Association of Inventory to Measure and Assess imaGe Disturbance – Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors

Abstract

Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID.Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff.Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID.Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.

Efficacy of a Brief Tele–Cognitive Behavioral Treatment vs Attention Control for Head and Neck Cancer Survivors With Body Image Distress

“…Emerging data since this trial was designed have determined that an IMAGE-HN score of 22 or higher indicates clinically relevant HNC-related BID and confirmed that IMAGE-HN is a more sensitive and accurate measure of BID among HNC survivors than the Body Image Scale. 3…”

“…1 Because these changes are highly visible and affect daily social function, 75% of HNC survivors express body image concerns, 2 and up to 28% have clinically significant body image distress (BID). 3,4 Body image distress is a source of devastating psychosocial morbidity and functional impairment for HNC survivors, contributing to a 6-fold increase in moderate-severe depressive symptoms, an 8-fold increase in moderate-severe anxiety symptoms, as well as social isolation and feelings of stigmatization. 3,[5][6][7][8][9][10] Although clinically significant HNC-related BID does not improve over time without treatment, 11 evidence-based management strategies to manage BID in this population are lacking.…”

“…3,4 Body image distress is a source of devastating psychosocial morbidity and functional impairment for HNC survivors, contributing to a 6-fold increase in moderate-severe depressive symptoms, an 8-fold increase in moderate-severe anxiety symptoms, as well as social isolation and feelings of stigmatization. 3,[5][6][7][8][9][10] Although clinically significant HNC-related BID does not improve over time without treatment, 11 evidence-based management strategies to manage BID in this population are lacking. 12 Trials evaluating interventions to conceal disfigurement 13,14 and improve self-compassion 15 have shown that they do not improve BID among HNC survivors.…”

Mental health considerations in patients undergoing complex head and neck reconstruction

“…The IMAGE-HN has been shown to be reliable and valid [47 ▪▪ ,49]. It represents a significance advance in the field, and an important tool for evaluating the psychosocial impact of head and neck cancer treatment [49].…”

“…Body image-related distress is a disorder characterized by a distressing self-perceived change in appearance and function [44,45]. It can lead to social isolation, stigmatization, depression, and self-harm [26,46] [49].…”