Body image distress in head and neck cancer patients: what are we looking at?

Melissant, Heleen C.; Jansen, Femke; Eerenstein, Simone E. J.; Cuijpers, Pim; Laan, Ellen; Lissenberg‐Witte, Birgit I.; Schuit, Anouk S.; Sherman, Kerry A.; Leemans, C. René; Leeuw, Irma M. Verdonck‐de

doi:10.1007/s00520-020-05725-1

Cited by 47 publications

(71 citation statements)

References 46 publications

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“…Our results suggest that appearance‐related outcomes play a significant role in social dysfunction after free flap reconstruction. This is important as recent literature suggests 20% of all patients with HNC may experience significant body image distress/disturbance (BID) 13 . A qualitative interview study revealed that HNC patients experience BID across several domains, including concerns about outward appearance and social avoidance 14 .…”

Section: Discussionmentioning

confidence: 99%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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Objectives/Hypothesis To better understand aesthetic patient‐reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. Study Design Single‐center prospectively obtained in‐office validated questionnaire‐based study. Methods Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE‐Q scales: Appearance‐Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. Results One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2–30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4–24.4, P = .019) and 10.4% lower SF (95% CI: −20.7 to −0.1, P = .047). Each appearance‐related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. Conclusions Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. Level of Evidence 3 Laryngoscope, 131:E2204–E2211, 2021

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Section: Discussionmentioning

confidence: 99%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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“…In total, 521 HNC survivors were invited for a survey on the prevalence of body image-related distress [ 8 ], of whom 233 participated (45% response rate) (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Another explanation for the absence of change may be the difference in body image symptoms between breast cancer and HNC survivors. For HNC survivors, damaged essential body functions like speech and swallowing with a large impact on social life are central aspects of body image-related distress [ 8 ]. Breast cancer and its treatment does not impair essential body functions as profoundly, so disfigurement may be a more central aspect of body image.…”

Section: Discussionmentioning

confidence: 99%

“…This usage was defined as having at least answered the first prompt (a negative event related to a changed body) and one self-compassion prompt. Secondary outcomes were body appreciation, HRQOL, HNC symptoms that were significantly associated with body image-related distress in a previous study: “problems with social contact” and “problems with wound healing” [ 8 ], sexuality, self-compassion, and psychological distress. To assess changes between T0 and T2 in sexual activity and reported sexual problems, McNemar tests were performed.…”

Section: Methodsmentioning

confidence: 99%

“…A changed face can have profound personal and social consequences, affecting one’s identity and social life [ 2 , 7 ]. Sexual concerns may also be present, for example, because patients have a diminished feeling of sexual attractiveness [ 3 ] It is estimated that 13–20% of HNC patients develop body image-related distress because of their changed body [ 8 ]. Body image is defined as “thoughts, feelings and perceptions about the entire body and its functioning” [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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A structured expressive writing activity targeting body image-related distress among head and neck cancer survivors: who do we reach and what are the effects?

Melissant

Jansen

Eerenstein

et al. 2021

Support Care Cancer

Self Cite

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Purpose The aim of this pretest–posttest study was to investigate the reach and effects of My Changed Body (MyCB), an expressive writing activity based on self-compassion, among head and neck cancer (HNC) survivors. Methods This pilot study had a pretest–posttest design. HNC survivors received an invitation to complete a baseline survey on body image-related distress. At the end of the survey, HNC survivors were asked if they were interested in the intervention study. This entailed the writing activity and a survey 1 week and 1 month post-intervention. The reach was calculated by dividing the number of participants in the intervention study, by the number of (1) eligible HNC survivors and (2) those who filled in the baseline survey. Linear mixed models were used to analyze the effect on body image-related distress. Logistic regression analysis was used to investigate factors associated with the reach and reduced body image-related distress. MyCB was evaluated using study-specific questions. Results The reach of MyCB was 15–33% (depending on reference group) and was associated with lower education level, more social eating problems, and fewer wound healing problems. Among the 87 participants, 9 (10%) showed a clinically relevant improvement in body image-related distress. No significant effect on body image-related distress was found. Self-compassion improved significantly during follow-up until 1 month post-intervention (p=0.003). Users rated satisfaction with MyCB as 7.2/10. Conclusion MyCB does not significantly improve body image-related distress, but is likely to increase self-compassion, which sustains for at least 1 month.

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Factors Associated With Risk of Body Image–Related Distress in Patients With Head and Neck Cancer

Macias

Hand

Maurer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Body image-related distress (BID) is common among head and neck cancer (HNC) survivors and associated with significant morbidity. Risk factors for HNC-related BID remain poorly characterized because prior research has used outcome measures that fail to fully capture BID as experienced by HNC survivors.OBJECTIVE To assess the association of demographic and oncologic characteristics with HNC-related BID using the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN), a validated, multidomain, patient-reported outcome measure of HNC-related BID. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study assessed 301 adult survivors of surgically managed HNC at 4 academic medical centers. MAIN OUTCOMES AND MEASURESThe primary outcome measure was IMAGE-HN scores, for which higher scores reflect more severe HNC-related BID. Multivariable linear regression analyses were performed to evaluate the association of patient characteristics with IMAGE-HN global and 4 subdomain (other-oriented appearance concerns, personal dissatisfaction with appearance, distress with functional impairments, and social avoidance) scores. RESULTSOf the 301 participants (212 [70.4%] male; mean [SD] age, 65.3 [11.7] years), 181 (60.1%) underwent free flap reconstruction. Graduation from college (β = −9.6; 95% CI, −17.5 to −1.7) or graduate school (β = −12.6; 95% CI, −21.2 to −3.8) was associated with lower IMAGE-HN social avoidance scores compared with less than a high school education.

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Body image distress in head and neck cancer patients: what are we looking at?

Cited by 47 publications

References 46 publications

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

A structured expressive writing activity targeting body image-related distress among head and neck cancer survivors: who do we reach and what are the effects?

Factors Associated With Risk of Body Image–Related Distress in Patients With Head and Neck Cancer

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