Body image in colorectal cancer patients: A longitudinal study

Impact of social support on body image during chemotherapy in patients with breast cancer: The chain mediating role of depression and self-efficacy

Objective

To explore the mediating roles of depression and self-efficacy in the relationship between social support and body image in patients with breast cancer during chemotherapy.

Methods

A convenience sampling method was employed to survey 647 breast cancer chemotherapy patients. The survey included validated scales assessing social support, depression, self-efficacy, and body image. The chain mediation model was established using Mplus 8.3 software.

Results

Social support was negatively correlated with depression (P < 0.001) and poor body image (P < 0.001) and positively correlated with self-efficacy (P < 0.001). Social support indirectly affected body image through three mediating pathways: depression (β = -0.084, P < 0.001), self-efficacy (β = -0.060, P < 0.01), and the depression-self-efficacy pathway (β = -0.058, P < 0.001). The indirect effect accounted for 55.96% of the total effect.

Conclusions

The results support our hypothesis. Enhancing social support, alleviating depression, and improving self-efficacy through psychological interventions are recommended to improve body image in breast cancer patients during chemotherapy.

Relationship between core symptoms, function, and quality of life in colorectal cancer patients: a network analysis

PURPOSE

To identify core symptoms in patients with colorectal cancer and investigate how these symptoms correlate with functional status and quality of life (QoL).

METHODS

This study included patients over 18 years of age who underwent therapeutic surgery for colorectal cancer with or without a stoma. The European Organization for Research and Treatment of Cancer - Quality of Life Questionnaire Core 30 (EORTC-QLQ C30) and Colorectal Cancer Module (EORTC-QLQ CR29) were used. Data analysis involved constructing networks using the qgraph package in R, identifying core symptoms based on strength centrality, and assessing centrality stability using the bootnet package.

RESULTS

The study included 511 patients: 321 without a stoma and 190 with a stoma. The QoL score for both groups were 55.06 and 55.09, showing no significant difference (p= 0.991). Fatigue and pain are common core symptoms in colorectal cancer surgery patients, whereas appetite loss (rs = 0.37) is specific to those without a stoma and body image concerns (rs = 1.06) are central issues for stoma patients. Notably, despite its prevalence and severity, anxiety was not a core symptom in either group of patients. In the QoL network, emotional functioning served as an intermediary link between QoL and core symptoms in patients without a stoma, whereas QoL was directly associated with core symptoms in patients with a stoma.

CONCLUSION

Improving quality of life requires distinct clinical pathways depending on whether the patient has a stoma, necessitating individualized symptom management strategies in the early postoperative period.

Perioperative Trends in Distress Among Cancer Patients: A Systematic Review and Meta-Analysis

INTRODUCTION

Distress is common among cancer patients, especially those undergoing surgery. However, no study has systematically analyzed distress trends in this population. The purpose of this study was to systematically review perioperative rates of distress, as well as differences across cancer types, in cancer patients undergoing surgical intervention.

METHODS

A systematic review was conducted using PubMed, EMBASE, Scopus, and APA PsycINFO (searched until July 17, 2023). Included studies were clinical studies of cancer patients undergoing surgery reporting distress measured by the National Comprehensive Cancer Network (NCCN) distress thermometer (DT). Data on study and patient characteristics, and preoperative and postoperative distress rates were extracted. Results were pooled, and overall distress rates were calculated as weighted means. Subanalysis by cancer type was performed. Three meta-analyses were conducted: (1) preoperative distress, (2) postoperative distress, and (3) change in distress.

RESULTS

Fifty-seven studies including 13,410 cancer patients were reviewed. Most patients were female (67.4%), White (77.8%), and married/partnered (72.2%), with an average age of 59.2 years. The most common cancers were breast (14 studies), brain (8), and colorectal (7). Weighted mean pre- and postoperative distress scores were 5.1 and 4.5, respectively. Distress remained high through 30 days postoperatively, then declined thereafter. Brain cancer patients reported the highest postoperative distress (5.1), followed by breast cancer patients (4.9).

CONCLUSION

The perioperative phase is a critical period of elevated distress in cancer patients. Preoperatively, patients experience moderate to severe levels of distress, which persist throughout the early postoperative phase, gradually declining from the 1-month postoperative mark onwards.

Body image as a mediator between bowel dysfunction symptoms and psychological outcomes among patients with colorectal cancer

BACKGROUND

Colorectal cancer (CRC) survivors commonly experience bowel dysfunction symptoms because of treatment, leading to psychological distress. While previous studies have focused on managing physical symptoms and the impact of a stoma on psychological outcomes, CRC patients without a stoma may also suffer from psychological distress, including body image distress due to their bowel dysfunction symptoms. Body image distress may mediate the relationship between bowel dysfunction symptoms and psychological outcomes in CRC patients.

OBJECTIVES

This study aims to (1) identify bowel dysfunction symptoms, body image distress, and psychological outcomes in CRC survivors and (2) examine the mediating role of body image in the relationship between bowel dysfunction symptoms and psychological outcomes.

METHODS

A cross-sectional and correlational design was employed, and CRC survivors completed the Low Anterior Resection Syndrome (LARS) Score, Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS) questionnaires. The mediated role of body image was examined using Hayes' PROCESS macro.

RESULTS

A total of 193 CRC patients provided data, with 65.8% reporting experiencing bowel dysfunction symptoms, 44.6% reporting body image distress, and 40.4% experiencing anxiety and depression. Body image was found to partially mediate the effect of bowel dysfunction symptoms on both anxiety (β = 0.0446, 95% CI = 0.0061, 0.0968) and depression (β = 0.0411, 95% CI = 0.0034, 0.0941).

CONCLUSION AND IMPLICATIONS

The significant mediating role of body image underscores the importance of addressing both bowel dysfunction symptoms and body image distress. Healthcare professionals should integrate both physical and psychological aspects to promote psychological well-being.

Exploration of Body Image in Postoperative Patients With Oral Cancer: An Exploratory Sequential Mixed Methods Study

BACKGROUND

Postoperative patients with oral cancer are deeply distressed about their body image. However, their true inner feelings and the factors influencing body image remain unclear.

AIMS

This study aims to investigate the experience of body image disturbance in patients 3 months after oral cancer surgery and analyze the influencing factors.

METHODS

This study process was divided into three steps: (1) semi-structured interviews, based on the Society Ecosystems Theory, of patients with body image disorders 3 months after oral cancer surgery, followed by theme summaries; (2) appropriate selection of scales according to the qualitative results; and (3) a cross-sectional survey to explore the factors and pathways affecting the body image of the patients.

RESULTS

Qualitative research summarized nine themes from the individual, family/employment, and societal/institutional levels, with the individual level being most commonly mentioned. Further investigation into the individual factors influencing the body image of the patients revealed that self-esteem and social alienation have a chain mediating effect on the relationship between speech handicap and body image.

CONCLUSIONS

The body image of postoperative patients with oral cancer is influenced by personal, family, and societal aspects. These study results lay the groundwork for formulating interventions to alleviate body image concerns.

Social isolation profiles and conditional process analysis among postoperative enterostomy patients with colorectal cancer

PURPOSE

This study aimed to identify social isolation latent profiles and analyze the specific mechanisms in which social support, resilience, and posttraumatic growth associated social isolation from the perspective of positive psychology. Suggestions were offered to improve the mental health status of postoperative enterostomy patients with colorectal cancer.

METHODS

This was a cross-sectional survey. From December 2022 to September 2023, convenience sampling was used to select 303 enterostomy patients from three hospitals in Guangzhou. A paper questionnaire was used to investigate their levels of social support, resilience, posttraumatic growth, and social isolation. T-test, ANOVA, Pearson Correlation Analysis, Latent Profile Analysis and Conditional Process Analysis were used to analyze the correlation between variables.

RESULTS

(1) Education level, occupation, family monthly income per capita and times of changing enterostomy bag per week were significantly associated with social isolation. (2) Social isolation of patients included low alienation-fluctuation group (Class 1, 13.9%), medium group (Class 2, 64.0%), high alienation-low meaning group (Class 3, 22.1%). (3) Social isolation was negatively correlated with social support, resilience, and posttraumatic growth (P < 0.001). (4) Resilience played a mediating role in the association between social support and social isolation. (5) The second half path of the mediation model was moderated by posttraumatic growth.

CONCLUSIONS

Clinical staff, community personnel and family members should pay attention to the potential differences in social isolation experienced by patients. Suitable psychological strategies should be employed to enhance resilience, promote posttraumatic growth, for improving the patients' mental health levels and help them return to society.

Mental Health Interventions to Improve Body Image Outcomes for Ostomates: A Systematic Review

Ostomy surgery is a life-saving procedure extending an individual's life span. However, the emotional impact can negatively influence body image and quality of life. This systematic review investigated the effectiveness of mental health interventions provided pre and/or post-operative to ostomates. Two reviewers independently screened 2,759 titles and abstracts and 377 full-text studies. Twelve studies met the criteria for inclusion. The findings indicate that ostomates of all ages and genders benefit from mental health interventions to improve function, body image, and psychological outcomes. Healthcare practitioners should incorporate body image management into rehabilitation to improve ostomates' quality of life.

Living with a permanent ostomy: a descriptive phenomenological study on postsurgical experiences in patients with colorectal cancer

OBJECTIVES

To explore the postsurgery lived experiences of patients with colorectal cancer with a permanent ostomy for informing initiatives to improve patient care and future quantitative research.

DESIGN

A descriptive qualitative phenomenological study.

SETTING

We conducted this study in the Colorectal Cancer Division at the Cancer Center of West China Hospital, Sichuan University, a premier institution renowned for its comprehensive cancer care and research.

PARTICIPANTS

12 patients who had undergone surgeries for colorectal cancer with a permanent ostomy.

RESULTS

Our interviews revealed profound adjustments in the lives of colorectal cancer survivors living with permanent ostomies. Participants articulated a transition to a 'new normal', characterised by extensive daily life adjustments, psychological adaptation and ongoing management challenges. Key themes identified included the adaptation to a reshaped daily routine and altered perceptions of quality of life. Many faced substantial challenges in stoma care, requiring significant learning and adaptation. Psychological adaptations were marked by a redefinition of body autonomy and personal identity, alongside a recalibration of social interactions and privacy. The need for robust professional guidance and a comprehensive social support system was universally emphasised.

CONCLUSIONS

Patients with colorectal cancer with permanent ostomies navigate significant changes in their lives postsurgery, undertaking a complex process of reconstructing and adapting to a new normalcy. They recalibrate their physical, psychological and social well-being, demonstrating resilience and adaptability in the face of these challenges. Their pervasive expression of needs for information and support may reflect gaps in the existing patient education and support measures and communication strategies. Healthcare professionals and policy-makers should adopt a patient-centred approach acknowledging the multifaceted nature of postsurgery recovery and adaptation by fostering open communication, tailoring personalised education and facilitating supportive community networks.

Substantial Impairment of Quality of Life during COVID-19 Pandemic in Patients with Advanced Rectal Cancer

The aim of this study was to analyze the quality of life of patients with advanced rectal cancer before and during the COVID-19 pandemic and to determine whether the pandemic affected patients’ quality of life. The study included 389 patients and was performed from May 2010 to June 2021. The fifteen months from March 2020 to June 2021 were categorized as the COVID-19 period. Patients were surveyed using the QLQ-C30 and QLQ-CR38 questionnaires. The questionnaires were used at different phases of radiochemotherapy: prior to RCT (day 1), during RCT (day 14), at the end of RCT (day 35), and prior to mesorectal surgery (day 70). Scores were formed from the questions. In addition, scores were analyzed for different age groups (<64 and >64) and sexes (female and male). Overall, patients reported lower functional scores and higher symptom scores during the pandemic than before the pandemic. Although it had been expected that older and younger patients would differ clearly, there were only minor differences. The comparison between the two sexes showed very different scores, with female patients having lower functional scores and higher symptom scores than male patients before and especially during COVID-19. In conclusion, age does not play a major role in quality of life, but sex does play an important role in perception of functioning and symptoms. COVID-19 also had a major impact on patients’ lives, as it was a very isolating and stressful time for everyone, especially cancer patients, which was reflected in worsening scores.

Body Image and Quality of Life in Women with Congenital Adrenal Hyperplasia

Objective: Women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) may have poor quality of life (QoL) and low satisfaction with body appearance. We investigated the influence of the patients’ satisfaction with their support on their QoL and body image. Design: Retrospective, comparative, Europe-wide study as part of the multicenter dsd-LIFE study. Methods: 203 women with CAH were included in this study. We investigated the patients’ QoL and body image compared to a healthy control group. The patients’ satisfaction with their treatment and support in childhood and adolescence as well as in adulthood was assessed by questionnaire and its influence on the patients’ body image and QoL was analyzed by multiple regression models. Results: Women with CAH showed worse body image and poorer physical, psychological and social QoL compared to a healthy reference population. The patients’ satisfaction with professional care in the last 12 months was a significant positive predictor for all four domains of QoL (psychological, physical, social, environmental). Dissatisfaction with care in childhood and adolescence and with general support through different stages of life was a significant negative predictor for QoL and body image. Conclusions: These results show that women with CAH have poor QoL and body image compared to a healthy reference population. Psychosocial factors such as general and family support, and social interactions with professionals have a substantial impact on QoL and body image in adult females with CAH. This should be taken into account regarding patient care and multimodal therapy.

Understanding the psychosocial impact of colorectal cancer on young-onset patients: A scoping review

OBJECTIVE

The incidence of young-onset (<50 years) colorectal cancer (CRC) has been increasing internationally. The psychosocial experience of younger cancer patients is vastly different from older patients, especially in domains such as financial toxicity, body image, and sexual dysfunction. What is unknown is the cancer type-specific experience. The aim of the current scoping review was to examine (1) the psychosocial factors and/or outcomes associated with young-onset CRC and (2) other determinants that influences these outcomes.

METHODS

A systematic search was conducted on four databases (PubMed, CINAHL, Scopus and PsycINFO) from inception to December 2020 using key terms and combinations. Primary literature that examined the psychosocial (e.g., quality-of-life, emotional, social, sexual) impact of young-onset CRC were included.

RESULTS

A total of 1389 records were assessed by four reviewers, with a total of seven studies meeting inclusion criteria (n = 5 quantitative, n = 1 qualitative and n = 1 case series). All studies indicated there was significant psychosocial impact in younger CRC patients, including emotional impact, social impact, physical burden, sexual impact, work impact, unmet needs, financial impact and global quality of life. Three studies explored other determinants that influenced the psychosocial experience and found that socioeconomic background (e.g., being female, lower education), CRC treatment (e.g., chemotherapy) and health status were associated with worse psychosocial impact.

CONCLUSIONS

Young-onset CRC patients face severe psychosocial impact unique to this age group, such as self-image and sexual impact. Social support services and resources needs to be uniquely tailored. More empirical investigations are required to understand its long-term impact and influence of other psychosocial domains.

Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study

Objective

Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse.

Methods

Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.

Results

Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.

Conclusion

This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.