Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study

Demographic Differences and Associations Between Body Image and Quality of Life Among Japanese Adolescents with Congenital Physical Disabilities

This study aimed to examine the levels, demographic differences, and associations between body image (BI) and quality of life (QOL) among Japanese adolescents with congenital physical disabilities. A self-report questionnaire was administered to 107 Japanese adolescents with congenital physical disabilities, which included demographic variables, the Multidimensional Body-Self Relations Questionnaire, and the Japanese version of the World Health Organization Quality of Life Brief Version. Data were analyzed using Cronbach's α coefficient, descriptive statistics, t-tests, one-way ANOVA, and Pearson's correlation coefficient. The mean BI score was 2.96 ± 0.39. The domain-specific mean scores were as follows: health evaluation (3.49 ± 0.67), health orientation (3.11 ± 0.57), fitness evaluation (3.03 ± 0.93), fitness orientation (3.02 ± 0.70), appearance orientation (2.70 ± 0.61), and appearance evaluation (2.61 ± 0.61). The mean QOL score was 3.51 ± 0.50. The domain-specific mean scores were as follows: social relationships (3.61 ± 0.91), environment (3.60 ± 0.59), physical (3.46 ± 0.55), and psychological (3.42 ± 0.63). BI significantly varied by gender, school level, type of disability, and activities of daily living (ADLs), while QOL varied by school level and ADLs. All BI domains, except appearance orientation (investments for enhancing appearance), were positively correlated with QOL. Our findings suggest that school level and ADLs are key predictors of both BI and QOL among Japanese adolescents with congenital physical disabilities and that physical-fitness- and health-related BI are closely associated with QOL.

Quality of life and its predictors among breast cancer patients treated with surgery-a retrospective minimum 3-year follow-up study

Aim

Quality of life (QoL) has been identified as an important indicator of positive outcomes among breast cancer (BC) survivors. However, the status and predictors of QoL in China remain unclear. This retrospective follow-up study aimed to examine the QoL levels among BC patients following surgery and to assess the influence of sociodemographic, clinical, and psychological factors on QoL.

Methods

An institution-based retrospective follow-up study was conducted among 714 BC patients who received surgery at the First Affiliated Hospital of Guangxi Medical University between January 2016 and December 2019. Our primary outcome measure was QoL, assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Anxiety and depression were evaluated by the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), respectively. Data on the patient demographics and clinical were derived from medical records. Results are presented as means (SD), medians [Q1, Q3], or percentage (%). We used R 4.2.2 software to identify factors associated with QoL after BC surgery. AMOS 28.0 was used to construct a structural equation model (SEM) to predict QoL outcomes.

Results

The overall QoL score was 43.30 ± 4.77 (mean ± SD). Predictive factors were: surgery type, radiotherapy, anxiety, and depression (p<0.05). The results of the SEM indicated that anxiety and depression had a direct negative effect on QoL (effect value was -0.46, -0.84, respectively, p<0.05), radiotherapy had a direct positive effect on QoL (effect value was 0.71, p<0.05). The type of surgery (mastectomy) impacted QoL both directly and indirectly through its association with depression, with direct and indirect effect values of -0.96 and -0.66, respectively (p < 0.05).

Conclusion

The QoL of BC patients after surgery is generally moderate to low. Medical staff should prioritize early identification and rehabilitation management for patients experiencing anxiety, depression, radiotherapy, and mastectomy to enhance their QoL. Our findings provide a strong foundation for developing nursing intervention plans and assessment guidelines for practitioners caring for BC patients.

Assessing the factors associated with body image perception and quality of life of Palestinian women undergoing breast cancer treatment: a cross-sectional study

BACKGROUND

Worldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy. Breast cancer poses a significant burden on the health and quality of life of women and can lead to substantial physical burdens and significant psychological problems, including distress, anxiety, depression, and sexuality-related issues, including negative body image. This study was conducted to assess how women diagnosed with, treated, and/or receiving treatment for breast cancer perceived their body image.

METHODS

A cross-sectional study design was used to assess body image perceptions among Palestinian women diagnosed with breast cancer. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care in the period between November 2023 and March 2024. An interviewer-administered questionnaire was used to collect the data. Body perception was assessed using the body image self-rating questionnaire for breast cancer (BISQ-BC).

RESULTS

In this study, 376 women with breast cancer completed the interviewer-administered questionnaire (response rate = 75.2%. The mean age of the women was 44.0 ± 5.3 years. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Multiple linear regression showed that younger age, employment status, living in cities, marital status, educational level, presence of comorbidities, and longer time passes since diagnosis with breast cancer were associated with the different aspects of body image perception and behavior.

CONCLUSION

The findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

How to improve emotional regulation in breast cancer survivors? A psychological intervention

Objective

Psychological interventions are pivotal in enhancing the Quality of Life for breast cancer survivors, with a primary focus on addressing affective and cognitive challenges through group discussions among those diagnosed with the disease. While the influence of Body Image on overall well-being is well-documented, research on interventions specifically designed to address Body Image concerns in this demographic remains scarce. The present study aimed to fill this gap by evaluating the outcomes of a psychological intervention focused on fostering a positive Body Image among 25 breast cancer survivors.

Method

Participants were divided into an experimental group, which received the intervention (n = 13), and a control group that did not receive any psychological support (n = 12).

Results

Our findings highlight significant disparities in emotional regulation strategies, specifically cognitive reappraisal and expressive suppression, with the intervention group reporting enhanced emotional regulation. Contrary to initial hypotheses, the analysis unveiled statistically significant differences in both negative (social physique anxiety) and positive (functionality appreciation) body image dimensions, indicating elevated levels of social physique anxiety and reduced functionality appreciation among intervention participants.

Conclusion

The total results may suggest that the intervention, while effective in enhancing emotional regulation, heightened awareness of body image issues, leading to increased social physique anxiety and diminished functionality appreciation. The paper further discusses practical implications arising from these insights.

Needs of breast cancer survivors: a systematic review of quantitative data

This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.

The relationship among body image, psychological distress, and quality of life in young breast cancer patients: a cross-sectional study

Purpose

The aim of this study is to explore the interrelationships among body image perception, levels of psychological distress, and the quality of life (QOL) experienced by young breast cancer patients.

Methods

This study analyzed data from 339 young female breast cancer patients aged between 18 and 40 years (mean age was 33.47 years) from August 2023 to February 2024. Data on demographic characteristics, psychological distress, body image, medical coping, and QOL of young breast cancer patients were collected. Psychological distress, body image, medical coping, and QOL were measured using the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Body Image Scale (BIS), Medical Coping Modes Questionnaire (MCMQ), and Functional Assessment of Cancer Therapy-Breast (FACT-B), respectively. Multiple regression analysis was conducted to examine factors influencing QOL.

Results

After adjusting for covariates, significant predictors of QOL in young survivors included psychological distress (β = -3.125; p = 0.002), anxiety and depression (β = -4.31; p < 0.001), cognitive dimension of body image (β = -0.218; p = 0.027), behavioral dimension of body image (β = 0.579; p = 0.047), and confrontational dimension of medical coping (β = -0.124; p = 0.01).

Conclusion

The findings suggest that higher levels of body image concerns and psychological distress are associated with poorer QOL among young female breast cancer patients. Furthermore, breast cancer patients facing with more positive medical coping strategies predicted a higher QOL.

Relationship between kinesiophobia and quality of life among patients with breast cancer-related lymphedema: Chain-mediating effect of self-care and functional exercise compliance

Objective

Breast cancer-related lymphedema (BCRL) significantly impacts the quality of life (QoL) of breast cancer survivors following treatment. This study explores the association between kinesiophobia (fear of pain caused by movement) and QoL in postsurgical BCRL survivors and examines whether self-care and compliance with functional exercise act as mediators between these variables.

Methods

This cross-sectional study surveyed 274 BCRL patients at three tertiary hospitals in Shenyang City, China, from May 2020 to October 2022. The participants completed self-reported questionnaires on self-care, functional exercise compliance, kinesiophobia, and QoL. Medication analysis was conducted using the PROCESS macro (Model 6).

Results

Kinesiophobia was found to have negative association with self-care (P < 0.001), functional exercise compliance (P < 0.001), and QoL (P < 0.001). Kinesiophobia indirectly affected QoL through three mediating pathways: self-care (effect = -0.132), functional exercise compliance (effect = -0.390), and a combination of self-care and functional exercise compliance (effect = -0.220), collectively accounting for 7.9%, 23.3%, and 13.1% of the total effect, respectively.

Conclusions

This study highlights the substantial chain-mediating role of self-care and functional exercise compliance in the relationship between kinesiophobia and QoL. It provides valuable evidence supporting the protective effects of self-care and functional exercise compliance in mitigating kinesiophobia and enhancing the QoL of BCRL survivors.

Predictors of information needs among women with breast cancer receiving adjuvant therapy at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia: a cross-sectional study

BACKGROUND

Women undergoing adjuvant therapy for breast cancer have diverse information needs that remain unfulfilled. Extensive research has shown that access to relevant information about their condition can significantly enhance the quality of life for these women, making it an essential part of cancer care. However, various clinical and socioeconomic factors influence the information needs of these women. Hence, the primary aim of this study is to identify predictors of the information needs of women undergoing adjuvant therapy for breast cancer. In addition, this study will also describe the preferred sources of information and the optimal timing for its acquisition.

METHODS

A facility-based cross-sectional study was undertaken at Tikur Anbessa Specialty Hospital, enlisting a cohort comprising 121 women undergoing adjuvant therapy for breast cancer. Trained interviewers administered an Amharic-translated Toronto information needs questionnaire specifically designed for breast cancer to assess the information needs of the study participants Statistical analysis was executed using the sophisticated software SPSS (version 25). Descriptive statistics were employed to summarize the variables of the study. A linear regression analyses was then carried out to identify notable predictors that significantly influenced the information needs of the women.

RESULTS

The total mean score for overall information needs in the current study was 194.30 (± 28.01), with a range scale of 142-260 and a standardized mean score of 3.74 (± 0.54). The disease and treatment domains had the highest information needs, with standardized mean scores (standard deviation) of 4.00 (± 0.54) and 3.77 (± 0.59), respectively. 95% of the participants sought information from healthcare professionals, and 67.7% of the women needed the information before beginning the treatments. Predictors of information needs were following a single treatment option (β = 12.68; 95% CI (0.68, 24.68); P = 0.039) and joining higher education and above (β = 17.1; 95% CI (1.47, 34.14); P = 0.033).

CONCLUSION

The women exhibited a substantial demand for information. Healthcare professionals need to consider the women's educational background and treatment status while delivering the needed information.

The mediating effect of coping styles between self-compassion and body image disturbance in young breast cancer survivors: a cross-sectional study

BACKGROUND

Young breast cancer survivors with body image disturbance have poor quality of life. Self-compassion and different coping styles can influence their body image. The purpose of the study was to investigate the relationship between self-compassion, coping styles, and body image disturbance, and examined the mediation role of coping styles between self-compassion and body image disturbance among young breast cancer survivors in China.

METHODS

In the cross-sectional study, a total of 310 young women with breast cancer were assessed on self-compassion, coping styles, and body image disturbance by self-reported questionnaires in China. Spearman's correlation was used to test the links between variables and to verify the indirect effects between variables by constructing a structural equation model.

RESULTS

There were correlations between self-compassion, different coping styles, and body image disturbance. Confrontation, avoidance, and acceptance-resignation coping had significant mediation effects on the association between self-compassion and body image disturbance. The mediation effects of confrontation coping were greater than avoidance, and acceptance-resignation coping.

CONCLUSIONS

In this study, different coping styles acted as mediators between self-compassion and body image disturbance, providing support for further understanding the mechanism between self-compassion and body image disturbance, and developing comprehensive interventions for body image disturbance. Oncology nurses should pay attention to the breast cancer survivors' self-compassion and coping styles and encourage them to adopt adaptive coping strategies, which can reduce body image disturbance.

Pre-operative and early postoperative health-related quality of life of breast cancer woman: a Lebanese prospective study

Breast cancer (BC) is a major health concern in Lebanon, with an increasing incidence rate due to advancements in treatment modalities. Evaluating the impact of the BC and its treatment on a woman's Health-Related Quality of Life (HRQoL), and comparing these patterns before and after breast conserving surgery is important to identify areas where interventions may be needed to improve the overall well-being of women with BC. This study aimed to evaluate the HRQoL pre and post-operative breast conserving surgery and just prior to initiation of adjuvant therapy in newly diagnosed patients with BC in Lebanon, specifically focusing on changes in body image. A prospective cohort study was conducted on 120 patients in two health care facilities in Lebanon, collecting sociodemographic and clinical data, and using the EORTC QLQ-C30 and QLQ-BR23 questionnaires to evaluate HRQoL. The outcomes were measured at baseline and then one-day post-operative breast surgery. Results revealed a statistically and clinically significant decrease in body image (mean difference of 8.1 points (95% 4.3;11.1)), physical functioning (mean difference of 6.1 points (95% 3.3;8.5)), and emotional functioning (mean difference of -8.4 points (95%-12.4; -4.9) after surgery. Positive change of physical functioning score was observed among married women. Positive change of emotional functioning score was observed among patients with poor body image score and high future perspective score. Our findings provide valuable insights for clinicians and researchers on the impact of breast conserving surgery on HRQoL in Lebanese women.

Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up

BACKGROUND

Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period.

METHODS

Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.

RESULTS

After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC.

CONCLUSION

The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

Tailored Psychological Interventions to Manage Body Image: An Opinion Study on Breast Cancer Survivors

OBJECTIVE

Oncological care affects the body strongly, even some years after therapies. Body image, as the mental representation of one's own body, is particularly affected by breast cancer, with a high level of dissatisfaction and negative perception. Literature has shown the effectiveness of various psychological interventions to promote body image in breast cancer survivors, dealing with inner sensations and related emotions and thoughts. The present opinion study presents BI issues and personalized psychological interventions to increase a positive BI in breast cancer survivors.

CONCLUSIONS

Implementing specific and personalized psychological interventions tailored on BI, the characteristics of oncological journey and emotional and cognitive issues is fundamental. Directions for clinical practice are given.

Exploring the moderated role of two psychological programs on sexual pleasure from physical symptoms, body image distortion and emotional problems of Hispanic women with breast cancer

Decreased sexual pleasure is a common problem in women with breast cancer. The aim of this study was to evaluate the effect of psychoeducation vs. acceptance and commitment therapy to improve sexual pleasure according to the predictive role of physical, cognitive and emotional factors. Results of 139 Hispanic women (Mexico and Spain) diagnosed with breast cancer reveal that only the emotional factor of depression predicts decreased sexual pleasure. Although women who participated in the psychoeducation program presented greater physical symptomatology, body image distortions and emotional distress, the results seem to indicate that psychoeducational guidelines are relevant to improve sexual pleasure in those women who manifest higher levels of previous depression. Future research is required to clarify these issues.

Perceived needs and health-related quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study

OBJECTIVES

Women with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL.

DESIGN

Cross-sectional design.

SETTING

Two tertiary level hospitals in Shaanxi Province, China.

PARTICIPANTS

Women newly diagnosed with breast cancer were recruited.

OUTCOME MEASURES

The Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL.

RESULTS

A total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=-0.067, p=0.024) and mental component summary (MCS) (b=-0.185, p&lt;0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c'=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c'=0.194, p&lt;0.001) and perceived needs importance (a=0.458, p&lt;0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=-0.031; 95% CI -0.058 to -0.004) and the relationship between perceived needs satisfaction and MCS (a*b=-0.085; 95% CI -0.138 to -0.043).

CONCLUSION

For women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.

Body image and quality of life in women with breast cancer: Appreciating the body and its functionality

Women with breast cancer often experience major physical changes, which can impact their body image and Quality of Life (QoL). Traditional assessments of body image implemented within breast cancer research focus solely on body dissatisfaction. This study explored the association between both positive and negative body image and QoL. Australian women (N = 123) within 5-years of a breast cancer diagnosis were invited to complete a web-based questionnaire including measures of body appreciation and functionality appreciation, cancer-specific measures of body dissatisfaction and QoL, and demographic, health and treatment/illness questions. All body image measures were significantly associated with QoL (p < .01). However, when body image variables were entered simultaneously as predictors of QoL (adjusting for comorbidity, treatment and employment), only body dissatisfaction was significantly associated with QoL (p < .001). Further analyses indicated this was due to shared variance in QoL between body and functionality appreciation, suggesting they assess highly related constructs within this population. Results indicate positive and negative components of body image are relevant to QoL within breast cancer populations; though, body dissatisfaction remained the strongest predictor of QoL indicating its pervasiveness. Future research should explore the development and use of breast cancer-specific measures of positive body image.

Unmet needs of 1210 Chinese breast cancer survivors and associated factors: a multicentre cross-sectional study

Background

Breast cancer survivors (BCSs) often have potential unmet needs. Identification of the specific needs of BCSs is very significant for medical service provision. This study aimed to (1) investigate the unmet needs and quality of life (QoL) of BCSs in China, (2) explore the diverse factors associated with their unmet needs, and (3) assess the association between their unmet needs and QoL.

Methods

A multicentre, cross-sectional survey was administered to 1210 Chinese BCSs. The Cancer Survivor Profile-Breast Cancer and the Functional Assessment of Cancer Therapy-Breast scale were administered to survivors who gave informed consent to participate. Data were analysed using t-test, ANOVA, multiple regression analysis, and Pearson correlations.

Results

The 1192 participants completed questionnaires (response rate 98.51%). Our study reveals that the most prevalent unmet needs were in the ‘symptom burden domain’. The unmet needs of BCSs depend on eleven factors; age, time since diagnosis, education level, occupation, payment, family income status, stage of cancer, treatment, family history of cancer, pain, and physical activities. To ensure the provision of high-quality survivorship care and a high satisfaction level, more attention should be paid to actively identifying and addressing the unmet needs of BCSs. The problem areas identified in the Cancer Survivor Profile for breast cancer were negatively associated with all subscales of QoL except the health behaviour domain, with the correlation coefficient ranging from − 0.815 to − 0.011.

Conclusion

Chinese BCSs exhibit a high demand for unmet needs in this study, and the most prevalent unmet needs were in the ‘symptom burden domain’. There was a significant association between patients’ unmet needs (as defined in the Cancer Survivor Profile for breast cancer) and QoL. Future research should focus on enhancements to survivorship or follow-up care to address unmet needs and further improve QoL.