Factors associated with healthcare professional's rating of disfigurement and self-perceived body image in female patients with head and neck cancer

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

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR CANCER SURVIVORS

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

Body image distress among cancer patients: needs for psychosocial intervention development

Objectives

This study examines the body image distress among patients with head and neck cancer (HNC) visiting a tertiary care hospital for follow-ups.

Design

A cross-sectional survey purposively enrolled 170 head and neck cancer (HNC) patients who had undergone cancer surgery at a newly established tertiary care hospital, North India.

Methods

A structured pre-tested socio-demographic and clinical profile checklist and the Derriford Appearance Scale-24 (DAS-24) were used to collect information. An appropriate descriptive and inferential statistic was applied to compute the findings.

Results

The median age of the participants was 46.0 years, and 80% of the participants were unemployed. The mean body image distress score was 57.95 (SD = 10.3, 47–66.75, range 42–77). The body image distress shows a significant association with age (p < .001), gender (p = 0.003), and working status (p = 0.032) of the HNC patients. Multilinear regression reported gender as an independent predictor (95% CI: 0.615–8.646, p = 0.025) for body image distress in HNC patients.

Conclusions

HNC patients reported substantial body image distress due to changes in body appearance. Female patients who had undergone surgery at young age reported higher body image distress. Recommending cosmetic surgery and nurse-led psychosocial nursing intervention on routine follow-ups are other potential strategies to improve facial appearance to overcome the negative impact of body image.

Burnout or Fade Away; experiences of health professionals caring for patients with head and neck cancer

PURPOSE

The oncology workforce has been found to have high risk of burnout; however, limited research has explored the experiences of health professionals working with head and neck cancer patients. The objective of this qualitative study was to explore the experiences of health professionals who work directly with patients diagnosed with head and neck cancers, with a focus on work-life balance, mental health and wellbeing.

METHOD

A total of 21 in-depth semi-structured interviews were conducted with health professionals including radiation oncologists, medical oncologists, nurses, and associated medical and allied health professionals. A qualitative research approach based on social constructionist theory was used. Thematic analysis was used to identify and code themes.

RESULTS

Five main themes emerged: 1. Conscientiousness; 2. Empathy; 3. Challenges; 4. Coping; and 5. Burnout or Fade Away. Challenges included sub-themes of Time & Resource Constraints, Work-Life Imbalance, Patients with Complex Needs, and Lack of Self-Care.

CONCLUSION

It is vital to the sustainability of head and neck oncology services that this highly skilled workforce is retained. The development of interventions that will reduce the risk of burnout and improve retention and capacity of health professionals may include advanced communication skills training, trauma sensitivity training, self-compassion and stress management skills.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Body image and its associated factors among Chinese head and neck cancer patients undergoing surgical treatment: a cross-sectional survey

PURPOSE

Body image is a critical psychosocial issue for patients with head and neck cancer. However, the current status and associated factors of body image in patients with head and neck cancer in Mainland China remain unknown. This study aimed to explore body image concerns for head and neck cancer patients undergoing surgical treatment in Mainland China and to identify the associated factors.

METHODS

A cross-sectional study was conducted including 154 patients who underwent surgery for head and neck cancer at Tianjin Medical University Cancer Institute & Hospital in Mainland China. Participants were surveyed using the Body Image Scale (BIS), the Perceived Social Support Scale (PSSS), the Simplified Coping Style Questionnaire (SCSQ), the Hospital Anxiety and Depression Scale (HADS), and a questionnaire designed for this study. The Mann-Whitney U test, Kruskal-Wallis H test, Spearman's rank correlation, and stepwise multiple regression analysis were used to analyze the data.

RESULTS

The score of BIS was 6.00 (4.00, 8.00). Multiple regression analysis revealed that anxiety, cancer stage, sex, active coping style, and educational level were factors related to body image. These five variables accounted for 40.7% of the total variance in body image.

CONCLUSIONS

These findings indicate body image dissatisfaction in surgically treated patients with head and neck cancer. Patients with greater anxiety, a more advanced cancer stage, female sex, fewer active coping strategies, and higher education are more likely to have an inferior body image. Assessment and effective psychosocial interventions are needed initially for patients with head and neck cancer to manage body image concerns.

Factors influencing body image in posttreatment oral cavity cancer patients

OBJECTIVE

The purpose of this study of posttreatment oral cavity cancer (OCC) patients was to identify factors associated with self-reported overall body image, perceived attractiveness, and dissatisfaction with body appearance.

METHODS

This cross-sectional study recruited patients with OCC from the outpatient radiation department of a single cancer center in Northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Hospital Anxiety and Depression Scale (HADS), the Liebowitz Social Anxiety Scale (LSAS), the University of Washington Quality of Life Scale (UW-QOL), and the Body Image Scale (BIS).

RESULTS

A total of 168 patients were included in this current study, 76 females and 92 males. Negative overall body image was associated with greater degree of depression, greater fear of social interactions, poorer social-emotional function, receipt of surgery, female gender, and greater avoidance of social interaction; these factors explained 49.0% of the variance in this outcome measure. Poor perceived attractiveness was associated with greater depression, greater fear of social interaction, and receipt of surgery; these factors explained 25.4% of the variance in this outcome measure. Dissatisfaction with body appearance was associated with poor social-emotional function, greater fear of social interaction, receipt of reconstruction, advanced cancer stage, and female gender; these factors explained 52.2% of the variance in this outcome measure.

CONCLUSIONS

This study of posttreatment OCC patients indicated that depression and fear of social interaction strongly influenced overall body image, perceived attractiveness, and dissatisfaction with body appearance.

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

OBJECTIVE

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

STUDY DESIGN

Qualitative methods approach using semistructured key informant interviews.

SETTING

Academic medical center.

SUBJECTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Prospective Cohort Pilot Study

This prospective cohort pilot study sought to characterize the short-term temporal trajectory of, and risk factors for, body image disturbance (BID) in patients with head and neck cancer (HNC). Most patients were male (35/56), had oral cavity cancer (33/56), and underwent microvascular reconstruction (37/56). Using the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, the prevalence of BID (BIS ≥10) increased from 11% preoperatively to 25% at 1 month postoperatively and 27% at 3 months posttreatment (P < .001 and P = .0014 relative to baseline, respectively). Risk factors for BID included female sex (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.3-19.8), pT 3 to 4 tumors (OR, 8.9; 95% CI, 2.0-63.7), and more severe baseline shame and stigma (OR, 1.06; 95% CI, 1.01-1.13), depression (OR, 1.25; 95% CI, 1.06-1.51), and social isolation (OR, 1.21; 95% CI, 1.01-1.49). The prevalence and severity of BID increase immediately posttreatment. Demographic, oncologic, and psychosocial characteristics identify high-risk patients for targeted interventions.

A Systematic Review of Patient-Reported Outcome Measures Assessing Body Image Disturbance in Patients with Head and Neck Cancer

OBJECTIVE

To synthesize published literature describing the severity of body image disturbance (BID) in patients with head and neck cancer (HNC) over time, its psychosocial and functional associations, and treatment strategies as assessed by patient-reported outcome measures (PROMs).

DATA SOURCE

PubMed/MEDLINE, Scopus, PsycINFO, Web of Science, and Google Scholar.

REVIEW METHODS

A systematic review of the English-language literature was performed to identify studies of BID in patients with HNC using psychometrically validated PROMs to assess (1) severity of BID over time, (2) psychosocial and functional associations, and (3) management strategies.

RESULTS

A total of 17 studies met inclusion criteria. BID was assessed via 10 different PROMs, none of which were HNC-specific measures of BID. Two of 2 longitudinal studies (100%) reported that BID improved from pretreatment to posttreatment, and 2 of 3 longitudinal studies (67%) showed that the severity of BID decreased over time as survivors got further out from treatment. Seven of 17 studies (41%) described negative functional and psychosocial associations with BID, although study methodology limited conclusions about cause and effect. None of the studies assessing interventions to manage BID (0/2, 0%) demonstrated an improvement in BID relative to control.

CONCLUSION

BID in patients with HNC has negative functional and psychosocial associations and lacks evidence-based treatment. Research is limited by the lack of an HNC-specific BID PROM. Further research should address knowledge gaps related to the lack of an HNC-specific BID PROM, longitudinal course of BID in patients with HNC, confusion with regards to risk factors and outcomes, and lack of prevention and treatment strategies.