Table 1.

Body Image Screener for Cancer Reconstruction Survey

Body Image Screener for Cancer Reconstruction (BICR)
Many patients have concerns about how cancer treatment will change the way they look. Both men and women worry about changes to their appearance before and after reconstructive surgery.
Body image specialists are available to help you cope with appearance concerns. Our specialists can help you: discuss difficult treatment decisions that will affect your appearance better prepare for future changes to your appearance adjust to appearance changes during and after reconstructive treatment.
Please read each question and circle the number that describes your feelings.
	Not at all	A little	Quite a bit	Very much
1. How concerned are you about recent changes to your appearance and body?	0	1	2	3
2. How much do you worry about future changes to your appearance from reconstructive surgery?	0	1	2	3
	None of the time	A little of the time	Some of the time	Most of the time
3. How often do you think about your appearance?	0	1	2	3
4. How often do you avoid certain activities because of concerns about your appearance?	0	1	2	3