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INTRODUCTION

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Body image is a critical psychosocial issue for individuals with cancer as the disease and its treatment can result in significant changes in physical appearance and bodily functioning. Although adjustment to bodily changes can vary significantly depending on the patient, it is important to recognize that all patients with cancer regardless of tumor site, stage, or treatment modality undergo a process of body image adaptation. Similar to other medical patients, individuals with cancer can experience many possible cosmetic and functional changes, some of which are temporary, while others are more permanent. The degree to which these changes are accompanied by significant distress and difficulties with emotional, social, and occupational functioning is influenced by a host of personality, medical, and treatment-related factors. This chapter focuses on how to better identify, evaluate, and treat psychosocial difficulties stemming from body image concerns in the oncology setting. In order to fully appreciate the complex process of adjusting to bodily changes, considerable attention is being given to defining the construct of body image and discussing its theoretical underpinnings. Unique body image issues that arise in the oncology setting are also an important focus here. This chapter concludes with practical suggestions and advice for health care professionals on how to work more effectively with patients exhibiting body image concerns, and ways to alleviate and/or prevent more serious behavioral and psychosocial problems through early recognition and intervention.

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DEFINITION OF BODY IMAGE

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It has been argued that the lack of clear and consistent definition of body image in psychosocial oncology research is a significant barrier to conducting conceptually driven research and theoretically informed psychological assessments and treatment.1 Body image is a complex and multidimensional construct that encompasses a range of experiences, yet much existing research in the oncology setting relies on loosely constructed or simplistic definitions. Body image cannot be adequately captured with a single-item measure or by merely asking about patient satisfaction with cosmetic outcome.

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Body image is a multifaceted concept involving perceptions, thoughts, and feelings about the entire body and its functioning.2 When one conceptualizes body image in this comprehensive manner, it is clear that the range of bodily changes cancer patients may undergo prior to, during the process of, or following treatment are encompassed here. This includes but is not limited to scarring, swelling, skin discoloration, hair loss, tooth loss, sensory changes (eg, numbness, tingling, burning), functional alterations (eg, changes in speech, swallowing, articulation, hearing, eyesight, bowel/bladder incontinence), sexuality/fertility effects, weight gain, weight loss, loss of mobility, and use of prosthetic devices. While changes to physical appearance are an important component of body image, it is critical to emphasize that body image experiences extend well beyond perception of appearance.3

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A fundamental element of body image experiences is that they are subjective and, as such, do not reflect the objective reality of the body.3 This point is underscored by a wealth ...

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