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

Abstract

ObjectiveHead and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse.MethodsTwo hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.ResultsSixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.ConclusionThis longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.

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

“…Radical surgery was found in previous studies to change one’s appearance and have an impact on body image concerns [ 13 ]. Physical functioning as a determinant is also in accordance with past research, which found impairments in speech and eating as predictors of body image concerns [ 6 , 31 , 32 ]. Having a positive body image often means placing less value on physical appearance and more on physical ability and functionality [ 6 , 20 , 33 ].…”

“…Physical functioning as a determinant is also in accordance with past research, which found impairments in speech and eating as predictors of body image concerns [ 6 , 31 , 32 ]. Having a positive body image often means placing less value on physical appearance and more on physical ability and functionality [ 6 , 20 , 33 ]. Patients who are less physically able because of pain or other symptoms can experience an altered perception of their bodies [ 6 , 20 , 33 ].…”

“…Having a positive body image often means placing less value on physical appearance and more on physical ability and functionality [ 6 , 20 , 33 ]. Patients who are less physically able because of pain or other symptoms can experience an altered perception of their bodies [ 6 , 20 , 33 ]. Functional impairment can cause an individual to feel uncomfortable and self-conscious due to their physical limitations and a feeling that something is wrong with their body [ 6 , 20 , 33 ].…”

“…Body image concerns in adults with cancer have distinct characteristics that differ from individuals with eating disorders, leading to different treatments [ 4 , 5 ]. The main characteristics of body image concerns in adults treated for cancer are: (1) perceiving a change in appearance and feeling displeasure with the perceived change, (2) experiencing a decline in functional abilities, and (3) experiencing psychological distress about the perceived changes in appearance and/or function [ 6 ].…”

“…Patients and survivors of head and neck cancer (HNC) are also highly susceptible to body image concerns due to the visible physical and functional disturbances these types of cancer often cause [ 1 , 2 ]. Previous research suggests that 89% of patients with HNC present with some level of body image concerns immediately post-treatment (3 months), with 20% mild to moderate and 9% moderate to severe levels, respectively [ 6 ]. HNC are malignant tumours arising in the lining surfaces of the oral cavity, salivary glands, pharynx, larynx, sinuses, and nasal cavity, which are often diagnosed in advanced stages and require invasive treatments that lead to altered facial appearance, pain, and the changes on basic functional abilities, such as swallowing, speaking, and breathing [ 1 , 2 ].…”