Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study

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

Objective

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

Methods

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

Results

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

Conclusions

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

Body Image Distress and Depression in Head and Neck Cancer Patients- a Narrative Review

Body image distress (BID) and depression are significant psychosocial concerns in individuals with head and neck cancer (HNC). The unique physical and functional challenges associated with HNC contribute to alterations in self-perception and quality of life. However, the interplay between BID and depression remains underexplored in this patient population. This narrative review aims to synthesize current evidence on the relationship between BID and depression in patients with HNC, identify key determinants influencing these conditions, and explore potential intervention strategies to improve psychosocial outcomes. A non-systematic literature search was conducted from December 2024 to January 2025 using PubMed and Google Scholar. Studies published in the last five years (2019-2024) focusing on BID and depression in HNC patients and survivors were included. Both qualitative and quantitative studies were reviewed. Key areas of analysis included prevalence, risk factors, quality of life impact, and psychosocial interventions. The literature suggests a bidirectional relationship between BID and depression in HNC, where the presence of one exacerbates the severity of the other. Depression is a key predictor of BID, while other contributing factors include younger age, female gender, advanced cancer stage, extensive surgical interventions, postoperative radiation, social isolation, and dissatisfaction with aesthetic outcomes. BID and depression collectively contribute to poorer quality of life, impairing social-emotional functioning and treatment adherence. Emerging research highlights shame, stigma, and unmet needs (e.g., sexual dysfunction, substance use) as additional factors influencing BID and depression. Interventions such as cognitive behavioral therapy (CBT), telemedicine-based counseling, and peer support programs show promise in mitigating these psychosocial burdens, but their accessibility remains inconsistent. BID and depression are interrelated and significantly impact the well-being of patients with HNC. A multidisciplinary approach integrating psychological support, functional rehabilitation, and aesthetic interventions is essential for improving patient outcomes. Future research should prioritize longitudinal studies, standardized assessment tools, and culturally sensitive interventions to enhance the understanding and management of BID and depression in HNC survivors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-025-05461-0.

The Important Value of Nursing "Compassionate Care": A Phenomenological Study From the Perspective of Patients Living With a Cancer Diagnosis

BACKGROUND

Although the number of studies on the reflection of compassionate care practices in patient experiences has increased in recent years, the issue is still not sufficiently studied and clearly defined, and no study has been conducted with patients living with a cancer diagnosis in Türkiye.

OBJECTIVE

This study aimed to examine the perspectives of compassionate care and compassionate care experiences of cancer patients in-depth using qualitative methods.

METHODS

Between March and August 2024, 22 phenomenological semistructured interviews were conducted with cancer patients. The data were analyzed using Colaizzi's 7-step descriptive analysis approach.

RESULTS

Five themes emerged from the analysis: (1) compassionate care behaviors, (2) noncompassionate care behaviors, (3) the value of compassionate care for the patients, (4) perceptions of compassionate care barriers, and (5) suggestions to improve compassionate care.

CONCLUSIONS

Compassionate care from cancer patients' perspectives involves being friendly, respectful, and responsive to needs, whereas noncompassionate care behaviors mainly involve ineffective communication skills. Compassionate care has a positive effect on the outcomes of cancer patients with a long and challenging treatment journey. On the contrary, it may adversely affect communication, leading to an increase in unmet needs and a poor impact on cancer prognosis.

IMPLICATIONS FOR PRACTICE

Cancer nurses should be trained to gain awareness of compassionate care and practices to ensure compassionate care, and training should be repeated regularly. For institution managers, reducing the patient-nurse ratio, monitoring cancer nurses for compassion fatigue, implementing prevention and coping programs, and creating a corporate culture to provide compassionate care are recommended.

Protocol for a multisite, parallel-group, randomized clinical trial comparing a brief tele-cognitive behavioral therapy intervention (BRIGHT) with attention control for the reduction of body image-related distress among head and neck cancer survivors

One in four head and neck cancer (HNC) survivors experience clinically significant body image distress (BID), a devastating psychosocial morbidity that adversely affects quality of life. To date, effective interventions for these patients are lacking. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment), a brief cognitive behavioral treatment (CBT), has shown potential efficacy as a novel treatment paradigm for HNC survivors with BID. The primary objective of this randomized clinical trial (RCT) is to test the hypothesis that BRIGHT improves BID among HNC survivors relative to an Attention Control (AC) intervention. In this multisite RCT, N = 180 HNC survivors with BID will be randomized 1:1 to six weeks of BRIGHT or AC of dose and delivery-matched survivorship education. Outcomes are assessed at baseline and 2, 3, 6, and 9-months post-randomization. The primary endpoint is the IMAGE-HN (Inventory to Measure and Assess imaGe disturbancE-Head and Neck) score, a validated patient-reported outcome of HNC-related BID. Secondary endpoints include the HN Shame and Stigma Scale, the PROMIS SF v1.0-Depression 8a, Anxiety 8a, and Ability to Participate in Social Activities 8a, the Beck Scale for Suicidal Ideation, and the EORTC QLQ-HN35 Trouble with Social Eating and Trouble with Social Contact subscales. The trial will also evaluate whether the effect of BRIGHT on BID is mediated through improvements in automatic thinking and body image coping strategies. Findings from this multisite RCT will provide a rigorous test of the efficacy of BRIGHT as the first evidence-based strategy to manage BID among HNC survivors. TRIAL REGISTRATION ID: NCT05442957.

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.

Generative Artificial Intelligence (AI) to Uncover Insights From Breast Cancer Patients' Perceptions to Mindfulness-Based Stress Reduction (MBSR) Interventions

The study's central objective is to harness the power of generative Artificial Intelligence (AI), in particular based on Large Language Models, as a valuable resource for delving deeper into the insights offered by patients with breast cancer (BC) who actively participated in a Mindfulness-Based Stress Reduction (MBSR) program. In a 6-week MBSR program, each session lasted 2 hours and encompassed a range of techniques, including sitting meditation, body scan, Hatha yoga, and walking meditation. A total of 25 participants were enrolled in the study. The majority of these participants reported a high level of satisfaction with the mindfulness course. The application of generative AI enabled a comprehensive analysis of the participants' responses, revealing distinct subgroups among them. The MBSR program was found to be beneficial for most participants, serving as a valuable tool in managing the psychological stresses associated with BC.

Body image and social appearance anxiety in patients with cancer undergoing radiotherapy: Across-sectional study

BACKGROUND

The body image of patients with cancer can be negatively affected due to treatment toxicities. Changes in body image may cause patients to experience social appearance anxiety. This study aimed to evaluate the body image and social appearance anxiety of patients with cancer undergoing radiotherapy.

METHODS

The cross-sectional study was conducted with 153 patients with cancer undergoing radiotherapy in a university hospital. The data were collected with a Patient Information Form, the Body Image Scale, and the Social Appearance Anxiety Scale and the Radiation Therapy Oncology Group Skin Toxicity Criteria.

RESULTS

Patients' mean body image score was 15.18 ± 8.26 (min = 0, max = 30), mean social appearance anxiety score was 45.29 ± 14.50 (min = 16, max = 80). Patients with low education levels and low-income levels had higher body image and social appearance anxiety scores (p < 0.01). Body image and social appearance anxiety scores were found to be higher in patients with advanced cancer, grade III-IV skin toxicity, pain, fatigue, and constipation (p < 0.05).

CONCLUSIONS

Radiotherapy may negatively affect body image and social appearance anxiety. Assessments of body image and social appearance anxiety regularly before, during, and after treatment are essential. Psychosocial support should be provided to patients to reduce body image and social appearance anxiety and increase their well-being. Patients with cancer especially those who have low income and education levels, advanced cancer stage and skin toxicity, and suffer from pain, fatigue, constipation, etc. should be supported by methods such as counseling and social support groups.

Moon-like Facies by Glucocorticoid Is Associated With the Development of Diabetes and Body Image Disturbance

Context

Moon-like facies (MLF) are a typical side effect of glucocorticoid (GC) therapy; however, its predisposing factors, relationship with GC-induced complications, and effects on body image are not well understood.

Objective

This study aimed to determine the predisposing factors for MLF during GC therapy; its association with GC-induced diabetes, hypertension, and dyslipidemia; and its effects on body image.

Methods

This prospective observational study spanned 24 weeks and targeted patients who received GC therapy at the University of Yamanashi Hospital from June 2020 to August 2022. The MLF was defined based on the following 3 factors: (1) an increase in facial measurement lengths, (2) subjective facial changes by patients' self-assessment using a visual analog scale; (3) objective and qualitative facial changes assessed by physicians. We examined the predisposing factors for MLF and the association of MLF with GC-induced diabetes, hypertension, dyslipidemia, and body image.

Results

The cumulative incidence rate of MLF at 24 weeks was 37.6%. Predisposing factors for MLF were an initial oral prednisolone dosage of ≥ 30 mg/day [odds ratio (OR) 63.91, 95% confidence interval (CI) 5.82-701.81] and female (OR 6.66, 95% CI 1.35-32.79). MLF showed a significant association with the onset of GC-induced diabetes (OR 6.58, 95% CI 1.25-34.74). MLF was also an independent factor contributing to body image disturbance (β = -18.94, P = .01).

Conclusion

MLF contributes to body image disturbance and is associated with the development of GC-induced diabetes; therefore, it is clinically important as a physical manifestation of GC therapy.

Cancer-Related Fatigue and Its Influencing Factors Among Colorectal Cancer Patients: A Generalized Linear Modeling Approach

Purpose

This study aimed to improve cancer-related fatigue (CRF) and health outcomes of colorectal cancer patients by understanding the status quo of CRF, exploring the relations of coping, anxiety symptoms, depressive symptoms, body image perception and CRF, and also identifying the factors affecting CRF based on a generalized linear modeling approach.

Patients and Methods

An exploratory cross-sectional study was conducted on 370 colorectal cancer patients at two hospitals in Anhui Province, China, from July 2020 to February 2021. The data were collected by using general information questionnaire, cancer fatigue scale, simplified coping style questionnaire, generalized anxiety disorder-7 scale, patient health questionnaire-9, and body image scale. Descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analyses, and generalized linear model analyses were applied to analyze the data.

Results

The average CRF score of the patients was 21.612 (SD=6.160), with a prevalence rate of 69.4% for clinically relevant fatigue. The generalized linear model revealed that: In step 1, gender (female) (B=1.799, Waldχ2=7.506, p=0.006), per capita monthly income (1001-3000 RMB) (B=-1.673, Waldχ2=5.536, p=0.019) and treatment modalities (chemotherapy+others) (B=2.425, Waldχ2=8.211, p=0.004) were related to CRF. In step 2, depressive symptoms (B=1.223, Waldχ2=129.019, p<0.001) and negative coping strategies (B=0.215, Waldχ2=11.347, p=0.001) exhibited significant positive correlations with CRF, positive coping strategies (B=-0.319, Waldχ2=59.175, p<0.001) showed significant negative correlations with CRF; While anxiety symptoms (B=0.162, Waldχ2=1.840, p=0.175) and body image perception (B=0.013, Waldχ2=0.048, p=0.826) had no correlations with CRF.

Conclusion

The prevalence of CRF was relatively high among colorectal cancer patients. Coping and depressive symptoms were the modifiable influencing factors of CRF. Tailored interventions dedicated to promoting positive coping behavior, diminishing negative coping behavior and reducing depressive symptoms may improve the CRF of patients with colorectal cancer. Healthcare providers working with these patients should receive corresponding education and training in these complementary treatments. Additionally, when developing non-pharmacological interventions, appropriate consideration of the patients' gender, income condition and the type of anticancer treatment is also necessary.

Status and Influencing Factors of Body Image Disturbance in Patients With Hemifacial Spasm: A Quantitative and Qualitative Study

OBJECTIVE

Patients diagnosed with hemifacial spasm (HFS) often experience significant facial changes that affect their body image and potentially have a negative impact on their physical and psychological well-being. This study therefore seeks to identify the current state of body image of Chinese patients with HFS, analyze the factors that influence it, and further explore their experiences based on their level of body image disturbance (BID) using a mixed methods approach.

METHODS

A mixed-methods study was conducted between January 2021 and June 2023. Phase I encompassed the completion of questionnaires by 124 participants. Subsequently, in Phase II, in-depth interviews were conducted with 15 individuals selected from Phase I to gain deeper insights into their specific experiences with BID.

RESULTS

Patients afflicted with HFS achieved Body Image Scale scores 9.00 (0.00, 12.00). Age, anxiety, depression, and fear of negative evaluation were identified as predictors of exacerbated BID (P < 0.05). Qualitative research predominantly centered on 2 primary themes: the experiences and outward manifestations of BID in HFS patients. These individuals expressed dissatisfaction with their appearance, apprehensions about being the focus of attention, and instances of social avoidance.

CONCLUSIONS

Owing to varying degrees of anxiety, depression, and apprehension about external evaluation, individuals grappling with HFS are susceptible to experiencing BID. Consequently, when devising interventions, it is imperative to conduct a comprehensive assessment of the patient's condition and implement targeted measures aimed at ameliorating body image, ultimately enhancing the overall quality of life for the patient.

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 ( B uilding a R enewed I ma G e after H ead & neck cancer T reatment) 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-months 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. 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. Trial Registration: ClinicalTrials.gov identifier: NCT03831100.

The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer-A Qualitative Study

BACKGROUND AND AIM

The objective was to decrease patient menopausal symptoms, sleep disturbance, and body image using a nonpharmacological therapy for cultivating key healthy lifestyle habits in patients with breast cancer.

MATERIALS AND METHODS

The participants were 26 women with breast cancer who had recently received structured mindfulness-based stress reduction (MBSR) training in a clinical trial. Focus groups and interviews were conducted, during which the participants were asked semistructured, open-ended questions regarding the experiences of MBSR.

RESULTS

The participants indicated that MBSR helped them to alleviate hot flashes and night sweats, and improve sleep quality and be more at ease with the external aspect of their body. On the other hand, during MBSR intervention in a group manner, the participants felt more psychological support and an outlet for sharing negative emotional experiences.

CONCLUSION

This study identified the short-term benefits associated with group-based MBSR for women with breast cancer. In addition, our research identified the difficulties of intervention measures and coping methods. The study described the benefits of MBSR for patients with breast cancer. The findings of this study will help nursing staff identify the main coping menopausal symptoms and control negative mental health.