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

Abstract

Objectives To characterize the temporal trajectory of body image disturbance (BID) in patients with surgically treated head and neck cancer (HNC). Study Design Prospective cohort study. Setting Academic medical center. Subjects and Methods: Patients with HNC who were undergoing surgery completed the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, pretreatment and 1, 3, 6, 9, and 12 months posttreatment. Changes in BIS scores (ΔBIS) relative to pretreatment (primary endpoint) were analyzed with a linear mixed model. Associations between demographics, clinical characteristics, psychosocial attributes, and persistently elevated BIS scores and increases in BIS scores ≥5 points relative to pretreatment (secondary endpoints) were analyzed through logistic regression. Results Of the 68 patients, most were male (n = 43), had oral cavity cancer (n = 37), and underwent microvascular reconstruction (n = 45). Relative to baseline, mean ΔBIS scores were elevated at 1 month postoperatively (2.9; 95% CI, 1.3-4.4) and 3 (3.2; 95% CI, 1.5-4.9) and 6 (1.8; 95% CI, 0.02-3.6) months posttreatment before returning to baseline at 9 months posttreatment (0.9; 95% CI, –0.8 to 2.5). Forty-three percent of patients (19 of 44) had persistently elevated BIS scores at 9 months posttreatment relative to baseline, and 51% (31 of 61) experienced an increase in BIS scores ≥5 relative to baseline. Conclusions In this cohort of patients surgically treated for HNC, BID worsens posttreatment before returning to pretreatment (baseline) levels at 9 months posttreatment. However, 4 in 10 patients will experience a protracted course with persistent posttreatment body image concerns, and half will experience a significant increase in BIS scores relative to pretreatment levels.

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

“…We similarly found that each individual ARPD question was predictive of impaired SF, demonstrating that aesthetic‐related distress is associated with social functioning. Up to 40% of HNC patients who undergo surgery may experience a protracted course of BID, lasting beyond 9 months postoperatively 15 . In this study, patients who were more than 1 year from reconstruction did not demonstrate any significant improvements in ARPD or SF scores.…”

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

“…Our preliminary data, with high response rates and a large effect size suggest that psychosocial interventions (eg, CBT) to treat BID in HNC patients merit further study. A recent prospective cohort study aiming to characterize the natural history of BID demonstrated that HNC survivors with body image concerns (ie, a historical control for BRIGHT) show no improvement in BID (as measured by BIS scores) in the first 12‐months posttreatment 9 . The large effect size of BRIGHT on BID observed in this study thus appears to be substantial and differs from the temporal trajectory of untreated BID in the target population.…”

“…These changes occur in highly visible, socially significant parts of the body that are integral to self‐conception, communication, and interpersonal relationships 4‐6 . Based on single‐institution cross sectional and cohort studies of HNC patients, up to 75% express body image concerns when assessed using screening questionnaires or upon structured clinical interview 7‐9 . When severe, these image concerns can result in high rates of body image disturbance (BID), a disorder characterized by a displeasing self‐perceived change in appearance and/or function 4,10,11 .…”

“…[4][5][6] Based on single-institution cross sectional and cohort studies of HNC patients, up to 75% express body image concerns when assessed using screening questionnaires or upon structured clinical interview. [7][8][9] When severe, these image concerns can result in high rates of body image disturbance (BID), a disorder characterized by a displeasing self-perceived change in appearance and/or function. 4,10,11 BID results in devastating psychosocial morbidity and is an important contributor to social isolation, 12 stigmatization, 4 depression, 5,13 decreased intimacy, 14 and worse quality of life (QOL) 4,6 among HNC survivors.…”

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

“…With increased psychological distress, HNC patients have a four-time increased risk of death from suicide over the general population and two-time increased risk over non-HNC patients [ 155 , 156 ]. Patients who have undergone major reconstruction are susceptible to body image disorder, manifesting in dissatisfaction in appearance, lowered self-esteem, and tendency toward social isolation [ 148 , 157 , 158 ]. Active research in survivorship care aims to address these psychosocial effects.…”