced breast cancer in Ghana

Background

The study sought to understand the supportive care needs of women with advanced breast cancer from the perspectives of healthcare professionals (HCPs) and key informants of charitable/non-governmental organisations (NGOs), that provide supportive care services to women with advanced breast cancer, in Ghana.

Methods

A qualitative descriptive approach was employed via one-to-one semi-structured interviews with 13 HCPs and key informants of charitable/NGOs in Ghana that provide supportive care services to women with advanced breast cancer. The study was underpinned by Bradshaw’s taxonomy of social needs and Fitch’s supportive care framework. The data were analysed using a deductive content analysis approach.

Results

Healthcare providers and key informants perceived that women with advanced breast cancer in Ghana have numerous and complex supportive care needs in key areas that align with Fitch’s supportive care framework, including informational, psychological, emotional, physical, practical, social, sexuality and spiritual needs.

Conclusion

Participants perceived that women who have advanced breast cancer in Ghana require ongoing information about their condition, treatments and related effects, as well as spiritual support and guidance particularly due to the fatalistic beliefs they often associate with the condition. Tailored supportive care interventions and services, which address the unique sociocultural circumstances for this cohort, are required. Additional research is needed to explore how multidisciplinary teams can work collaboratively to provide comprehensive support to women in addressing their needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01931-7.

Mitigating negative emotions through virtual reality and embodiment

Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient’s experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.

Beyond biomedical classifications: breast cancer experience in Brazil, 1990-2015

The paper analyses illness experiences of breast cancer in women undergoing treatment at the Hospital of Cancer III of the National Institute of Cancer. It argues that part of the interviewed women's experience was constructed from the interaction between family coexistence and the mobilisation of different cultural meanings of the disease and femininity, negotiating senses for biomedical entities. The study results from a qualitative research of ethnographic inspiration that interviewed women undergoing treatment from breast cancer during 2015. It draws on the accounts to discuss the interaction of society with biomedical entities for the significance of cancer in Brazil between the 1990s and 2010s.

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.

Impact of Exercise Training on Depressive Symptoms in Cancer Patients: A Critical Analysis

BACKGROUND

Cancer patients must deal with several health challenges, including emotional distress and depressive symptoms. This study aimed to evaluate evidence from published systematic reviews and meta-analyses about the efficacy of exercise on depressive symptoms in cancer patients.

METHODS

We searched for previous meta-analyses of randomised controlled trials on PubMed, Web of Science and Scopus, with data inception to 30 December 2021. Two independent researchers assessed the methodological quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) instrument. Six meta-analyses were integrated. All included middle-aged and older adults. Five presented moderate quality, and one presented low quality.

RESULTS

Overall, a significant reduction in depressive symptoms was observed among the included studies. However, the heterogeneity between studies was high, and high-quality evidence for the efficacy of exercise on depressive symptoms was limited.

CONCLUSIONS

Exercise could be a possibility in the treatment of depressive symptoms in cancer patients, especially when supervised and outside the home. The better dose of exercise needs to be clarified. More high-quality evidence is needed to better prescribe exercise to this vulnerable population.

Anticipatory Mourning and Narrative Meaning-Making in the Younger Breast Cancer Experience: An Application of the Meaning of Loss Codebook

Breast cancer (BC) in women under 50 is a potentially traumatic experience that can upset a woman’s life during a crucial phase of her lifespan. Anticipatory mourning linked to the diagnosis of BC can produce a series of inevitable losses similar to those of the bereaved. Narration can be one tool to construct meaning, to grow through the experience, and reconfigure time perspectives during and after the illness. The aim of this study was to apply the Meaning of Loss Codebook (MLC) to the narrative context of young women with BC. An ad hoc narrative interview was administered to 17 women at four times during the first year of treatment. A thematic analysis was performed using the MLC, adopting a bottom-up and top-down methodology. The results highlight the MLC’s usefulness in capturing the experiences of the women, allowing for a greater appreciation of the nuances of the meanings embodied in their narratives. The thematic categories grounded in the MLC cover the whole experience of BC during the first year of treatment, attesting to the possibility of extending the use of the MLC to observe the longitudinal elaboration of the psychic experience of BC in addition to its established validity in the context of bereavement and loss.

Study design and protocol for tailored Acceptance and Commitment Therapy (ACT) to optimize quality of life in women living with metastatic breast cancer

Women living with metastatic (stage IV) breast cancer face unique challenges, including arduous treatments, side effects, chronic symptom burden, and emotional distress. Nevertheless, most research has paradoxically focused on optimizing quality of life in women with early-stage, non-metastatic breast cancer. Acceptance and Commitment Therapy (ACT) is an evidence-based, third-wave cognitive behavioral therapy that focuses on creating 'a life worth living' by promoting meaning and purpose and optimizing quality of life. ACT may be particularly well-suited for women with metastatic breast cancer as it addresses salient existential concerns, while allowing for the co-occurrence of feelings of grief and loss that are normal and expected when facing a life-limiting prognosis. This manuscript describes the rationale and study design of a pilot randomized controlled trial to develop and assess the feasibility and acceptability of a tailored ACT intervention for women living with metastatic breast cancer. Participants (N = 30) will be randomized 1:1 to either ACT, cognitive behavioral stress management (CBSM), or a usual care control. Both ACT and CBSM are 8-week, group-based interventions that will be delivered online. Primary outcomes are rates of acceptance, retention, and satisfaction. Preliminary effects on variables of interest, including meaning and purpose, psychological flexibility, and several domains of quality of life, will also be examined. Findings will inform the conduct of a full-scale randomized controlled trial of our tailored ACT intervention in women living with metastatic breast cancer.

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

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

Self-referential processes and resting-state connectivity in breast cancer patients before and 1 year after chemotherapy

Modifications in the processing of information relevant to oneself have been reported in breast cancer (BC) patients. Here, we characterize the longitudinal changes to self-representations in BC patients and how they are related to intrinsic functional brain connectivity. We tested 16 BC patients before (T1) and 1 year after the end of chemotherapy (T2) along with 24 healthy control participants (HC) at similar time points. Participants underwent resting-state fMRI and completed the Questionnaire of Self-Representation (QSR), which evaluates self-assertion and self-esteem. Resting-state functional connectivity (RSFC) was calculated for regions implicated in self-referential processes (dorsomedial prefrontal cortex [dmPFC], posterior cingulate cortex [PCC], and dorsal anterior cingulate cortex [dACC]) and correlated with QSR scores. QSR scores were on average larger in patients compared with HC and did not vary over time. RSFC between the dACC and regions supporting body awareness (precentral/postcentral and supramarginal gyri, superior parietal lobule) decreased more between T1 and T2 in BC patients than in HC. BC patients had lower RSFC than HC between the dmPFC and the PCC, and regions supporting mental imagery (precuneus, lingual gyrus), at each time point, and a greater decrease from T1 and T2. QSR scores negatively correlated with RSFC. Patients described themselves as having greater self-awareness and positive self-image, reflecting a fighting spirit. In parallel, patients presented a decrease in cortical activity related to body awareness and mental imagery of self-representations over time that may be related to the positive self-image patients have and could reflect a temporary adaptive strategy.

God Attachment: Resource or Complication in Women's and Their Partners' Adjustment to the Threat of Breast Cancer

This study explored the role of adult attachment and God attachment in women's and their partners' adjustment to the threat of breast cancer. Women and their partners were assessed on their adult attachment, God attachment, empathic coping and couple adjustment prior to the women receiving their breast biopsy results. Results showed that a secure God attachment buffered the effects of an anxious adult attachment on the use of empathic coping for women and their partners. In addition, findings revealed that an avoidant God attachment potentially undermined the effects of a secure adult attachment on the use of empathic coping for women. For partners, an avoidant God attachment was directly related to a lesser use of empathic coping and a lower level of couple adjustment. In conclusion, findings revealed that God attachment can have implications for each partner's ability to remain empathic and satisfied in their couple relationship when faced with the threat of breast cancer.

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.

Health-Related Quality of Life Issues Experienced by Thoracic and Breast Sarcoma Patients: A Rare and Understudied Group

Thoracic and breast sarcomas constitute a rare subgroup within the sarcoma population. There is limited knowledge about their health-related quality of life (HRQoL) and a valid disease-specific HRQoL instrument is lacking. This qualitative study aimed to investigate the HRQoL issues experienced by a small group of thoracic and breast sarcoma patients. Semi-structured interviews with 19 thoracic and four breast sarcoma patients were conducted and thematically analysed. Physical issues mentioned by both groups were fatigue, sleep disturbances, pain, wound infections, and symptoms related to chemotherapy and radiotherapy. Tightness in the back and restrictions in performing tasks above arm height were specific physical issues for breast sarcoma patients, whereas respiratory problems were only mentioned by thoracic sarcoma patients. Body image issues, changes in mood, fear of recurrence, and living with uncertainty were important mental health issues for both subgroups. Social issues in both groups included challenges in work and relationships, financial difficulties, loss of independence, and limitations in social activities. The identified physical, mental, and social health challenges can significantly impact thoracic and breast sarcoma patients’ HRQoL. Results of this qualitative study will guide personalised supportive care for breast and thoracic sarcoma patients and help in determining the best possible HRQoL measurement strategy for sarcoma patients with different primary sarcoma locations.

Dietary Risk with Other Risk Factors of Breast Cancer

Breast cancer is one of the most common and feared cancers. The incidence of breast cancer is persistently on the rise due to urbanization and lifestyle changes. Breast cancer cannot be prevented fully but can be effectively treated and controlled if risk factors are determined accurately. Detection of breast cancer at an early stage along with the advancement in treatment options has provided a greater chance of survival.

Sexual Quality of Life in Women with Breast Cancer

For women with breast cancer, sexual quality of life is one of the most disrupted aspects of life often associated with long-term physical and emotional difficulties. The main goal of this paper is to systematically review the literature to determine the level of sexual quality of life in women with breast cancer considering the individual and combined impact of grade, progression of the disease, type of treatment, body image, degree of depression, and anxiety, self-esteem, and social partner support and to determine whether the perception of the body, level of self-esteem and the presence of depressive and anxiety symptoms differ regarding different types of treatment or the level of partners' social support. Using the PRISMA method, all found literature published in electronic databases PubMed, EBSCO, and Hrcak were reviewed and resulted in 10 relevant scientific and review papers. The results showed that women with breast cancer reported disruption in their sexual quality of life. Among the types of treatment, mastectomy and chemotherapy proved to be the most important, while it is not possible to draw clear conclusions about degree and progression of the disease. Disturbed body image, depressive and anxiety symptoms, lower self-esteem, and inadequate social support of the partner are associated with a lower sexual quality of life. The discussion provides detailed explanations of these results and highlights implications for future research.

A Whole New World: A Medical Student's Reflection on the Moments Before Surgery for Breast Cancer

Medical school clerkship offers third year medical students multiple opportunities to acquire clinical experience through real patient interactions and integration into the healthcare teams of different specialties. As part of the general surgery rotation, medical students are invited to scrub in to assist with surgeries-a chance to simultaneously gain medical knowledge while developing technical skills. In what is often an impersonal experience for most patients, students are encouraged to consider the patient's perspective throughout their surgical journey from the pre-operative to post-operative stages. In this reflection, a third year medical student discusses her experience on the moments before breast surgery. From the point of view of a breast cancer patient, she reflects on the impact of a mastectomy on a patient's identity and comments on the importance of empathy in helping a patient grapple with their unique illness experience.

The role of breast reconstruction choice on body image patient-reported outcomes at four years post-mastectomy for breast cancer: A longitudinal prospective cohort study

OBJECTIVES

To examine the impact of breast reconstruction on women's perceptions of body image over time and to assess the influence of sociodemographic variables on body image.

METHODS

A prospective, longitudinal cohort study, using validated breast cancer-specific questionnaires, to compare patient-reported outcomes in women choosing immediate (n = 61), delayed (n = 16) or no (n = 23) breast reconstruction.

RESULTS

One hundred women completed baseline questionnaires that included items on body image; 30 women completed all four annual follow-up sets, while 20 women completed baseline only. The three groups were well matched at baseline and similar trajectories in body image measures were identified over 48 months in all groups. At 12 months post-mastectomy, significant changes were seen in eight of the 10 subscales; this reduced to seven subscales at 24 months and four at 36 months. By 48 months, only three subscales remained significantly different to baseline scores: women remained less vulnerable and had fewer limitations (improved outcomes); the one worse outcome was persistently higher levels of arm concern. Three of the sociodemographic variables (health insurance, age and employment status) showed significant inter-group differences at some time points.

CONCLUSION

These findings suggest women recover from the negative impact of mastectomy on body image within four years of surgery, whether they have immediate, delayed or no reconstruction. Our results provide some indirect evidence that having a choice of BR options is important, regardless of the choice made. Four years appears to be a suitable follow-up period for future studies in this area.

Effect of mind and body education on quality of life among young breast cancer patients: a randomized controlled trial

PURPOSE

This study aim was to evaluate efficacy of the combination with cosmetic and psychosocial education program on body image, sexual function, and emotional function among young-onset breast cancer (YBC).

METHODS

An unblended, randomized, controlled trial design was conducted in patients newly diagnosed with stage I-III breast cancer from 2014 to 2015. The intervention group received a structured education program including appearance management and mind control for 4 weeks. The outcome of this study shows effect on body image and sexual functioning and a distress due to altered appearance and anxiety after the intervention and 6 months after intervention.

RESULTS

Among 228 eligible patients, 109 (47.8%) agreed to participate in the present study and were randomized to intervention (n = 54) or control (n = 55) groups. After intervention, the intervention group reported significantly better body image compared to the control group (mean score of 75.0 vs. 59.3, respectively; P < 0.01). The intervention group also reported significantly lower levels of distress due to altered appearance and higher levels of sexual functioning compared to the control group after the intervention. The effects were maintained even 6 months after intervention.

CONCLUSION(S)

Body image intervention for YBC had effect on improving body image and sexual functioning and a reduction in distress due to altered appearance and anxiety. Trial registration number and date of registration: The study was registered at the Clinical Research Information Service (no. KCT0001191, https://cris.nih.go.kr/cris ) on 23 July 2014.

BEAUTY and the breast: is adjuvant chemotherapy the right time for a beauty boost? Lessons learned from a large randomized controlled trial

PURPOSE

Beauty care (BTC) is offered at many cancer hospitals having a great uptake among patients. Nevertheless, its benefits in the Quality of life (QoL) of cancer survivors have not been assessed so far.

METHODS

Our study aims to determine whether BTC improves patients' QoL related to their body image measured by the BRBI scale of the QLQ-BR23 questionnaire at the end of adjuvant chemotherapy, after breast cancer (BC) surgery. The BEAUTY study is a prospective, randomized, controlled intervention trial. The following patient-reported outcomes were filled before initiation of chemotherapy (T1) and after their last cycle (T2): EORTC QLQ-C30, QLQ-BR23, and Body Image Scale (BIS). Primary objective was improvement in the BIS of BR23 (BRBI). A qualitative assessment of patients' experience was performed at each cycle through a relevant questionnaire.

RESULTS

In total, 269 (67%) patients filled BRBI at T1 and T2. Mean BRBI scores substantially decreased between T1 and T2 and were not different with or without BTC (p = 0.88). Qualitative assessment suggests impact of BTC in physical well-being and avoids thoughts related to the disease.

CONCLUSION

A substantial proportion of patients have a poor body image and chemotherapy induced a substantial degradation of BRBI scores. Although BTC does not seem to impact BRBI scores, the qualitative assessment suggests some benefit of BTC in other domains. Our study highlights the need to assess patients-perceived body image and build tailored interventions at this critical phase of their disease and generates hypothesis for the impact of BTC among BC patients. Clinical trial registration The study is registered at ClinicalTrials.gov under the NCT01459003 number since October 25, 2011.

A Grateful Disposition Promotes the Well-Being of Women with Breast Cancer Through Adaptive Coping

Introduction

Gratitude has been studied as a disposition that reflects the extent to which people appreciate what they have in life knowing that it has not been given to them forever. Being grateful has been found to promote quality of life, which is why it may be used to cope in difficult times including during breast cancer diagnosis and treatment.

Methods

Dispositional gratitude was examined in relation to the well-being of women with breast cancer. In the current study, 119 women with breast cancer completed questionnaires that measured gratitude, well-being, coping styles, depression, and anxiety.

Results

Correlational analyses found that dispositional gratitude was positively correlated with well-being (p < 0.001) and was negatively correlated with depression (p < 0.05) and anxiety (p < 0.05). Gratitude was also positively correlated with the use of task-oriented (p < 0.05) and socially oriented coping (p < 0.01) techniques. Analyses of mediation using PROCESS found that the use of task-oriented and socially oriented coping mediated relationships between gratitude and well-being, between gratitude and anxiety, and between gratitude and depression.

Conclusion

In terms of application, the present results suggest that among women who have breast cancer, increasing dispositional gratitude may increase adaptive coping, which in turn will increase their well-being.

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors

BACKGROUND

The majority of breast cancer survivors (BCSs) experience body image concerns following treatment. Body Image distress (BID) is associated with psychological distress and diminished quality of life. A web-based self-compassion focused writing activity (My Changed Body - MyCB) reduces BID in BCSs, yet limited research exists on participant characteristics associated with such intervention adherence. Self-compassion-based meditations are also efficacious in reducing BID in non-BCS populations. This parallel, double-blind pilot randomised controlled trial aimed to assess the feasibility and acceptability of MyCB, with and without an additional meditation component, on BID and related psychological outcomes in BCSs. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#ACTRN12619001693112).

METHODS

BCSs were randomly allocated to MyCB (n = 39), MyCB + Meditation (MyCB + M) (n = 17) or an expressive writing (EW) active control arm (n = 23). The primary outcome was BID. Secondary outcomes were body appreciation, affect (positive and negative), psychological distress (depression, anxiety and stress) and self-compassion (state and trait). Assessments were completed online at baseline, post-intervention and 1-month.

RESULTS

Adherence to the MyCB writing (45%) and meditation (50%) was modest, and acceptability was high for both MyCB and MyCB + M. Intent to treat linear mixed model analyses indicated: Post-intervention - state self-compassion and positive affect increased for MyCB compared to EW; 1-month: BID scores decreased across all conditions; trait self-compassion increased and anxiety decreased for MyCB + M compared to MyCB and EW.

CONCLUSION

These findings provide preliminary evidence for the efficacy and potential clinical use of the MyCB brief web-based self-compassion intervention alone and with the addition of meditation, to increase self-compassion and psychological wellbeing in BCSs.

Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity

Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.

An Improved Stress-Scale Specifically Designed to Measure Stress of Women with Newly Diagnosed Breast Cancer

Most breast cancer patients are middle-aged women actively involved in establishing a family, developing a career, or raising children. With the exception of the Newly Diagnosed Breast Cancer Stress Scale (NDBCSS), few stress scales have been designed for women with breast cancer. This study checked the dimensionality of the NDBCSS by confirmatory factor analysis (CFA) and the results showed a poor fit, indicating an urgent need for improvement. Exploratory factor analysis (EFA) using the varimax rotation method was performed to improve the model, the revised NDBCSS (NDBCSS-R), which showed a good Kaiser-Meyer-Olkin value, Bartlett’s test of sphericity, and internal consistency reliability. The NDBCSS-R showed improved indices compared with NDBCSS, including: chi-square fit statistics/degree of freedom (CMIN/DF), goodness-of-fit index (GFI), adjusted goodness of fit index (AGFI), normed fix index (NFI), relative fit index (RFI), incremental fix index (IFI), Tucker–Lewis index (TLI), comparative fix index (CFI), root mean square error of approximation (RMSEA), root mean square residual (RMR), parsimonious goodness-fit-index (PGFI), and parsimonious normed fit index (PNFI). In conclusion, the improved NDBCSS-R can provide health professionals with an early understanding of the stress levels of women with breast cancer so that they can provide immediate medical intervention to prevent vicious cycles in a timely manner.

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

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

The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer (stages I, II, and III) were evaluated with different self-report questionnaires. Afterward, patients were divided into two groups (high and low levels of alexithymia) to analyze dependent variables (body image and psychological adjustment) according to the type of surgery (radical mastectomy or breast conserving therapy). The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy.