Body Image
Overview
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Body image is the internal mindset a woman has about her physical appearance
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Radiation, chemotherapy, and surgical intervention (lumpectomy/mastectomy) cause physical changes to a woman’s appearance. Additional impacts from treatment include vaginal dryness, decreased elasticity, hair loss, and mood changes
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As expected, negative body image is correlated with greater psychological distress, while women with a positive body image experience less psychological distress
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Younger women, following cancer treatment, report more challenges with body image than older women. This impacts quality of life and extends to concerns regarding fertility
Professional Insights
Dr. Lydia Shapira - Medical Oncologist, Stanford University Professor of Medicine (Oncology)
Overview
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Progress has been made in the area of support services for women with breast cancer, particularly in counseling and family-building intervention. However, mental health support following cancer treatment requires significant progress
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Cancer treatment often results in role loss, disrupting family dynamics and requiring support to manage life's changes
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Interdisciplinary communication is essential to support the needs of an individual
Clinical Interactions
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Use general, open-ended questions like "How has your cancer diagnosis affected the way you feel about your body?" to gauge how a topic has impacted an individual
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Utilize therapeutic listening techniques and engage with empathetic and non-judgmental questions
Click below to learn more from Dr. Shapira:
Dr. Michelle Fingeret, Clinical Psychologist Ph.D. - Fingeret Psychology Services
Overview
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It's normal to be concerned about changes in appearance or physical functioning as a result of breast cancer treatment
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Understand the individual from their subjective experience - how does cancer impact their meaningful life experiences?
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Enhancing a woman’s visual appearance through makeup, hair, and clothes can positively impact body image
Clinical Interactions
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Being told “you look great,” can dissuade someone from expressing body image concerns
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Initiate conversations surrounding body image, rather than waiting for the affected individual to start the discussion
Click below to learn more from Dr. Fingeret:
Dr. Matthew Cordova, Clinical Psychologist Ph.D. - Palo Alto University
Overview
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Body image challenges depend on age and the kind of treatment-experienced
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Societally, women’s bodies are objectified and there is a large focus on beauty standards which impacts body image
Clinical Interactions
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Some women face the challenging choice of whether to undergo a mastectomy. They consider whether the mastectomy will improve their chance of survival and whether to undergo reconstruction
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Hair may grow back differently after chemotherapy, making it challenging to uphold traditional beauty standards
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Inform patients that body changes are a common experience during treatment to decrease stigma during prehabilitation
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Don’t make assumptions about what women want post-treatment (reconstruction may not be important to their body image)
Click below to learn more from Dr. Cordova
Abby Keller, RN, Certified Life and Health Coach
Overview
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Nutrition
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Maintenance of a healthy weight is essential during the cancer recovery journey (BMI should not be used as an indicator of healthy weight)
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Understanding an individual’s previous relationship with food and prior body image challenges are essential, as this dynamic continues following cancer treatment
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Food is a social experience - treatment that cause loss of appetite, food aversion, or nausea create an additional layer of grief
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Conflicting theories exist on proper nutrition post cancer treatment - this creates pressure in determining which foods to consume
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Clinical Interactions
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A deep guilt exists around a cancer diagnosis. Many individuals believe a healthier lifestyle may have prevented the cancer
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Women in traditional households express guilt for not being able to assume the same roles as before. It is challenging to prioritize themself and delegate other responsibilities.
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Following a cancer treatment, women need to establish trust with their bodies again. The fear of one’s body betraying them is a common experience among cancer survivors
Click below to learn more from Abby Keller:
Tiffany Bystra - MS, OTR/L
Overview
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There are society and public perceptions of what beauty is that women face after breast cancer. Clinicians can help a woman navigate and appreciate what her body can do or did versus what it cannot
Clinical Interactions
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OTPs are in a position to ask intimate questions to a patients daily routine on a deeper level. OTPs have an understanding of cognitive distortions, cognitive behavioral and psychodynamic and relational connections that make them suited for this role
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OTPs cam provide resources to specialized support such as mental health practitioners, psychologists, and licensed professional counselors
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There is the opportunity to introduce the concept of different orthoses to women ( Ex: lambs wool puffs that mimic the presence of a breast)
Click below to learn more from Tiffany Bystra:
Athena Manzino, PT, DPT, CLT
Overview
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Women face challenges reconnecting with their previous roles and responsibilities held pre diagnoses and surgical operation
Clinical Interactions
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Lymphedema is non-reversible meaning lifetime care with a compression garment – wearing a compression sleeve or garment openly can impact individual’s body image
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Breast swelling (and the size difference between breasts) are frequent challenges women
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Some women who with no lymphedema may be challenged from scars from lumpectomies or mastectomies. Even a small scar may impact women
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psychosocially because the breast is a very important part of their very important part of their body. It's, you know, their femininity and sexuality.
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Reconnecting with the body: As nerves regenerate, hypersensitivity occurs. It may be beneficial to lightly introduce physical touch and slowly add pressure to desensitize the area. Physical touch will allow the individual to become more comfortable and reconnect with their body.
Click here to learn more from Athena Manzino
OT Insights
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Support the grief process: - experiencing grief is a way to manage fear
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Use general, open-ended questions : "How has your cancer diagnosis impacted the way you feel about your body?"
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Avoid invalidating feelings with phrases such as “you look great”
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Clinicians should involve themselves in prehabilitation process and inform patients that physical changes are a common experience during treatment to decrease stigma
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Utilize therapeutic listening techniques and engage with empathetic and non-judgmental questions
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Include family in sessions, if they support the environment and are invited by the affected individual (individual is main priority)
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Assumptions should not be. made about what women want post-treatment (reconstruction may not be important to body image)
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Body image and nutrition are interrelated. Clinicians should understand an individual's previous relationship to food and explore their history of negative body image to address challenges following cancer treatment
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OTPs have the opportunity to introduce ortheses and other tools to help mitigate the physical change from breast cancer treatments
References:
Paterson, C. L., Lengacher, C. A., Donovan, K. A., Kip, K. E., & Tofthagen, C. S. (2016). Body image in younger breast cancer survivors. Cancer Nursing, 39(1). https://doi.org/10.1097/ncc.0000000000000251
Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis‐Bilinski, K. (2012). My changed body: Breast cancer, body image, distress and self‐compassion. Psycho-Oncology, 22(8), 1872–1879. https://doi.org/10.1002/pon.3230