A body image scale for use with cancer patients

Assessment of Patient-Reported Outcomes for Closed-Incision Negative Pressure Therapy with Wide-Coverage Dressings in Simple Mastectomy and Immediate Implant-Based Breast Reconstruction

Objective: A new configuration of closed-incision negative pressure therapy (ciNPT) dressings now covers the incision and a broader area of peri-incisional tissues. We have implemented these ciNPT dressings following simple mastectomy (SM) or skin-sparing mastectomy with implant-based reconstruction (IBR). This study assesses patient-reported outcomes of this new protocol. Approach: Patients underwent SM or IBR for breast cancer. ciNPT with wide-coverage dressings were placed over the entire breast, and -125 mmHg was applied for 14 days. Upon dressing removal, patients rated their experience using the Wound-Q™ Suction Device Scale and recorded their satisfaction on a Likert scale ranging 1-5. Results: Thirteen SM patients and 12 IBR patients were included in the study. The median age was 62 years, and SM patients were significantly older (p < 0.01). Patients rated the ciNPT device highest on items relating to its function and appearance, and lowest on noise and interference with sleep and physical activity. The overall mean score for the combined cohort was 64.8/100. The mean score for SM patients (74.8 ± 19.9) was significantly greater than for IBR patients (53.9 ± 9.6, p < 0.01). The mean overall patient satisfaction rating was 3.92 on a 5-point scale; 4.0 in the SM group and 3.8 in the IBR group. Innovation: This study is the first to report on the patient experience with these newly available wide-coverage ciNPT dressings. Conclusion: Overall, the dressing was well-tolerated by patients, and satisfaction was high. The positive reception of ciNPT with wide-coverage dressings supports continued use at our hospital.

Body image among people living with HIV: A systematic review

OBJECTIVES

The aim of this systematic review was to analyse, synthesise and review existing research on body image among people living with HIV (PLWH). Specifically, the review investigated the relationship of body image with sociodemographic and clinical variables and psychological correlates among PLWH.

METHOD

A comprehensive literature search was conducted using Web of Science, PsycARTICLES, MedLine, ProQuest and Scopus databases and yielded a total of 699 abstracts. The inclusion criteria encompassed quantitative and peer-reviewed articles published in English devoted to HIV/AIDS adult patients, with validated measurements of body image operationalized explicitly as an outcome variable.

RESULTS

A total of 17 articles were accepted for systematic review and analysis. The quality of the studies was evaluated using STROBE guidelines for observational studies. The findings revealed that body image disturbances are common among PLWH and are influenced by factors such as lipodystrophy, depression, anxiety, self-efficacy in health behaviours, social support, stigma and quality of life. Higher body image disturbance was also linked to poorer adherence to antiretroviral therapy (ART) and increased HIV sexual transmission risk behaviours.

CONCLUSIONS

Body image is a crucial aspect of the psychosocial functioning of PLWH. Despite medical advancements, PLWH continue to face significant body image disturbances that impact their quality of life. Future research should focus on longitudinal studies, diverse geographical contexts and interventions aimed at improving body image among this population. Addressing body image concerns through psychosocial support and therapeutic interventions can potentially enhance the overall well-being and health outcomes of PLWH.

Patient- and clinician-assessed five-year normal tissue effects following one-week versus three-week axillary radiotherapy for breast cancer: Results from the phase III FAST-Forward trial randomised nodal sub-study

BACKGROUND AND PURPOSE

FAST-Forward showed that 26 Gray (Gy) in 5 fractions (Fr) over one week adjuvant radiotherapy to breast or chest wall was as safe and effective as a three-week schedule (40 Gy/15Fr) for early breast cancer. The nodal sub-study investigated whether a one-week schedule is safe for adjuvant axillary radiotherapy.

MATERIALS AND METHODS

In this randomised, non-inferiority, non-blinded sub-study (ISRCTN19906132), patients with invasive breast cancer (pT1-3, pN1-3a, M0) following surgery requiring axillary radiotherapy (any or all levels 1-4) were randomised to 40 Gy/15Fr (three weeks, control), 26 Gy/5Fr or 27 Gy/5Fr (one week) atlas-based radiotherapy planning, including quality assurance. The 27 Gy/5Fr group closed early due to three-year main trial normal tissue effects suggesting 26 Gy/5Fr would be optimal; this analysis focusses on comparison between 26 Gy/5Fr and control. Primary endpoint was five-year patient-reported moderate or marked arm or hand swelling, aiming to exclude a 10 % increase (assuming 10 % incidence with control; 90 % power, one-sided α = 0.05, n = 172 per group).

RESULTS

469 patients were randomised from 50 UK centres (182 40 Gy/15Fr, 183 26 Gy/5Fr, 104 27 Gy/5Fr). Median age 61 years; 250 (54 %) and 182 (39 %) had grade 2 and 3 tumours respectively; 261 (56 %) had axillary dissection. Of those who completed a five-year questionnaire, 11/107 (10 %) 40 Gy/15Fr and 13/116 (11 %) 26 Gy/5Fr reported moderate or marked arm or hand swelling, difference 1 % (90 % confidence interval -6%, 8 %, p = 0.49). Other arm and shoulder symptoms were similar between groups with no cases of brachial plexopathy.

CONCLUSION

Five-year patient-reported normal tissue effects suggest 26 Gy/5Fr/1-week hypofractionation is safe for breast cancer patients requiring adjuvant axillary radiotherapy.

Mediating effects of psychological resilience on the relationship between social support and body image dissatisfaction among patients with primary brain tumors in China

Several studies have documented that patients with different types of tumors experience serious body image dissatisfaction (BID). However, few studies have explored BID in patients with brain tumors. This study examined the level of BID and verified the mediating effects of psychological resilience on the relationship between social support and BID among Chinese patients with primary brain tumors. Participants included 226 Chinese patients with primary brain tumor (64.2% women) between 18 and 80 years of age (mean age = 48.36 ± 12.44), who completed the measures of a demographic questionnaire, the Multidimensional Perceived Social Support Scale (MPSSS), Resilience Scale-14 (RS-14), and Body Image Scale (BIS). The average BIS score among Chinese patients with primary brain tumors was 6.20 (SD = 4.85; range, 0-24), and 200 (88.5%) participants experienced body image dissatisfaction (BIS score ≥ 1), and 50 (22.1%) were significant body image dissatisfaction (BIS score ≥ 10). Spearman's rank-order correlation indicated that BID, psychological resilience, and social support were significantly correlated. Mediation analysis indicated that the direct paths from social support to psychological resilience and psychological resilience to BID were both significant, but the path from social support to BID was not, psychological resilience played a complete mediating role between social support and BID. The current results support that Chinese patients with brain tumors experience BID, and more awareness and interventions should be given from healthcare professionals. These findings have implications for developing and implementing intervention programs to enhance social support and psychological resilience among this population and cope with BID.

Resilience and renewal: the personal impact of physical activity in breast cancer survivors

This study investigates the multifaceted impact of physical activity on the holistic recovery of breast cancer survivors, emphasizing psychological, social, and physical dimensions. Beyond medical treatments, reclaiming identity and autonomy post-breast cancer is a complex process involving physical and emotional well-being. The research utilized a qualitative approach, conducting in-depth interviews with five female survivors aged 41 to 57, as well as a group interview with the three pysical activity instructors who led the participants´exercise sessions. Participants completed a 12-week resistance training protocol title EFICAN (Exercise and Cancer), a structured intervention specifically designed by the research team for this study, combining individual and small-group sessions. Survivors shared personal experiences of how physical activity influenced their post-treatment recovery, while the instructors provided complementary insights into the participants´observed changes. Thematic analysis was applied to identify patterns and core themes. Three primary themes emerged: (1) physical activity as a catalyst for empowerment and recovery, (2) the significance of social bonds formed during group activities, and (3) transformative changes in body perception and self-acceptance. Participants highlighted that exercise helped regain control over their bodies, mitigate side effects, and foster resilience. Group activities provided emotional support, reducing isolation and promoting psychological well-being. Instructors echoed these findings, describing visible improvements in participants' confidence, emotional expression, and social engagement. The study findings align with existing literature, while the inclusion of instructors' perspectives adds a novel contribution to the understanding of how physical activity supports psycho-social recovery. Integrating structured physical activity into post-treatment care can support emotional healing and strengthen social bonds. Clinical programs should celebrate individual achievements and include group-based exercises to enhance adherence and overall well-being. The study's small sample size may limit generalizability. Future research should explore diverse populations and incorporate quantitative methods to complement qualitative findings. Physical activity plays a crucial role in transitioning from surviving to thriving post-cancer. It supports not only physical health but also psychological resilience and social connection, reinforcing that survivors' voices are essential in shaping recovery programs.

Factors associated with physical activity among Thai women with breast cancer postmastectomy at a university hospital, Thailand: A cross-sectional study

The primary treatment for breast cancer patients is surgery which often impacts physical activity (PA). This study aimed to investigate factors associated with the PA level of Thai women with breast cancer after surgical mastectomy at Siriraj Hospital, Thailand. Ninety-three participants completed the questionnaires which included personal information, the Global Physical Activity Questionnaire, perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence and situational influence, the Thai Body Image Index score, and the Thai Hospital Anxiety and Depression Scale. Data was analysed using descriptive statistics, Chi-square statistics (Odds-Ratio and 95% Confidence Interval) and multiple logistic regression analysis. The study found that post-mastectomy Thai women participated in sufficient PA (2.8 metabolic equivalent of tasks (METs)). It was also found that PA at work was associated with occupation, higher incomes, moderate satisfaction as assessed by the Thai Body Image Index score, and higher levels of anxiety and depression. Participation in recreational activities was associated with older age, higher perceived self-efficacy, and greater interpersonal influence. However, statistically significant associations from the chi-square test did not remain significant after analysis with the multiple logistic regression. By exploring these associations, we can tailor supportive care strategies to address the PA needs of individuals affected by breast cancer which is essential for the development of comprehensive interventions that optimize patient health and well-being throughout the cancer journey.

Sexual dysfunction and body image in BRCA mutation carriers before and after risk-reducing salpingo-oophorectomy: a cross-sectional study

BACKGROUND

BRCA mutation carriers opting for prophylactic risk-reducing salpingo-oophorectomy (RRSO) face potential impacts on sexual functioning and body image.

AIM

The aim of the study was to assess the extent of sexual dysfunction (SD) and body image impairment in BRCA patients, both with and without cancer, and before and after undergoing RRSO.

METHODS

The present cross-sectional study involved a group of BRCA-positive patients (n = 220) from the Gynecological Hereditary Cancer Risk Clinic, categorized into two different subgroups: A-premenopausal and B-postmenopausal women, with (1) or without and (2) a breast cancer (BC) diagnosis. Before RRSO and at a 6-month follow-up assessment, all participants were requested to complete a validated survey on body image (the Body Image Scale), sexual functioning (Female Sexual Function Index), and psychological well-being (the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index fatigue subscale of the Functional Assessment of Chronic Illness Therapy-Fatigue).

OUTCOMES

The outcomes include scores on measures of body image, sexual functioning, and psychological well-being across the four study groups (A1-premenopausal women with BC, A2-premenopausal women without BC, B1-postmenopausal women with BC, and B2-postmenopausal women without BC).

RESULTS

After RRSO, a significant decrease in sexual function and body image was observed across all groups (P < 0.01 in A1 and B1 groups and P < 0.02 in A2 and B2 groups). The most relevant changes were observed in the premenopausal and cancer-affected BRCA carriers (A2) (P < 0.001). The multivariate logistic regression analysis identified obesity, prior cancer, depression, and fatigue as risk factors for SD, while younger age and hormone replacement therapy emerged as protective factors.

CLINICAL IMPLICATIONS

Surgical menopause, body image concerns, anxiety, and depression contribute to the observed SD following RRSO and should be addressed by healthcare providers.

STRENGTHS AND LIMITATIONS

This study's strength lies in its comprehensive evaluation of the impact of RRSO on BRCA mutation carriers, both before and after the procedure. The assessment includes measures of anxiety and fatigue. The limitations of the study include possible selection bias among participants, the lack of measures for sexual distress and a control group without BRCA mutation, and the limited number of patients without SD.

CONCLUSION

Patients undergoing RRSO frequently experience substantial psychosexual dysfunction; therefore, preoperative counseling is necessary to mitigate the incidence of SD and body image concerns in this population.

Relations between trajectories of weight loss and changes in psychological health over a period of 2 years following bariatric metabolic surgery

PURPOSE

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24 months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses.

METHOD

Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24 months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression.

RESULTS

BMI and HR-QoL improved significantly for all patients from pre-surgery to 24 months post-operation, though some patients deteriorated in their outcomes after 12 months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories.

CONCLUSION

Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

An internet-delivered psychoeducational intervention (Fex-Can 2.0) targeting fertility-related distress and sexual dysfunction in young adults diagnosed with cancer: Study protocol of a randomized controlled trial with an internal pilot phase

BACKGROUND

While previous literature has continuously demonstrated the negative effects of cancer and its treatment on fertility and sexuality, evidence-based interventions to alleviate fertility-related distress and sexual dysfunction are lacking. This study protocol describes the internal pilot study and randomized controlled trial of an internet-delivered psychoeducational intervention: Fex-Can 2.0. The primary objective is to determine efficacy of Fex-Can 2.0 in terms of reduction of fertility-related distress and sexual dysfunction at end of the 12-week intervention. The internal pilot study will assess feasibility of the study, determined according to pre-specified progression criteria and individual interviews.

METHODS

The study has a randomized controlled design, with an internal pilot phase. The intervention group will receive Fex-Can 2.0, consisting of psychoeducational- and behavior change content. The control group will be allocated to standard care. Primary outcomes are fertility-related distress (RCAC) and sexual function and satisfaction (PROMIS SexFS Brief Sexual Profile). Secondary outcomes include body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), need satisfaction and frustration scale (NSFS), fertility- and sex-related knowledge, and self-efficacy related to fertility and sex life. Outcomes will be assessed at baseline, directly after the intervention, and 12 weeks later. During the internal pilot, data on trial recruitment, data collection, drop out, and adherence will be collected to assess feasibility. Semi-structured interviews will be conducted to further assess acceptability of Fex-Can 2.0.

CONCLUSIONS

This randomized controlled trial aims to evaluate whether Fex-Can 2.0 is superior to standard care, in terms of reducing fertility-related distress and sexual dysfunction in young adults diagnosed with cancer. If proven efficacious, the Fex-Can 2.0 intervention may be a valuable resource in health care, with the potential to significantly improve the care of young adults experiencing fertility-related distress and/or sexual dysfunction following cancer.

TRIAL REGISTRATION

ClinicalTrials.gov ISRCTN18040643.

A Critical Discourse Analysis of the Language of Stigmatization of Breast Cancer Patients in Nigeria

Breast cancer is a significant health concern globally, including in Nigeria, where its incidence is rising. An essential component of breast cancer care is the psychosocial wellbeing of patients, which is often shaped by the language used in healthcare and society. While some research has explored stigmatization of breast cancer patients, no study has focused on language as a tool for this stigmatization in Nigeria. This study examines how language perpetuates the stigmatization of breast cancer patients and explores ways to use language to improve their lives and health. Using Norman Fairclough's model of critical discourse analysis and a descriptive design, data was collected through interviews with 50 respondents at the University College Hospital in Ibadan, Nigeria. The study's discourse analysis revealed that stigmatization is perpetuated through language, including negative stereotypes, body shaming, spiritual interpretations, and derogatory terms. These discourses reflect broader social and cultural factors such as norms, beliefs, and power dynamics that reinforce stigmatization. The research highlights the effects of stigmatizing language, including denial, loss of femininity, shame, and fear of a new identity. The findings call for policies and interventions to reduce stigma, improve patient experiences, and raise public awareness of breast cancer.

The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity

BACKGROUND

It is well known that social rehabilitation is an important part of the overall recovery of breast cancer survivors. Previous research has demonstrated that social anxiety is prevalent among breast cancer survivors, which is not only a significant psychological issue, but also impairs survivors' social rehabilitation and diminishes their quality of life. Therefore, understanding the factors and mechanisms influencing social anxiety in breast cancer survivors is crucial. This study aimed to investigate the mediating and moderating effects of body image and self-concept clarity on social comparison orientation and social anxiety in breast cancer survivors.

METHODS

The convenience sampling method was employed to survey 382 breast cancer survivors. The sample comprised participants aged 30-69 years: 69 - 56 years(28.01%), 45-55 years (39.53% ), and 30-44 years (32.46%). Data was collected using a general information questionnaire, the Social Anxiety Scale, the Body Image Scale, the Social Comparison Orientation Scale, and the Self-Concept Clarity Scale. The SPSS macro program PROCESS plug-in was utilized for mediation and moderation analyses.

RESULTS

This study revealed a partial mediation effect of body image between social comparison orientation and social anxiety (β = 0.100, 95% CI [0.052, 0.162]), accounting for 27% of the total variance. Furthermore, self-concept clarity moderates the influence of social comparison orientation on social anxiety through body image. Specifically, as self-concept clarity increases, the influence of social comparison orientation on body image is gradually weakened, and the impact of body image on social anxiety becomes progressively weaker.

CONCLUSIONS

Social comparison orientation influences the social anxiety of breast cancer survivors through body image. Self-concept clarity exerts a moderating effect, attenuating the influence of social comparison orientation on body image and body image on social anxiety. The findings provide a theoretical and practical foundation for research on the social rehabilitation of breast cancer survivors.

CLINICAL TRIAL NUMBER

Not applicable.

A multidisciplinary and structured approach for comprehensive evaluation of functional outcomes, adverse events, psychosocial outcomes and health-related quality of life after local therapy for bone sarcoma in children: protocol for a cross-sectional study

Introduction

Bone sarcoma patients face intensive treatment, including life-changing local therapy, which impacts both short- and long-term functioning. Moreover, bone sarcoma survivors experience the highest burden of adverse events of all childhood cancer survivors. To address these issues, we set up a structured multidisciplinary outpatient follow-up clinic for patients who completed treatment and integrated this clinic into the standard of care. This study protocol describes the methodology of a cross-sectional study that aims to systematically report the functional outcomes, adverse events, psychosocial outcomes and health-related quality of life of the cohort seen at this clinic.

Methods and analysis

Participants are recruited at the multidisciplinary follow-up clinic and their consent is obtained. Standard of care clinical assessments serve as the primary data source for this study. Furthermore, additional research assessments are performed to further expand our knowledge. Assessments are structured by standardized assessment sets that we developed based on literature review and joint national expertise in bone sarcoma care. The sets comply with international guidelines such as the World Health Organization's International Classification of Functioning, disability and health, and include a combination of patient-reported, clinician-reported and performance-based outcome measures for comprehensive representation of outcomes.

Discussion

This study will generate valuable knowledge on the functional outcomes, adverse events, psychosocial outcomes and quality of life of a national cohort of pediatric bone sarcoma patients in follow-up care. By aligning additional research assessments with standardized patient care, a comprehensive range of outcomes will be obtained while minimizing the patient's burden. Moreover, this protocol may serve as a template for clinics and research internationally, allowing for the merging of standardized outcome data in such rare disease. This will facilitate the optimization of current patient care and inform the important shared decision-making process for local treatment in future patients.

Function, Satisfaction, and Sexual Activity of Trans Women After Vulvovaginoplasty: Results of a Multicenter Study

Purpose

This study aimed to analyze the functional outcomes after vulvovaginoplasty for trans women with a comprehensive analysis, including sexual function, satisfaction, and esthetic results.

Methods

A prospective, observational, multicenter study of trans women who underwent vulvovaginoplasty between 2007 and 2019 was conducted at three different centers in France. Data collection was achieved through an online questionnaire. Participants were asked to complete a questionnaire that included the Female Sexual Function Index (FSFI), the Female Genital Self-Image Scale (FGSIS), the Body Image Scale (BIS), and nonvalidated questions to explore sexual practices, related orgasm, genital sensitivity, and specific postsurgical satisfaction.

Results

A total of 158 women were included. Highest scores of the FSFI were obtained for the satisfaction domain, lubrication was scored the lowest. Two-thirds (64%, 89/138) of sexually active women had an FSFI score <26.5 (cutoff suggested for sexual dysfunction); the total mean±standard deviation (SD) FSFI score was 21.2±9.5. Self-image was favorable overall; the mean±SD BIS score was 4.5±5.2 and the mean±SD FGSIS score of 22.1±4.3. Masturbation was the most frequent sexual activity and the only one that led to a positive mean orgasm frequency score. The clitoris was the area women most frequently reported as having "sufficient sensitivity" (67.7%).

Conclusion

This multi-institutional study of functional outcomes after vulvovaginoplasty found positive esthetic outcomes and high satisfaction. More than 85% of trans women were sexually active, and sexuality was rich and common despite mixed functional results. These results enlighten the postoperative outcomes and thereby the points to discuss with women considering vulvovaginoplasty.

Peaceful acceptance and struggle with terminal cancer: The role of mindfulness, self-compassion, and body image distress

OBJECTIVES

This study aimed to examine the extent to which mindfulness, self-compassion, and body image distress are associated with peaceful acceptance or struggle with illness in terminally ill cancer patients, after controlling for psychological distress, sociodemographic characteristics (age, gender, education, marital status), and clinical characteristics (body mass index, Karnofsky Performance Status, time since diagnosis).

METHODS

A cross-sectional study was conducted with 135 terminally ill cancer patients. Participants were consecutively sampled. Two five-step hierarchical regression models were performed, one for peaceful acceptance and the other for struggle with illness. The models included sociodemographic (step 1), clinical characteristics (step 2), psychological distress (step 3), mindfulness and self-compassion (step 4), and body image distress (step 5).

RESULTS

Body image distress was negatively associated with peaceful acceptance after controlling for the other variables. Both body image distress and self-compassion were uniquely associated with struggle with illness, in a positive and negative direction, respectively. The overall models explained 33% of the variance in peaceful acceptance and 61% in struggle with illness.

SIGNIFICANCE OF RESULTS

Targeting body image distress may be important for both enhancing peaceful acceptance and reducing struggle with one's terminal condition. Addressing self-compassion, however, may help patients alleviate the struggle alone. These findings suggest that peaceful acceptance and struggle with illness may follow different clinical pathways with partly different underlying mechanisms. This study provides a foundation for future research to develop interventions for body image and self-compassion specifically tailored to the needs of terminally ill cancer patients.

Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review

BACKGROUND

People with skin disease suffer due to disease-related physical symptoms, as well as due to significant psychosocial burden. A major contributor of this burden is the experience of stigmatization. Research indicates that people with visible skin diseases deal with both social stigma and self-stigma.

OBJECTIVE

This systematic literature review aimed to aggregate existing research on correlates and mechanisms that contribute to self-stigmatization among people with atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa and to, ultimately, identify targets for psychosocial interventions.

METHODS

The review followed PRISMA guidelines. Four databases, PubMed, OVID, Web of Science and PsycINFO were searched for peer-reviewed articles. Studies were identified by two independent researchers and were eligible if they (1) assessed adults with one of five chronic skin diseases-atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa, (2) measured self-stigma or relevant synonyms, (3) evaluated psychosocial correlates, predictors or explanatory mechanisms of self-stigma and (4) were published in German or English in a peer-reviewed journal. The Johanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to evaluate the quality of studies.

RESULTS

Twenty-seven studies were included with a mean quality rating of 7.04 (out of 8). Social stigma, coping strategies (such as lack of acceptance) and lack of social support were identified as main predictors of self-stigma. Although study quality was good, all but one study had a cross-sectional design that does not allow examining causal relationships among the determinants of self-stigma.

CONCLUSIONS

Findings from the present review revealed several psychosocial variables that are malleable and potentially suitable as intervention targets. Those variables such as acceptance should be targeted in evidence-based interventions specifically developed to reduce self-stigma to, ultimately, improve mental health of people affected.

The Impact of a Positive Body Image Program (Body Image Awareness Seminars) on the Positive and Negative Body Image of Individuals Living With Cancer

OBJECTIVE

Using action research principles to address gaps in existing interventions, and in consultation with members and administrators of Wellspring Canada, the purpose of the current study was to adapt and examine the impact of a novel (concept, content, and inclusivity) positive body image program (Body Image Awareness Seminars; BIAS) on positive and negative body image in individuals living with cancer.

METHODS

The project used a single-group pretest-posttest design with a 6-week follow-up. Over the 6-week program, 37 participants engaged in 90-min weekly group sessions consisting of researcher-led psychoeducation, group discussion, and activities grounded in positive body image research. Each seminar had a unique theme designed to promote respect, acceptance, and appreciation for the body. Participants completed the Body Image Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Measure of Body Apperception, Appearance Evaluation subscale, and Self-Compassion Scale anonymously using Qualtrics at the 3 data collection points. Homework assignments included optional readings and writing exercises based on the positive body image tenet taught that week.

RESULTS

Participants reported statistically significant improvements in positive body image (i.e., body appreciation, functionality appreciation), self-compassion, and negative body image (i.e., body image distress and disturbance, investment in body integrity and appearance evaluation), which were sustained at the 6-week follow-up in a subsample of participants (n = 11).

CONCLUSIONS

This study suggests that the adapted BIAS program can lead to improvements in both positive and negative body image in individuals living with diverse types of cancer. Results support the implementation of BIAS in the standard of care for those living with cancer to continue to affect positive change.

Effects of a sexual health enhancement program for women with breast cancer: A quasi-experimental study

OBJECTIVE

This study evaluated the effectiveness of a culturally adapted Sexual Health Enhancement (SHE) program, grounded in the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, in addressing sexual health challenges in women with breast cancer. It examined the program's impacts on sexual function, distress, body image, marital intimacy, and sexual knowledge.

METHODS

A quasi-experimental pretest-posttest design included 50 married women diagnosed with breast cancer within five years post-mastectomy without reconstruction. Participants were divided into intervention (n = 24) and control (n = 26) groups. The intervention consisted of four weekly group sessions and phone consultations. Outcomes were assessed at baseline, one week, and five weeks posttest using validated tools.

RESULTS

The intervention group showed significant improvements in sexual distress (F = 24.852, p < 0.001), body image (F = 25.887, p < 0.001), and sexual knowledge (F = 60.876, p < 0.001). Marital intimacy improved over time (F = 7.050, p = 0.011), but no significant group-by-time interaction was found (F = 0.478, p = 0.493). Sexual function showed no significant differences (F = 0.748, p = 0.391).

CONCLUSIONS

The SHE program effectively improved sexual distress, body image, and knowledge in breast cancer survivors. Tailored interventions for body image and marital intimacy remain essential, and future research should explore digital solutions and spousal involvement to enhance outcomes.

Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) Checklist: A New Reporting Checklist Based on Evidential Assessment of the Number of Trocars and Positions

Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.

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.

Development and Validation of Facial Line Distress Scale-Glabellar Lines (FINE-GL)

Purpose

We developed and validated facial line distress scale-glabellar lines (FINE-GL) to evaluate the severity and psychosocial distress associated with GL.

Patients and Methods

In Phase I, a preliminary item pool for the FINE-GL was developed through a literature review and expert consultation. This was followed by cognitive interviews to ensure comprehensibility of the items. In Phase II, we conducted a cross-sectional survey at a tertiary hospital and two local clinics in Korea. Exploratory factor analysis (EFA) was conducted to identify the underlying factor structure of the FINE-GL, and internal consistency and test-retest reliability were also examined.

Results

We yielded 20 items in four domains. The model fit was good. Coefficient alphas ranged from 0.92 to 0.95 for sub-domains and 0.97 for the total. The FINE-GL was moderately correlated with the appearance appraisal score and body image. In the test-retest, the range of ICC was 0.77-0.90.

Conclusion

FINE-GL is a reliable, valid, and comprehensive patient-reported outcome measure for assessing GL severity and distress. This will be helpful to determine a patient's eligibility for inclusion of study and to measure primary or secondary effectiveness endpoints for glabellar line treatment.

Translation and Linguistic Validation of BIS (Body Image Scale) for Breast Cancer Patients in India

A number of PROMs (patient-reported outcome measures) have been developed and validated for English-speaking populations but with limited utility in non-English-speaking countries. Body image scale (BIS) is a type of PROM which assesses the changes in the body image of a patient diagnosed with cancer. The current study was carried out to translate the BIS in Hindi and Marathi. Out of the 10 questions in the BIS questionnaire, Hindi and Marathi translations were already available for 4 questions (Questions no. 2, 4, 5, and 9) from the EORTC BR23 questionnaire. Remaining questions were translated using the EORTC translation manual, which includes forward translation, reconciliation, backward translation, proofreading, and pilot testing. Pilot testing done on 10 patients each for Hindi and Marathi showed at least 80% acceptability for all the questions for both Hindi and Marathi translations. Both the translated versions will be used for validation in a large cohort of breast cancer patients. The Hindi and Marathi versions of the BIS have very good acceptability and can be utilized for clinical trials once validated in cancer patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-024-02037-2.

Efficacy of a brief cognitive behavioral therapy for head and neck cancer survivors with body image distress: secondary outcomes from the BRIGHT pilot randomized clinical trial

PURPOSE

Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

METHODS

In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose and delivery-matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1 and 3-month post-intervention.

RESULTS

Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1).

CONCLUSIONS

In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03831100 .

IMPLICATIONS FOR CANCER SURVIVORS

These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

The associations between positive body image, well-being and psychological flexibility in breast cancer survivors

In Italy, breast cancer survivors are increasing. Body image is a complex posttreatment concern for breast cancer survivors, particularly younger women. This population reports higher levels of body-image concerns associated with higher psychological distress and lower quality of life. Body image concerns and factors that can impact the body image of older breast cancer survivors remain an important but under-explored research area. The purpose of this study is to examine the association of negative and positive body image with both well-being and psychological inflexibility in a sample of breast cancer survivors. 114 women who have completed breast cancer treatment (±5 years) completed a questionnaire to measure the research variables. Hierarchical regressions and indirect effects were performed. Functionality appreciation and body compassion accounted for a significant percentage of the variance of well-being (34%) and psychological inflexibility (50%) of the participants. The indirect effect of body dissatisfaction on well-being and psychological inflexibility through body compassion was significant. The results emphasise the relevance of the positive aspect of body image on well-being and psychological inflexibility. Functionality appreciation and body compassion contribute to understanding the health-status description of these women and could be considered in future health-promotion interventions aimed at reducing psychological distress associated with body image concerns in older breast cancer survivors.

Resilience and mindful attention as determinants of psychological distress among patients with a stoma: The mediating role of body image

This research investigated if dispositional mindfulness, resilience, and self-efficacy affect quality of life (QoL) and distress in a sample of patients with stoma. Further, it tested if body image distress and post-traumatic growth mediate these associations. A total of 102 patients with a stoma (mean age: 60.37 ± 12.79 years; 60 females, 52 males) volunteered for this cross-sectional study. The results revealed that mindful attention and resilience were direct, significant negative predictors of psychological distress. On the contrary, body image distress was directly and positively associated with psychological distress and significantly mediated the association between resilience and the dependent variable. The results emphasize the importance of interventions aimed at enhancing dispositional mindfulness and resilience as well as reducing body image-related distress to improve the QoL of patients with a stoma. Additional longitudinal and cross-cultural studies are needed to confirm these findings.

Accepting your Body after Cancer (ABC), a group-based online intervention for women treated for breast cancer: study protocol for a feasibility randomised controlled trial

INTRODUCTION

Breast cancer is the most common cancer among women worldwide. While increasing numbers of women are living beyond breast cancer, treatment-related body image concerns are common and associated with adverse consequences. Nonetheless, rigorously evaluated and effective body image interventions are lacking among this group. Accepting your Body after Cancer (ABC) has indicated promise in relation to inperson delivery. However, online delivery may increase accessibility and facilitate sustainability of the intervention. Therefore, we aim to establish the feasibility of conducting a fully powered randomised controlled trial to evaluate online delivery of ABC.

METHODS AND ANALYSIS

120 women who have received treatment for breast cancer and are experiencing body image concerns will be randomised equally to either the ABC or standard care control group. All participants in both conditions will receive a body image booklet for people who have had cancer. ABC participants will also take part in a weekly seven-session, group-based cognitive behavioural therapy intervention, delivered online by a psychologist and cancer support specialist. Outcome measures will be completed at baseline and 9 weeks, 20 weeks and 32 weeks post baseline. Quantitative data on recruitment, retention, ABC attendance and questionnaire completion rates will be analysed using descriptive statistics. Qualitative data will also be collected to better understand the feasibility and acceptability of the research process and intervention, with data analysed using 'codebook' thematic analysis.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Newcastle North Tyneside Research Ethics Committee (ref: 24/NE/0092). The findings will be disseminated to academic and health professionals via a peer-reviewed publication and presentations at relevant conferences. Results will also be disseminated to participants, national cancer organisations and the general public via accessible reports, online presentations and different communication channels.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT06412341; ISRCTN ISRCTN88199566; IRAS 327507; REC reference 24/NE/0092; funder reference NIHR205415.

The Esthetic Use of Botulinum Toxins in Cancer Patients: Providing a Foundation for Future Indications

Advances in oncological treatments have improved the survival rates of cancer patients but have often resulted in significant physical changes that negatively impact their self-esteem and psychological well-being. Cancer patients frequently ask esthetic practitioners to perform procedures to address such changes. However, practitioners often hesitate to satisfy such requests due to lacking guidelines or recommendations. The use of botulinum toxins (BoNTs) for esthetic purposes has shown significant promise in improving the quality of life for cancer patients. This review explores the broad application of BoNTs in many medical branches, focusing on oncology. A substantial amount of literature shows that BoNTs are safe and effective as a type of adjunctive therapy compared to classical cancer treatments. We provide our expert opinion that the use of BoNTs for esthetic purposes is safe for cancer patients and even recommended for those whose mood is influenced by the worsening of their physical appearance. Careful patient selection and interdisciplinary collaboration are essential to the safe integration of BoNTs into cancer care.

The impact of weight loss after bariatric surgeries on the patient's body image, quality of life, and self-esteem

OBJECTIVES

The objective of this web-based study is to analyze the attributes of bariatric surgery cases ensuing health implications. Additionally, the study seeks to delve into the factors influencing post-bariatric psychological evaluations and the impact of various bariatric surgeries on weight loss and psycho-social assessment scores for patients who had undergone bariatric surgeries within a specific bariatric surgery center in Egypt between January 2017 and January 2024.

METHODS

An analytical cross-sectional study recruited 411 adults who had undergone different bariatric procedures by the same surgical team. We collected the data using a validated self-administered questionnaire that included the Body Image Scale (BIS), the Rosenberg Self-Esteem Scale (RSES), the quality-of-life score (QOLS), and the modified General Patient Satisfaction Score after Bariatric Surgeries (GSABS).

RESULTS

The most commonly performed bariatric surgery was sleeve gastrectomy (SG), accounting for 82.7% of the procedures. The majority of the patients (78%) were female, with a mean age of 35.8. Among the participants, 32.4% reported experiencing complications, and 21.2% of those individuals were still experiencing complications at the time of assessment. The BIS had a mean score of 16.54 ± 6.27, indicating an average body image perception. The RSES yielded a mean score of 20.11 ± 4.63, indicating average self-esteem, while the GSABS had a mean score of 8.08 ± 2.39, indicating an overall average level of patient satisfaction. No statistically significant differences were found between the various types of bariatric surgeries in terms of total body weight loss percentage, excess body weight loss percentage, or the timing of the intervention. However, increased time intervals from surgeries noted a significant reduction in the BIS.

CONCLUSION

The majority of patients who underwent SG and Roux-en-Y gastric bypass (RYGB) surgeries exhibited high GSABS scores. SG patients also had high BIS scores. However, all other interventions showed normal GSABS and BIS scores. All types of surgeries resulted in normal RSES and QOLS. Furthermore, the BIS score increases with the intervention's recentness, but it significantly decreases after the second-year post-surgery. Conversely, the older the timing of the intervention, the higher the RSES score after surgery.

Does Self-Compassion Expressive Writing Benefit People With an Ostomy? A Randomized Controlled Trial

PURPOSE

The purpose of this study was to investigate whether a self-compassion expressive writing activity could improve psychological well-being in people with an ostomy, as assessed by changes in body image distress, ostomy-specific quality of life (QOL), self-compassion, and dispositional disgust.

DESIGN

Randomized controlled trial design was used.

SUBJECTS AND SETTING

The sample comprised 175 English-speaking patients over 18 years of age with a fecal or urinary ostomy; all participants resided in Australia and New Zealand. All were recruited online between May and July 2019.

METHODS

Following completion of a baseline questionnaire, participants were randomly assigned to complete either an online self-compassion expressive writing exercise (intervention group; n = 88; 50.29%) or a control expressive writing exercise (n = 87; 49.71%). Online questionnaires were completed 1-week and 1-month following completion of either expressive writing task. Intent-to-treat repeated-measure ANOVA analyses assessed benefits to self-compassion, body image distress, and ostomy-specific quality of life. Dispositional disgust sensitivity and propensity, as assessed by baseline scores on the Dispositional Disgust Sensitivity and Propensity Scale (DPSS), were assessed as moderators.

RESULTS

Analyses revealed that younger people with an ostomy had poorer self-compassion, greater body image distress, and poorer ostomy-specific QOL than older people, and those who had lived with their ostomy for longer had lower body image distress and greater QOL. There were no significant main effects of writing condition on primary measures; however, individuals in the intervention condition with low dispositional disgust had greater self-compassion, greater ostomy-specific QOL, and lower body image distress than those with high dispositional disgust.

CONCLUSION

Although expressive writing is a pragmatic and accessible intervention, our findings suggested that it was of benefit only to people with low dispositional disgust. Further work is required to establish an effective psychological tool for this under-researched population.

The Conceptualization and Measurement of Sexual Self-Concept and Sexual Self-Schema: A Systematic Literature Review

Sexual self-concept and sexual self-schema are multidimensional constructs critical to developing a more holistic theoretical understanding of the sexual self. With an increased amount of research exploring these constructs over the past few decades, a systematic review was warranted to highlight next steps for future research in this area. Therefore, utilizing a staged systematic review, we aimed to explore how these parallel concepts are measured and among which populations they are used. The evaluation of 236 unique manuscripts published 1990-2020 revealed the use of 38 established or constructed measures of sexual self-concept, and 16 established or constructed measures of sexual self-schema. Three distinct measures were used in more than one-fifth of the studies reviewed, although the use of full-form measures vs. subscales differed across studies. Although there was diversity in the samples used in the studies reviewed, these studies were conducted most commonly with samples consisting of individuals who were primarily, if not solely, cisgender, women, heterosexual, White, non-college attending, U.S. residents, and/or had no unique characteristics identified (e.g., cancer patient/survivor, pregnant). The largest proportion of studies reviewed examined sexual self-concept during emerging adulthood, followed by early adulthood and middle adulthood. Suggested directions for future research in this area include (a) reexamining and testing how current measures are capturing these constructs and among whom; (b) expanding samples to include and/or target specifically gender, sexual, and racial/ethnic minoritized groups as well as individuals with unique characteristics that would affect sexual well-being; and (c) utilizing samples in childhood, adolescence, and late adulthood.

Factors Influencing the Demoralisation Syndrome of Post-Operative Patients With Breast Cancer: A Cross-Sectional Study

AIM

We explored demoralisation syndrome among post-operative patients with breast cancer and its relationship with patients' body image and marital intimacy.

DESIGN

A cross-sectional study.

METHODS

In this cross-sectional study, 237 patients with breast cancer who were hospitalised in the breast surgery department of Grade A tertiary hospital in Xiamen, China from June 2022 to December 2023 and met the standards of adaxation were selected by the convenience sampling method. The survey tool consists of four parts: general data questionnaire, demoralisation scale-II (DS-II), quality of relationship index (QRI) and body image scale (BIS).

RESULTS

In this study, we examined the demoralisation syndrome in 237 post-operative breast cancer patients, predominantly aged 45-59 years (47.3%), with the majority living with family (94.1%) and having children (95.4%). A small proportion (5.9%) lived alone, and 3% were uninsured, opting to pay for their treatment out-of-pocket. The majority (83.1%) had undergone mastectomy, and 51.9% visited the hospital for chemotherapy, with 5.1% experiencing disease recurrence. The mean demoralisation score was 8.52 (SD = 8.47). We found that 22.8% had moderate and 14.8% had severe demoralisation symptoms. Socioeconomic factors such as age, residence, income, tumour staging, post-operative time, hospital purpose and disease recurrence were associated with demoralisation. Multivariate analysis revealed that income, cancer stage, recurrence, quality of recovery index (QRI) and BIS were independent influencing factors for demoralisation syndrome after breast cancer surgery. These findings highlight the importance of considering a range of patient characteristics when addressing demoralisation in post-operative breast cancer patients.

PATIENT CONTRIBUTION

Demoralisation syndrome in patients after breast cancer surgery is influenced by a combination of sociodemographics, disease, intimate relationship and body image. Clinical medical staff should accurately evaluate and identify patients with demoralisation syndrome after breast cancer surgery and formulate and implement personalised intervention strategies according to their physical conditions and possible influencing factors, so as to reduce the incidence of demoralisation syndrome and improve the quality of life.

Stoma Acceptance Mediates Body Image Distress and Mental Health-Related Quality of Life: A Single-Center Study on Radical Cystectomy Patients with Ureterostomy

Background: Muscle-invasive bladder cancer and subsequent radical cystectomy with ureterocutaneostomy significantly impact patients' body image and quality of life, potentially increasing the risk of adverse mental health outcomes. Acceptance may represent a psychosocial resource to buffer the effects of body image impairment on health, thereby supporting stoma adjustment and preserving quality of life. Objective: This study aimed to investigate the mediating role of stoma acceptance in the relationship between body image distress and mental health. Methods: A single-center cross-sectional survey was conducted with 73 muscle-invasive bladder cancer patients undergoing radical cystectomy with ureterocutaneostomy. Participants completed structured, anonymous self-report measures assessing body image distress, stoma acceptance, and mental health-related quality of life through validated questionnaires. Results: Statistical analyses revealed significant negative correlations between body image distress and mental health and stoma acceptance. Conversely, stoma acceptance was significantly and positively associated with mental health. Regression-based mediation modeling indicated that stoma acceptance exerted a significant mediating effect on the relationship between body image and mental health-related quality of life. Conclusions: These findings highlight the considerable and unprecedented role of stoma acceptance as a mediating factor that may promote the adjustment and enhance the quality of life of urostomy patients. Further research is warranted to explore interventions targeting stoma acceptance to prevent body image distress and promote mental health.

Impact of Body Image Perception on Behavioral Outcomes in Chinese Adolescent and Young Adult Survivors of Sarcoma

PURPOSE

To identify the prevalence and predictive factors of body image dissatisfaction among Chinese adolescent and young adult (AYA) survivors of sarcoma and to evaluate its associations with behavioral outcomes.

METHODS

In total, 116 AYA survivors (response rate: 88%; 48.3% female; mean age 28.2 years, SD = 8.2 years) of osteosarcoma (49.1%) or soft-tissue sarcoma (50.9%) were recruited from an academic hospital. The survivors self-reported their perceived body image using the Body Image Scale. Behavioral outcomes were assessed using DSM-oriented scales of the ASEBA Adult Self-Report checklist. Multivariable linear regression was conducted to identify predictors of body image perception and to investigate the association between body image dissatisfaction and behavioral outcomes (adjusted for clinically relevant variables and corrected for false discovery rate). Mediation analyses were performed to examine the mediating effects of body image perception between clinical, treatment, or socioenvironmental risk factors and behavioral outcomes.

RESULTS

At 15 years post-cancer diagnosis, one-third of the cohort (39.7%) reported dissatisfaction with their body image. The significant risk factors associated with body image dissatisfaction were being female (standardized coefficient estimate [Est] = 0.21, SE = 0.10; p = 0.047), surgery treatment (Est = 0.19, SE = 0.09; p = 0.046), and worse family functioning (Est = 0.27, SE = 0.10, p = 0.013). Body image dissatisfaction was associated with symptoms of depression (Est = 0.30, SE = 0.10; p = 0.005) and avoidant personality problems (Est = 0.37, SE = 0.11; p < 0.001). Negative body image perception significantly mediated the association between poor family functioning and avoidant personality problems (proportion-mediated 26.3%, p = 0.038).

CONCLUSION

Body image dissatisfaction was associated with more significant internalizing symptoms of depression, anxiety, and avoidant personality. A negative body image perception may mediate the association between poor family functioning and psychological distress among adult survivors. The provision of psychosocial intervention early during the cancer care continuum may mitigate the negative impact of body image distress in Chinese AYA survivors.

Implementing the framed portrait experience with Italian breast cancer survivors: a pilot study assessing short term effects of an existential approach to body image, coping skills, and self-efficacy

PURPOSE

Breast cancer (BC) and its treatments significantly impact the psychological wellbeing of women. Interventions offered during cancer survivorship have documented positive consequences for quality of life. However, limited evidence is available regarding the implementation of therapeutic photography. This study investigated the efficacy of the framed portrait experience (FPE) when implemented to BC survivors.

METHODS

A quasi-experimental study was conducted. Participants were enrolled in a non-randomized pre-post intervention with a comparison group. Forty BC survivors were recruited using a convenience sampling approach; of these, 20 were subsequently allocated to the intervention (FPE group) and 20 to the comparison group. Participants were assessed at pretest and posttest (3 weeks later) using self-reported measures of body image, coping, self-esteem, and self-efficacy. Independent samples t-tests compared group composition at pretest. Mixed between-within 2 × 2 repeated-measures ANOVAs examined pretest-posttest changes in the variables of interest.

RESULTS

No differences were detected between groups at pretest. A significant interaction effect on body image, problem-focused coping, emotion-focused coping, and in self-efficacy competence subscale (p < 0.05) was identified. Post hoc pairwise comparisons with the Bonferroni correction indicated improvement on these domains in the FPE group vs. comparison group. Additionally, significant main effects of time on self-efficacy total score and magnitude subscale (p < 0.05) were found.

CONCLUSIONS

Preliminary results support the efficacy of FPE, but further research is needed.

IMPLICATIONS FOR CANCER SURVIVORS

Existential approaches inclusive of self-portraits and illness narratives can be utilized to support BC survivors in the management of the psychological consequences of the illness.

Impact of diagnosis and surgical treatment of early stage borderline ovarian tumours on distress, anxiety, and psychosexual health

Women diagnosed with gynecological cancer are likely to face additional consequences beyond those common to all cancer patients leading to significant physical and psychological morbidity. Longitudinal studies addressing the prevalence of psychological distress, anxiety, or psychosexual health during follow-up in patients diagnosed with borderline ovarian tumors are lacking. This study explores this prevalence compared with controls who underwent comparable surgical treatment for benign ovarian tumors. A prospective 1:1 nonmatched case-control study was set up, registered on ClinicalTrials.gov under number NCT04253327. Thirty early stage borderline ovarian tumor patients participated, and 30 controls were included. The study materials consisted of different questionnaires. A general one on patient's sociodemographic and medical information. A questionnaire about anxiety and distress made up of three validated questionnaires: Hospital Anxiety and Depression Scale, Perceived Stress Scale and Body Image Scale. As last one the psychosexual health questionnaire consisted of the Female Sexual Function Index, the Female Sexual Distress Scale and two European Organisation for Research and Treatment of Cancer questionnaires. Both groups were comparable and did not differ significantly in terms of demographic characteristics. Patients with early stage borderline ovarian tumors experience a significant higher burden of mental health issues due to disease and treatment and/or are more worried about their future health. Surprisingly, both early stage borderline ovarian tumor patients and controls showed high levels of anxiety and moderate stress. Many patients in both groups experience sexual dysfunction and distress. These findings support active screening for anxiety, depression and psychosexual perturbance during postoperative follow-up to accommodate this.

Associations between sexuality, body image and health-related quality of life in patients treated for diffuse large B-cell lymphoma: A cross-sectional study

PURPOSE

Sexuality and body image are closely related to health-related quality of life (HRQoL), but these factors are less investigated in patients treated for lymphoma. Therefore, the aim of this study was to describe and explore the associations between sexuality, body image, comorbidities and HRQoL in patients treated for diffuse large B-cell lymphoma.

METHODS

A cross-sectional study with 257 patients (25% response rate) was conducted in 2019 using measures for sexuality, HRQoL and body image and data from the Swedish National Quality Registry for Leukemia-Subregistry for Lymphoma.

RESULTS

The participants had a mean HRQoL of 69.75 on a 1 to 100 scale, and the functional scales ranged from 68.50 for Role to 80.82 for Social functioning. The symptoms ranged from 5.56 for nausea and vomiting to 37.73 for fatigue. Regarding body image, the participants scored a total of 14.47 (reference values 10-40). The total score for Sexual adjustment was 3.02 (fair), and for the subscales Sexual Interest 2.63 (low), Sexual Relation 2.72 (low), Sexual Function 3.62 (high) and Sexual Satisfaction 3.50 (high). HRQoL was positively associated with Sexual Relation; however, negative body image and comorbidities showed negative associations. The model explains 39.6% of the variation in HRQoL.

CONCLUSION

The positive impact of sexual relationships on HRQoL was highlighted, which emphasised the unfavourable effect of negative body image and comorbidities on HRQoL for lymphoma patients. Cancer nurses should address these topics with patients to improve their long-term well-being.

Shared decision making in primary malignant bone tumour surgery around the knee in children and young adults: protocol for a prospective study

BACKGROUND

Children and young adults needing surgery for a primary malignant bone tumour around the knee face a difficult, life-changing decision. A previous study showed that this population wants to be involved more in the decision-making process and that more involvement leads to less decisional stress and regret. Therefore, a well-designed and standardized decision-making process based on the principles of shared decision-making needs to be designed, implemented, and evaluated.

METHODS

We developed a shared decision-making (SDM) model for this patient population, including an online decision aid (DA). This model has been implemented in the standard care of patients with a primary malignant bone tumour around the knee. Following implementation, we will analyse its effect on the decision-making process and the impact on patient experiences using questionnaires and interviews. Moreover, potential areas for improvement will be identified.

DISCUSSION

Given the importance of involving patients and parents in surgical decision-making, particularly in life-changing surgery such as malignant bone tumour surgery, and given the lack of SDM models applicable for this purpose, we want to share our model with the international community, including our study protocol for evaluating and optimising the model. This study will generate valuable knowledge to facilitate the optimisation of current patient care for local treatment. The sharing of our implementation and study protocol can serve as an example for other centres interested in implementing SDM methods in an era characterized by more empowered patients and parents who desire autonomy and reliable and realistic information.

Body image and psychosocial effects in women after treatment of breast cancer: A prospective study

PURPOSE

To explore treatment-related, socio-economic, and psychological factors influencing body image and return to work.

MATERIALS AND METHODS

137 patients participated in the study. A questionnaire was completed before surgery and at 1-year follow-up, where patients were also interviewed in person with questions modified from the Body Image Scale and the sexual adjustment scale as well as questions about their work status.

RESULTS

There was a significant decline in body image score from baseline to 1-year follow-up related to younger age, more extensive surgery and post-surgery treatments. Treatment with adjuvant chemotherapy was associated with a lower rating on ability to work in relation to mental requirements and later return to work. Higher anxiety scores at baseline were associated with both a decline in body image and a delay in return to work.

CONCLUSION

Breast cancer surgery can affect body image and especially adjuvant chemotherapy seems to affect work ability. However, personal characteristics are also involved and thus should be considered when planning for treatment of breast cancer.

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.

Immediate Psychological Implications of Risk-Reducing Mastectomies in Women With Increased Risk of Breast Cancer: A Comparative Study

BACKGROUND

Risk-reducing mastectomy is recommended for high-risk patients but may have significant psychological consequences. This study aimed to determine the differences in anxiety, depressive symptomatology, body image and quality of life in women with an increased risk of breast cancer immediately before and after undergoing risk-reducing mastectomy.

METHODS

Eighty-eight women with an increased risk of breast cancer due to BRCA1/2 mutations or a previous cancer diagnosis participated in this study. Instruments used were the Hospital Anxiety and Depression Scale, Body Image Scale and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Breast 23, administered 15-30 days before and after surgery.

RESULTS

Following surgery, there was an immediate and significant worsening in anxiety, depressive symptomatology and body image. There was a significant deterioration in global, physical, role, and social functioning, as well as in body image and sexual enjoyment scales. Additionally, there were increases in fatigue, nausea and vomiting, constipation, dyspnoea, insomnia, appetite loss, perceived financial difficulties, pain, systemic therapy side effects, and breast and arm symptoms. However, there was an improvement in future perspective. These changes occurred independently of whether participants had a cancer diagnosis or BRCA1/2 mutation.

CONCLUSION

Risk-reducing mastectomies have immediate psychological consequences. While these procedures improve future health perspective, they increase anxiety and depressive symptomatology and decrease body image and quality of life, regardless of cancer diagnosis or BRCA1/2 mutation. These findings highlight the psychological consequences of such surgical procedures, emphasizing the need for comprehensive psychological interventions both before and after surgery.

Breast Cancer: The Psychological Impact of Diagnosis, Treatment, and Remission

Breast cancer affects millions of people worldwide. With physical manifestations being the predominant feature of management, healthcare professionals can overlook the psychological toll that the disease can have on the patients and their support network. This literature review examines the vast multi-factorial approach that must be taken when managing breast cancer patients from initial screening to diagnostic investigations, treatment, and remission. A literature search in PubMed from January 2000 to April 2024 was executed. Data sets in the studies filtered during the literature search were collected and analysed, looking not only at the data itself but also the entirety of the study. This included its limitations and possible biases. From screening, the possibility of cancer as a diagnosis can trigger mixed emotions including fear, depression, and anxiety. During diagnostic, patients may find themselves subject to fear of negative body image evaluation and fear of judgment. Medical professionals must be prepared to support the patient when they experience these feelings. The treatment stages can be the most difficult for the patient as side effects and complications of treatment can impact their lives in numerous ways, making management challenging. These include pain, sexual dysfunction, and alopecia. Overall, the analysis of the selected literature showed areas in clinical practice that can be optimised when providing psychological support for a patient's cancer diagnosis, management, and treatment. Being able to counsel prior to the presentation of these, and ideally prevent unnecessary cases of these can substantially increase a patient's quality of life during treatment. This literature review hopes to identify and promote awareness and further implementation of support systems by healthcare professionals.

Coping style and psychopathological morbidity in patients with advanced melanoma: differences between cancer therapy, metastatic location and staging

BACKGROUND

The incidence of melanoma has been steadily increasing in recent years and remains one of the most frequent cancers in adolescents and young adults. The literature shows how a high percentage of melanoma patients present with high anxiety and depression scores and a correlation between worsening quality of life and impaired body image has been shown. The present study aimed to investigate the relationship between cutaneous and visceral metastasis in a group of 73 patients with advanced melanoma in relation to body image, anxiety, depression, and coping style.

METHODS

Hospital Anxiety and Depression Scale, Body Image Scale and Mini-Mac questionnaires were administered to a sample of 73 subjects with advanced melanoma (stage III and IV); Analyses were performed with SPSS version 28.01 and a P value <0.05 was considered significant.

RESULTS

Emerging results indicated greater body image impairment in patients with skin metastasis, no significant difference in anxiety and depression by staging. Patients receiving target therapy showed a reduction in anxiety and depression compared with patients receiving immunotherapy.

CONCLUSIONS

In line with the literature, cutaneous metastatic involvement negatively affected body image, a prevalence rate of anxiety and depression of 28,8% and 19.2%, respectively, emerged in the sample, while 17.8% reported significant body image impairment, suggesting how melanoma impacts in patient's quality of life.

A cognitive behavioral therapy-based intervention to address body image in patients with facial cancers: Results from a randomized controlled trial

OBJECTIVES

Body image adjustment is a crucial issue for patients with facial cancer, but body image-specific interventions are scarce. We report results of a novel psychotherapeutic intervention to address body image concerns during acute postoperative recovery following facial reconstructive surgery. Our primary aims were to evaluate the intervention's feasibility, acceptability, and efficacy on body image concerns, psychological distress, and quality of life (QOL).

METHODS

Adults with facial cancers who endorsed body image concerns were recruited to participate in a randomized controlled trial. The intervention group participated in 4 in-person counseling sessions. The control group received an educational booklet and a brief phone call. Participants completed measures of body image, distress, and QOL at baseline and at the 4-week follow-up to assess the impact of the intervention. Intervention outcomes were assessed with 2 sample t-tests or Mann-Whitney U tests as appropriate.

RESULTS

Twenty-nine participants completed both the baseline and follow-up assessments. The intervention demonstrated good feasibility with a high retention rate (79%), visit completion rate (81%), and high satisfaction scores (75% reported mean satisfaction score of >3). Intervention did not result in an observed statistically significant difference in reduction in body image dissatisfaction and disturbance, psychological distress, or improvement in QOL compared with the control group. However, intervention resulted in statistically significant difference in perceived social impact (-1 vs. -8.3, p = 0.033) compared to control group.

SIGNIFICANCE OF RESULTS

Our study highlights the potential clinical benefits of a novel psychotherapeutic intervention that targets body image concerns and suggests the need for further evaluation.

Body image and social anxiety in hemifacial spasm: Examining self-esteem and fear of negative evaluation as mediators

BACKGROUND

Individuals diagnosed with hemifacial spasm (HFS) frequently undergo noticeable alterations in their facial appearance. Such changes can detrimentally influence both their physical and psychological well-being. While prior studies have identified self-esteem and fear of negative evaluation (FNE) as key elements in social anxiety, their role in studies concerning body image and its correlation with social anxiety has been seldom explored. This research seeks to explore how self-esteem and FNE concurrently mediate the relationship between body image and social anxiety among Chinese individuals with HFS.

METHODS

Chinese patients with HFS (n=151) completed a cross-sectional questionnaire on the first day of admission that assessed body image, social anxiety, self-esteem, and FNE over the past week. Path analysis was used to test the hypothesis of the mediation model.

RESULTS

The hypothesized model showed that FNE was positively correlated with body image and social anxiety, while negative associations were found among body image, self-esteem and social anxiety. Self-esteem and FNE play a mediating role between body image and social anxiety.

CONCLUSION

Our findings suggest that self-esteem and FNE may be important psychological pathways that affect body image and social anxiety in Chinese patients with HFS. Supplementing mental health services that help increase self-esteem and reduce FNE should be considered to improve the psychological quality of patients with HFS.

A novel oncoplastic technique for centrally located breast cancers: An experience from a Tertiary care center in North India

CONTEXT

Oncoplastic breast surgery is the current standard for treatment of early breast cancer, offering a balance between good cosmetic outcomes and limited risk of locoregional recurrence. Still, the best technique of reconstruction for centrally located breast cancer (CLBC) is not established because of cosmetic issues associated with NAC resection and difficulties associated with its reconstruction.

AIMS

This study aims to present here a novel technique of post-BCS breast reconstruction for CLBC by latissimus dorsi (LD) flap coupled with immediate NAC reconstruction using modified Skate Flap.

METHODS AND MATERIAL

A total of 9 patients underwent oncoplastic breast reconstruction using the described technique for CLBC at our center from July 2018 to March 2020. Postoperative analysis was done for surgical complications, pathological, oncological, and cosmetic outcomes. QOL outcome was assessed using body image scale (BIS) and compared with another group of 9 mastectomy patients operated in the same time period.

STATISTICAL ANALYSIS

The analysis was done using SPSS software. P value was calculated using the Independent t-test.

RESULTS

Mean BIS score was 4.44 (range 1-8) in BCS vs 20 (range 11-27) in the mastectomy group, signifying better QOL in the BCS group. The postoperative cosmetic results, as evaluated by the patients, were excellent in 7 of 9 patients (77.77%), good in 1 patient (11.11%), and fair in 1 (11.11%), with an overall mean of 4.11 equivalent to 82% satisfaction.

CONCLUSIONS

Immediate reconstruction with LD flap and modified skate flap following resection of CLBC is a good technique for this difficult group of patients to be managed by BCS. Cosmetic results of this technique are satisfactory. Additionally, it avoids the need for a symmetrizing contralateral breast surgery as well as a second surgery on the ipsilateral breast.

Body Image Concerns in Adolescent and Young Adult Oncology Patients within Six Months of Upfront Diagnosis

This cross-sectional study described prevalent body image (BI) concerns among adolescents and young adults (AYAs) with neoplasms who received treatment at a quaternary care children's hospital. Thirty-two AYAs, aged 15-39 years, completed questionnaires assessing BI within six months of diagnosis. The most frequently endorsed questionnaire items included the following: desire for increased physical fitness (62.5%), self-consciousness about hair (45.2%), weight dissatisfaction (40.6%), lack of strength (37.5%), wearing loose clothing to hide one's body (37.5%), decreased agility (34.4%), shape dissatisfaction (32.2%), and self-perception of too much body fat (31.3%). Awareness of AYA BI concerns during treatment may generate early intervention targeting this complex issue.

Effects of online mindful self-compassion intervention on negative body image in breast cancer patients: A randomized controlled trail

PURPOSE

The incidence of breast cancer patients with negative body image has increased. However, research on interventions that explicitly reduce negative body image among breast cancer patients remains inadequate. The development of more pragmatic interventions is imperative. Therefore, we conducted this study to assess the effectiveness of a 6-week online Mindful Self-Compassion (MSC) intervention to reduce the negative body image in breast cancer patients.

METHODS

We randomly assigned 64 female breast cancer patients to either the MSC group or the control group. The MSC group received a 6-week online Mindful Self-Compassion intervention, while the control group received no psychological training. Participants were surveyed by the Self-Compassion Scale-Short Form (SCS-SF), the Self-Acceptance Questionnaire (SAQ), the Chinese Perceived Stress Scale (CPSS), and the Body Image Scale (BIS) at baseline (T1), post-intervention (T2), and 1-month follow-up (T3).

RESULTS

All outcome variables demonstrated significant time main effects and nonsignificant group main effects. The MSC and control groups had significant time × group interaction effects on self-compassion, self-acceptance, perceived stress, and negative body image. Simple main effects analysis revealed significant improvements in outcome variables at three-time points for the MSC group.

CONCLUSION

A 6-week online Mindful Self-Compassion intervention can improve self-compassion and self-acceptance and reduce perceived stress and negative body image among the breast cancer patients in MSC group. Mindful Self-Compassion intervention shows promise as a viable way to maintain the mental well-being of breast cancer patients.

Exercise interventions for self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer: a systematic review with meta-analysis and meta-regressions

PURPOSE

To synthesise the effectiveness of exercise interventions on self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer who are undergoing or have completed primary adjuvant treatments.

METHODS

A systematic review was conducted with meta-analysis and meta-regressions. Five electronic databases were searched from inception to June 2023, and hand searches were performed to explore the reference lists of similar systematic reviews. The established selection criteria were randomised clinical trials that evaluated any type of physical exercise intervention with self-perceived body image, self-esteem and self-efficacy as outcomes. No restrictions were imposed with respect to the control group. Main characteristics were extracted for each study. Meta-analyses, meta-regressions and sensitivity analyses were performed. The certainty of evidence for each outcome was graded using the GRADE approach. The risk of bias was evaluated using the RoB2 Cochrane tool.

RESULTS

Twenty studies, comprising 19 different samples (n = 2030), were included. In general, meta-analysis indicated that physical exercise interventions were not superior to controls for improving self-esteem and body image in women diagnosed with breast cancer. However, subgroup meta-analysis showed a significant difference in self-esteem improvement for resistance exercise (SMD = 0.31; 95% CI = 0.07, 0.55; p = 0.01; I2 = 0%) and supervised exercise (SMD = 0.25; 95% CI = 0.08, 0.42; p = 0.0004; I2 = 0%) compared with controls. Self-efficacy results were scarce and controversial. In addition, serious concerns were mainly detected in terms of the risk of bias and indirectness of the evidence, which caused the certainty of evidence to be very low for all outcomes.

CONCLUSION

Supervised exercise and resistance training appear to be effective exercise modalities for improving self-esteem in women diagnosed with breast cancer. In contrast, exercise interventions are not significantly associated with improvements in body image, while results on self-efficacy are controversial. However, due to the study's limitations, further research is needed.

Electrochemotherapy Treatment in a Patient with an Extended Basal Cell Carcinoma of the Face: A Case Report

BACKGROUND

Basal cell carcinomas (BCCs) are common human malignancies with a rising incidence in recent years. While BCCs have a low mortality rate, they are often associated with significant local skin damage characterized by erythema, skin ulceration, and persistent pigmentation. Surgery, radiotherapy, and systemic chemotherapy have traditionally been the principal treatments for these skin injuries. However, electrochemotherapy has recently been proposed as a novel local treatment with promising results for various skin cancers, including BCC, while avoiding the side effects of conventional therapies. ECT involves a local electrical stimulus that enhances cell membrane permeability, thereby enabling the targeted intracellular accumulation of the chemotherapeutic agent.

CASE REPORT

We report a case of a 68-year-old man with an ulcerated BCC, following his progress up to 14 months post-ECT treatment, with positive outcomes.

DISCUSSION AND CONCLUSIONS

We achieved a complete clinical response and noted an improvement in the patient's quality of life. This technique is fast, repeatable, requires minimal hospitalization, and reduces healthcare costs and adverse effects compared to major surgery. Therefore, it can be considered an alternative or complementary approach to traditional surgery for treating BCC of the head and neck.

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.

Effectiveness of acceptance commitment therapy for head and neck cancer patients with body image distress in China: a study protocol for randomised controlled trial

INTRODUCTION

The head and neck comprise vital organs and are apparent human body parts. Tumours here impair physical and sensory functions as well as appearance and social interactions, leading to body image distress (BID) and threatening mental health and quality of life. Acceptance and commitment therapy has shown effectiveness in improving BID in groups such as breast cancer patients. This study aims to apply this therapy to intervene in head and neck cancer (HNC) patients, aiming to improve BID and promote better psychological well-being.

METHODS AND ANALYSIS

This study is a prospective, parallel-group, randomised controlled trial. A total of 64 HNC patients will be allocated to either an intervention group or a control group. The intervention group will engage in a 3 week, six-session group-based acceptance and commitment therapy programme, while the control group will receive standard treatment. The primary outcome is cancer-related BID, and secondary outcomes are HNC-related BID, psychological flexibility, coping style and psychological distress. These indicators will be measured at baseline, postintervention and 1 month following the intervention's completion.

ETHICS AND DISSEMINATION

The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2308-67-02). The study results will be shared through peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300077863.