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

Abstract

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.

Body image concerns in long-term head and neck cancer survivors: prevalence and role of clinical factors and patient-reported late effects

“…Being on disability was significantly associated with BI concerns in bivariate analysis but not in the multivariable analysis. While bivariate findings are not the same as multivariable findings, this is worth mentioning, since disability has been associated with more severe BID in previous research [35]. HNC survivors on disability may experience more comorbidities, as well as a higher symptom burden, which in turn may influence their body image.…”

“…The cross-sectional design limits our understanding of the directionality of the relationships between patient-reported late effects and body image concerns. Some researchers have also argued that BIS may not be the ideal measure to assess body image in HNC survivors, since it was designed for patients with breast cancer [23,35]. However, since the scale has been used successfully with various cancer groups over the years, it is reasonable to suggest that it does identify relevant issues for a cancer population overall.…”

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

“…The development and validation of each of these HNC-specific PROMs represents significant progress. However, the clinical application of these PROMs to distinguish between HNC patients with and without clinically relevant BID remains uncertain (Macias et al, 2021).…”

“…To our knowledge, this is the first study to estimate the prevalence of HNC-related BID utilizing a tool created for and validated in patients with HNC. Future research should utilize the IMAGE-HN and its cutoff score to refine our understanding of the trajectory of HNC-related BID throughout HNC survivorship and better characterize the prevalence of HNC-related BID in relation to demographic, oncologic, and treatment characteristics (Graboyes et al, 2019;Macias et al, 2021).…”

Body image distress among cancer patients: needs for psychosocial intervention development

“…It has been described as a subjective perception of one’s insight regarding own body, based on self-interpretation and reactions to the judgment of others, with associated features such as identification, imitation, social factors, and emotional expression [ 8 ]. A visible disfigurement and functional impairment in the typical appearance of the body leads to a substantial negative impact on one’s psychological health, referred to as body image distress [ 9 ]. Additionally, body image distress denotes perceived physical anomaly such as obsessively examining oneself in the mirror, grooming to hide or fix the perceived flaw, and seeking reassurance from others about their appearance without satisfaction [ 10 ].…”