Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Prospective Cohort Pilot Study

Abstract

This prospective cohort pilot study sought to characterize the short-term temporal trajectory of, and risk factors for, body image disturbance (BID) in patients with head and neck cancer (HNC). Most patients were male (35/56), had oral cavity cancer (33/56), and underwent microvascular reconstruction (37/56). Using the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, the prevalence of BID (BIS ≥10) increased from 11% preoperatively to 25% at 1 month postoperatively and 27% at 3 months posttreatment ( P < .001 and P = .0014 relative to baseline, respectively). Risk factors for BID included female sex (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.3-19.8), pT 3 to 4 tumors (OR, 8.9; 95% CI, 2.0-63.7), and more severe baseline shame and stigma (OR, 1.06; 95% CI, 1.01-1.13), depression (OR, 1.25; 95% CI, 1.06-1.51), and social isolation (OR, 1.21; 95% CI, 1.01-1.49). The prevalence and severity of BID increase immediately posttreatment. Demographic, oncologic, and psychosocial characteristics identify high-risk patients for targeted interventions.

Temporal Trajectory of Body Image Disturbance in Patients with Surgically Treated Head and Neck Cancer

“…To our knowledge, this is the first prospective cohort study following surgically treated HNC survivors for 1 year posttreatment to assess the temporal trajectory of BID with a validated PROM of BID. As such, this study represents a methodological improvement over prior research that was cross-sectional in nature, 11,[13][14][15][16][17] included only short-term follow-up, 3,18 or used nonvalidated measures of BID. 19 Herein, we (1) demonstrate that the severity of BID worsens posttreatment relative to pretreatment (baseline) levels until 9 months posttreatment; (2) describe that >40% of patients fail to return to their pretreatment level at 9 months posttreatment; (3) highlight a large subset of HNC survivors who fail to recover to pretreatment body image levels and experience a more protracted course of posttreatment BID; and (4) show that >50% of HNC survivors experience clinically significant posttreatment worsening in body image concerns.…”

“…[9][10][11] There are significant gaps in our knowledge of the epidemiology of BID in HNC survivors, even though it is a key component of survivorship care. 12 Specifically, because most studies have been cross-sectional in nature, 11,[13][14][15][16][17] included only short-term follow-up, 3,18 or used nonvalidated measures of BID, 19 there is a lack of data about the temporal trajectory of, and risk factors for, BID in surgically treated HNC survivors. 1,2 It is critical to more fully characterize the longitudinal course of BID in HNC survivors to enhance preoperative counseling and facilitate the delivery of optimally timed preventative and therapeutic interventions targeted to high-risk patients.…”

Evaluation of a novel telemedicine‐based intervention to manage body image disturbance in head and neck cancer survivors

“…We used an intervention mapping approach to optimize BRIGHT delivery 17 . A needs assessment was conducted within our prospective cohort study of BID in HNC survivors to inform the timing (immediately post‐HNC treatment), setting (one‐on‐one psychotherapy), and delivery method (telemedicine or face‐to‐face) of BRIGHT 18 . We assessed the feasibility of delivering BRIGHT via patient‐owned technology.…”

“…17 A needs assessment was conducted within our prospective cohort study of BID in HNC survivors to inform the timing (immediately post-HNC treatment), setting (one-on-one psychotherapy), and delivery method (telemedicine or face-to-face) of BRIGHT. 18 We assessed the feasibility of delivering BRIGHT via patient-owned technology. Although a majority of our population owned a video-enabled device (smart phone = 83%, tablet = 36%, computer = 64%, none = 6%) and had home internet access (88%), we elected to provide each participant with the same video platform (tablet) and internet connection (cellular-enabled Wi-Fi) to standardize our approach.…”

Autoconceito e função do papel em pacientes com câncer de cabeça/pescoço

“…(10) Corroborando, em outra pesquisa, os entrevistados demonstraram vergonha com relação à imagem, após o aparecimento da doença, já que possuíam alterações físicas aparentes. (20) Diante disto, compreende-se que uma imagem corporal sem alterações físicas é sinônimo de equilíbrio e bem-estar, a qual está relacionada com o sentimento de felicidade e equilíbrio emocional. (21) Houve sentimento de desespero com relação à aparência.…”