The Role of Body Image in Adjustment to Breast Cancer

Marilyn W. Edmunds, PhD, CRNP


October 07, 2010

Longitudinal Study About the Body Image and Psychosocial Adjustment of Breast Cancer Patients During the Course of the Disease

Moreira H, Canavarro MC
Eur J Oncol Nurs. 2010;14:263-270

Article Summary

Background. The diagnosis of breast cancer requires challenging patient adjustments during the long and complex process of treatment. Breast amputation and chemotherapy-induced alopecia are 2 sources of significant change in body image with which patients may find difficulty coping. Clearly, how these women look at themselves and how they imagine that they look to others varies with the degree of investment in their appearance. How women process appearance-related information, and the development of compensatory behaviors and emotions all influence overall adjustment during the course of the disease.

Purpose. Previous research on body image in patients who have breast cancer has some limitations, such as the absence of longitudinal studies or the lack of a multidimensional perspective of body image. This study examined the evolution of body image dimensions (investment, emotions, and evaluations) from the period of surgery (T1) to 6 months after the end of treatment (T2). A worse body image (that is, higher levels of shame, self-consciousness, and dissatisfaction with appearance) was expected at this point. The study also aimed to explore the predictors of the emotional and evaluative dimensions of body image at T2 and, simultaneously, the predictive role of initial body image to psychosocial adjustment at T2. It was anticipated that a better body image at T1 would predict better adjustment outcomes at T2.

Methods. A total of 56 patients with breast cancer in Portugal participated in both T1 and T2 assessments and completed a battery of instruments that included measures of body image dimensions (appearance investment, self-consciousness of appearance, shame, and appearance satisfaction) and psychosocial adjustment (quality of life and emotional distress).

Results. Within the dimensions of body image, only the factor of shame increased over time. In general, it was found that the initial levels of investment predicted subsequent body image dimensions and having a mastectomy was associated with higher shame and lower appearance satisfaction at T2. However, initial body image scores did not predict later adjustment, with the exception of depression, where appearance investment played a relevant role. Women were assessed on a motivational salience subscale that measured the woman's efforts to be or feel attractive as well as the self-evaluative salience subscale, which assesses her belief in how her appearance influenced her self-worth and self-concept. If a woman had a high belief that her self-worth and self-concept were linked to body image but had a low desire to do anything to improve her appearance, this behavior was associated with high levels of depression.

Conclusions. These findings contribute to the knowledge in this area, using longitudinal data to provide new and relevant information about the evolution of body image dimensions and predictors of adjustment as women cope with the disfiguring treatments associated with breast cancer. This study moved beyond the theoretical to suggest clinical implications that can assist health professionals to implement strategies focused on body image throughout the course of disease.


Although this research shows that body image is important, it also suggests that body image issues are probably not a main source of concern at the initial phase of the disease when the women are focusing more on their disease and whether they will survive. However, body image concerns surface later when women try to deal with the changes in their appearance over time. This is common sense.

Also, the finding that anxiety tended to decrease over time, as steps were taken to remove the cancer, may also be considered logical. This research also confirmed that greater distress is perceived when a woman has a mastectomy compared with other more conserving surgery.

I thought it was interesting that the self-evaluative salience score seemed to measure how vulnerable a woman felt and the motivational scale was reflective of whether she was doing anything about it -- a protective factor. Making efforts to improve their physical attractiveness gave these women a sense of control over their appearance changes, which is an effective coping tool to deal with depression. Although the study did not deal with helping women improve their appearance as a definitive strategy in their adjustment to breast cancer, further research in this area might lead to exploration of which of self-help strategies might be the most helpful over time in both adjustment and improved quality of life.



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