Body Image Issues in Patients With Colorectal Cancer

Abstract

BackgroundStomas in colorectal cancer (CRC) survivors lead to body image problems. Advances in treatment help reduce the rate of stoma formation, but body image distress is still frequently experienced in CRC survivors.ObjectivesThis review is aimed toward mapping and describing the state of knowledge regarding body image in patients with CRC.MethodsA systematic literature search complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Screening and data extraction were performed by 2 reviewers independently for all potentially eligible studies.ResultsA total of 56 eligible articles were selected. The majority of these studies were quantitative studies (85%). The eligible studies were classified into 4 broad categories: instruments used to assess body image, prevalence of body image distress, factors related to body image, and impact of body image distress. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-CR38) colorectal questionnaire was the most common measurement tool found among the reviewed studies (70%), and body image distress was reported by 25.5% to 86% of participants. Excluding gender, age, type of surgery, adjuvant therapy, time from diagnosis, social support, and stoma status, changes in bowel habits was identified as affecting the body image of patients with CRC.ConclusionChanging bowel habits emerged as a significant factor causing body image distress for CRC survivors.Implications for PracticeClinicians should raise awareness about body image distress in patients with CRC, focus on finding effective measures and interventions intended to help alleviate symptoms of bowel dysfunction, and prepare patients to adapt to altered bowel functions.

Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review

“…Importantly, literature reviews mentioning the impact of gender on CRC patients’ psychological outcomes similarly stated that female patients experienced more anxiety, depression, psychological distress [ 4 ], and body image distress [ 6 , 9 ], which is in accordance with a systematic review focusing on gender differences in cancer patients’ experiences [ 17 ]. The systematic review also analyzed gender differences in coping, but no consistent conclusion was made due to conceptual differences, varied measurement tools, and limited studies [ 17 ].…”

“…The deep-rooted reasons could stem from socially constructed traditional gender roles; that is, females are characterized as being expressive [ 59 ], and males are expected to be stoical [ 60 ]. With regard to body image distress, its prevalence had a higher tendency in recent years, ranging from 25.2% to 80.1% [ 9 ]. This review shows that female gender was highly proved as a risk factor for body image distress, perhaps because females attach more importance to their appearance and consider it as their emotional strength [ 61 ].…”

“…In addition, body image distress is another most common CRC-related psychological symptom [ 6 ], which primarily stems from surgical scars, weight loss, and stoma bags [ 7 ]. Specifically, patients with a stoma were found to perceive worse and persistent body image distress than those without a stoma [ 9 ].…”

“…CRC also negatively influences patients’ social functioning (e.g., relationships with others). Common physical symptoms, like bowel dysfunction, stoma-related problems (e.g., leaks, blockages, and gas), and altered appearance, were found to evoke shame in CRC patients and concerns about contact with others, which made them unconfident to take part in social activities and feel further isolated from the social environment [ 7 , 9 ]. In addition, preoperative radiotherapy, complications during or after surgery, and a stoma were proven to be accurate predictors of increased sexual dysfunction [ 10 ].…”

“…They found that the issues of depression and body image were only discussed by female patients, while male patients disclosed little or no difficulties in adapting to cancer. According to these studies [ 4 , 6 , 9 , 17 , 18 ], female patients seemed to be a subgroup more vulnerable to CRC. However, to make more rigorous conclusions, it is necessary to systematically review the studies emerging in recent years that involved gender-related analyses about CRC patients’ psychosocial outcomes and/or coping strategies.…”