Oral Papers: Palliative Care & Oncology II
Objective: Head and Neck (HN) cancers may negatively affect body image due to the high visibility of tumor-induced physical changes and are associated with psychological distress, especially depression 1. Gastrointestinal (GI) cancer can affect body image through bladder/bowel dysfunction. Additionally, cancer treatment may cause dysfunction, which may be difficult to cope with. Indeed, radical surgery is a predictor for body image concerns 2. In the current study, we assessed body image severity and its association with depression and anxiety in HN & GI cancer patients before and after surgery.
Methods: A retrospective chart review was conducted of 187 patients with a new diagnosis of HN or GI cancer who were evaluated in the ambulatory psychiatric oncology clinic between 11/1/2017-2/2/2019. Patient status at the time of evaluation was identified as either pre/no surgery or post-surgery (pre/no surgery n=80, post-surgery n=94). The Body Image Scale (BIS) was used to assess body image concerns. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety, respectively. Data reflect mean ± S.D.
Results: Body image concerns were significantly higher in the post-surgery group (pre surgery: 6.62 +/- 6.65, post-surgery: 9.96 +/- 7.52, p = 0.002). No differences between HN and GI patients were observed (HN: 8.23 +/-6.68; GI: 8.20 +/- 7.76, p=0.980). In contrast, while depression and anxiety scores did not differ between patients pre or post-surgery; GI patients reported higher overall depression and anxiety scores than HN patients (GI: PHQ-9=11.47 +/- 6.10, GAD-7=9.87 +/-5.80, p=0.008) and (HNC: PHQ-9= 9.11 +/- 5.40, GAD- 7=7.88 +/- 5.85, p=0.024).
Body image concerns were positively correlated to depression in pre-surgery patients (HN: r=0.53, p =0.01; GI: r =0.67, p =0.01) and in post-surgery patients (HN: r=0.40, p=0.01; GI: r=0.35, p=0.02). Pre surgery body image concerns were further significantly related to anxiety in GI patients but not in HN patients (HN: r=0.27, p=0.07; GI: r=0.52, p=0.001). Post-surgery body image concerns were not associated with anxiety (HN: r=0.19, p=0.20; GI: r=0.27, p= 0.05).
Conclusion: Significantly, higher body image concerns in post-surgery patients in both types of cancer were detected. In addition, the association between depression and body image was observed in pre and post-surgical patients. While post-surgical patients are more likely to experience body image concerns, evaluation of depression when body image concerns are present is important at all stages in the cancer treatment trajectory.