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

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.

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

Otolaryngology ◽

10.1177/0194599819835534 ◽

2019 ◽

Vol 161 (1) ◽

pp. 105-110 ◽

Cited By ~ 3

Author(s):

Evan M. Graboyes ◽

Elizabeth G. Hill ◽

Courtney H. Marsh ◽

Stacey Maurer ◽

Terry A. Day ◽

...

Keyword(s):

Risk Factors ◽

Body Image ◽

Head And Neck Cancer ◽

Pilot Study ◽

Head And Neck ◽

Neck Cancer ◽

Prospective Cohort ◽

The Body ◽

Body Image Disturbance ◽

Patient Reported

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.

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Faculty Opinions recommendation of Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.740517857.793587958 ◽

2021 ◽

Author(s):

Giulio Cantu

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Psychosocial Outcomes ◽

Microvascular Reconstruction ◽

Patient Reported

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A Systematic Review of Patient-Reported Outcome Measures Assessing Body Image Disturbance in Patients with Head and Neck Cancer

Otolaryngology ◽

10.1177/0194599819829018 ◽

2019 ◽

Vol 160 (6) ◽

pp. 941-954 ◽

Cited By ~ 12

Author(s):

Mark A. Ellis ◽

Katherine R. Sterba ◽

Emily A. Brennan ◽

Stacey Maurer ◽

Elizabeth G. Hill ◽

...

Keyword(s):

Systematic Review ◽

Body Image ◽

Head And Neck Cancer ◽

Head And Neck ◽

Treatment Strategies ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Body Image Disturbance ◽

Patient Reported ◽

Over Time

Objective To synthesize published literature describing the severity of body image disturbance (BID) in patients with head and neck cancer (HNC) over time, its psychosocial and functional associations, and treatment strategies as assessed by patient-reported outcome measures (PROMs). Data Source PubMed/MEDLINE, Scopus, PsycINFO, Web of Science, and Google Scholar. Review Methods A systematic review of the English-language literature was performed to identify studies of BID in patients with HNC using psychometrically validated PROMs to assess (1) severity of BID over time, (2) psychosocial and functional associations, and (3) management strategies. Results A total of 17 studies met inclusion criteria. BID was assessed via 10 different PROMs, none of which were HNC-specific measures of BID. Two of 2 longitudinal studies (100%) reported that BID improved from pretreatment to posttreatment, and 2 of 3 longitudinal studies (67%) showed that the severity of BID decreased over time as survivors got further out from treatment. Seven of 17 studies (41%) described negative functional and psychosocial associations with BID, although study methodology limited conclusions about cause and effect. None of the studies assessing interventions to manage BID (0/2, 0%) demonstrated an improvement in BID relative to control. Conclusion BID in patients with HNC has negative functional and psychosocial associations and lacks evidence-based treatment. Research is limited by the lack of an HNC-specific BID PROM. Further research should address knowledge gaps related to the lack of an HNC-specific BID PROM, longitudinal course of BID in patients with HNC, confusion with regards to risk factors and outcomes, and lack of prevention and treatment strategies.

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An Investigation into Body Image Concerns in Head and Neck Cancer Patients Receiving Radiation or Chemoradiation Using the Body Image Scale (BIS): A Pilot Study

Journal of Medical Imaging and Radiation Sciences ◽

10.1016/j.jmir.2015.12.043 ◽

2016 ◽

Vol 47 (1) ◽

pp. S14

Author(s):

Leah Branch ◽

Carina Feuz ◽

Maurene McQuestion

Keyword(s):

Body Image ◽

Head And Neck Cancer ◽

Pilot Study ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

The Body ◽

Body Image Scale ◽

Body Image Concerns

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Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Patient-Centered Approach

Otolaryngology ◽

10.1177/0194599819837621 ◽

2019 ◽

Vol 161 (2) ◽

pp. 278-287 ◽

Cited By ~ 5

Author(s):

Mark A. Ellis ◽

Katherine R. Sterba ◽

Terry A. Day ◽

Courtney H. Marsh ◽

Stacy Maurer ◽

...

Keyword(s):

Body Image ◽

Head And Neck Cancer ◽

Head And Neck ◽

Conceptual Model ◽

Neck Cancer ◽

Body Image Disturbance ◽

Social Avoidance ◽

Functional Impairments ◽

Patient Centered ◽

Key Informant

ObjectiveTo promote patient-centered oncology care through an in-depth analysis of the patient experience of body image disturbance (BID) following surgery for head and neck cancer (HNC).Study DesignQualitative methods approach using semistructured key informant interviews.SettingAcademic medical center.Subjects and MethodsParticipants with surgically treated HNC underwent semistructured key informant interviews and completed a sociodemographic survey. Recorded interviews were transcribed, coded, and analyzed using template analysis to inform creation of a conceptual model.ResultsTwenty-two participants with surgically treated HNC were included, of whom 16 had advanced stage disease and 15 underwent free tissue transfer. Five key themes emerged characterizing the participants’ lived experiences with BID following HNC treatment: personal dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance. The participant’s perceived BID severity was modified by preoperative patient expectations, social support, and positive rational acceptance. These 5 key themes and 3 experiential modifiers form the basis of a novel, patient-centered conceptual model for understanding BID in HNC survivors.ConclusionA patient-centered approach to HNC care reveals that dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance are key conceptual domains characterizing HNC-related BID. Recognition of these psychosocial dimensions of BID in HNC patients can inform development of HNC-specific BID patient-reported outcome measures to facilitate quantitative assessment of BID as well as the development of novel preventative and therapeutic strategies for those at risk for, or suffering from, BID.

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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

Frontiers in Psychology ◽

10.3389/fpsyg.2021.794038 ◽

2021 ◽

Vol 12 ◽

Author(s):

David Macias ◽

Brittany N. Hand ◽

Patrik Pipkorn ◽

Amy M. Williams ◽

Steven S. Chang ◽

...

Keyword(s):

Body Image ◽

Head And Neck Cancer ◽

Head And Neck ◽

Scale Score ◽

Neck Cancer ◽

Outcome Measure ◽

Cutoff Score ◽

Score Difference ◽

Body Image Scale ◽

Patient Reported

Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID.Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff.Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID.Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.

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