[Skip to Navigation]
Views 602
Citations 0
Original Investigation
From the American Head and Neck Society
July 8, 2021

Factors Associated With Risk of Body Image–Related Distress in Patients With Head and Neck Cancer

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Medical University of South Carolina, Charleston
  • 2School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
  • 3Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
  • 4Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 5Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
  • 6Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 7College of Nursing, Medical University of South Carolina, Charleston
  • 8Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
  • 9Department of Public Health Sciences, Medical University of South Carolina, Charleston
  • 10Vanderbilt University School of Nursing, Nashville, Tennessee
JAMA Otolaryngol Head Neck Surg. Published online July 8, 2021. doi:10.1001/jamaoto.2021.1378
Key Points

Question  What are the factors associated with risk of body image–related distress (BID) among survivors of head and neck cancer (HNC)?

Findings  In this cross-sectional study of 301 adult HNC survivors, lower educational attainment, unemployment, complex reconstructive surgery, and higher number of treatment modalities were associated with more severe HNC-related BID as measured by a validated patient-reported outcome measure of HNC-related BID. However, these associations explained only a modest proportion of variance in scores on the Inventory to Measure and Assess imaGe disturbancE-Head & Neck.

Meaning  These findings suggest that although certain demographic and oncologic characteristics are associated with HNC-related BID, other risk factors appear to exist and should be explored in future studies.

Abstract

Importance  Body image–related distress (BID) is common among head and neck cancer (HNC) survivors and associated with significant morbidity. Risk factors for HNC-related BID remain poorly characterized because prior research has used outcome measures that fail to fully capture BID as experienced by HNC survivors.

Objective  To assess the association of demographic and oncologic characteristics with HNC-related BID using the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN), a validated, multidomain, patient-reported outcome measure of HNC-related BID.

Design, Setting, and Participants  This cross-sectional study assessed 301 adult survivors of surgically managed HNC at 4 academic medical centers.

Main Outcomes and Measures  The primary outcome measure was IMAGE-HN scores, for which higher scores reflect more severe HNC-related BID. Multivariable linear regression analyses were performed to evaluate the association of patient characteristics with IMAGE-HN global and 4 subdomain (other-oriented appearance concerns, personal dissatisfaction with appearance, distress with functional impairments, and social avoidance) scores.

Results  Of the 301 participants (212 [70.4%] male; mean [SD] age, 65.3 [11.7] years), 181 (60.1%) underwent free flap reconstruction. Graduation from college (β = −9.6; 95% CI, −17.5 to −1.7) or graduate school (β = −12.6; 95% CI, −21.2 to −3.8) was associated with lower IMAGE-HN social avoidance scores compared with less than a high school education. Compared with paid work, unemployment was associated with higher IMAGE-HN other-oriented appearance (β = 10.7; 95% CI, 2.0-19.3), personal dissatisfaction with appearance (β = 12.5; 95% CI, 1.2-23.7), and global (β = 8.0; 95% CI, 0.6-15.4) scores. Compared with no reconstruction, free flap reconstruction was associated with higher IMAGE-HN global scores (β = 11.5; 95% CI, 7.9-15.0) and all subdomain scores (other-oriented appearance: β = 13.1; 95% CI, 8.6-17.6; personal dissatisfaction with appearance: β = 15.4; 95% CI, 10.0-20.7; distress with functional impairment: β = 12.8; 95% CI, 8.1-17.4; and social avoidance and isolation: β = 10.2; 95% CI, 5.8-14.6). Higher IMAGE-HN distress with functional impairment scores were found in those who received surgery and adjuvant radiation (β = 7.8; 95% CI, 2.9-12.7) or chemoradiotherapy (β = 6.5; 95% CI, 1.8-11.3) compared with surgery alone. The multivariable regression model accounted for a modest proportion of variance in IMAGE-HN global (R2 = 0.18) and subdomain scores (R2 = 0.20 for other-oriented appearance, 0.14 for personal dissatisfaction with appearance, 0.21 for distress with functional impairment, and 0.13 for social avoidance and isolation).

Conclusions and Relevance  In this cross-sectional study, factors associated with risk of HNC-related BID included free flap reconstruction, lower educational attainment, unemployment, and multiple treatment modalities. These characteristics explain a modest proportion of variance in IMAGE-HN scores, suggesting that other characteristics may be the major risk factors for HNC-related BID and should be explored in future studies.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×