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Body image in patients with different types of cancer

['Jan Brederecke', 'Department Of Psychosomatic Medicine', 'Psychotherapy', 'Hannover Medical School', 'Hannover', 'Anja Heise', 'Tanja Zimmermann']

Date: 2021-12

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.

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.

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.

Introduction

With approximately 19.3 million new cancer diagnoses and an estimated 9.9 million deaths from cancer worldwide in 2020, cancer is currently one of the leading global health concerns [1]. At the same time, modern cancer treatments have led to an increased life expectancy of those affected, and the number of people living with and surviving cancer is growing as well [2]. In Germany, more than 1.7 million people have been diagnosed with cancer within the last five years [3]. In the long term, many patients experience not only physical complaints but also psychosocial problems such as anxiety and depression [4], sleep disturbances [5], post-traumatic growth [6], the impact of cancer on relationships [7], and fear of cancer recurrence [8]. Additionally, the survivor’s body image has long been of researchers’ interest due to the body-altering effect of cancer and many treatments. The body image construct in the domain of psycho-oncology can generally be conceptualized as multidimensional, including thoughts, feelings, and perceptions towards the own body, sexuality, and functionality and thus affecting a person’s quality of life [9–11].

Most of the body image-related research in the field of psycho-oncology focuses on the consequences of irreversible body alterations through surgical treatment (e.g. scars and amputations). Thus, researchers have assessed breast cancer surgery and its side effects [12], the impact of head and neck cancer treatment [13, 14], differences between colorectal cancer patients with and without a stoma [15], consequences of anal cancer treatment [16] and many more common scenarios. Also, the side effects of nonoperative therapies (e.g. chemotherapy, radiotherapy, hormone therapy) have been investigated intensively: hair loss [17], lymphedema [18], skin irritation and pain [19], and weight gain [20] amongst other side effects have been examined. As a result of all this, there is no doubt that cancer and its treatment can negatively affect a person’s body image. Furthermore, research indicates that a diminished body image satisfaction can have negative consequences on physical and psychological health, interpersonal relationships, lead to psychological distress and thus impair quality of life [21–26].

Most studies that investigate body image in cancer patients and survivors are exclusively conducted with female participants and focus nearly entirely on the most common cancer entities like breast cancer [10]. Studies with men and less frequent types of cancer are thus rare. Additionally, it is difficult to infer the actual extent to which cancer patients’ body image is impaired when compared to the general population as the number of case-control studies is also very limited [27]. In their 2015 systematic review, Lehmann, Hagedoorn, and Tuinman reported 25 studies that compared cancer survivors with control groups from the general population [27]. The authors could not find clear evidence that cancer survivors report decreased satisfaction with their bodies when compared to the general population as nearly 50% of the studies did not report differences between healthy and cancer populations, and some studies even found cancer survivors to have a more positive body image [27]. The ambiguous results were additionally amplified by the heterogeneity in measures and the specific aspects of body image that were assessed [27]. Furthermore, several of the measures were experimenter derived and some studies had other relevant methodological issues [27]. As most studies regarding body image in cancer patients and survivors are conducted in female breast cancer patients, many of the common measures were especially developed and validated for this population only, making comparisons to other cancer types or the general population difficult [28].

Another area that has hardly been explored so far in psycho-oncological body image research is intimate relationships. Nonetheless, close relationships have been shown to be important sources of coping with cancer [29] and spousal reactions, as well as marital satisfaction, are thus likely to influence body image difficulties [10]. The general literature on body image and intimate relationships reports that the social dimension of the bodily self-image can be influenced by intimate relationships, especially for women but also for men [30]. This assumption is supported by studies showing, that body image satisfaction and sexual satisfaction are equally associated with perceived relationship quality in men as well as women [31]. In women diagnosed with breast cancer who are married or in committed relationships, a conjoint process of mutual support was found to even be an effective coping strategy as well [32]. This dyadic consideration also raises the question of a dyadic study of body image. Previous studies have examined body image from the patient’s perspective. However, there is a lack of studies that also examine the perception of body image from the partners’ perspective. The present study aims to achieve this by examining body image from two perspectives: body self-acceptance (SA; patient’s perspective) and perceived partner acceptance of one’s body (PA; partner’s perspective).

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[1] Url: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260602

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