Table 4.
Factors Associated with Body Image Disturbance in Patients with Head and Neck Cancer.a
| Factors Associated with
BID |
|||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Author | Year | Country | Design | Time(s) of Measurement | Sample Size | Sex (Female), % | HN Subsite, % | Treatment Modality, % | PROM of BID | Demographics | Oncologic and Treatment Characteristics | Functional and Psychosocial Associations | Quality Rating |
| Beal et al25 | 2018 | United States | Prospective Quality | 1. Pre-Mohs surgery 2. 6 months post-Mohs surgery |
1. 239 2. 80b |
40 | Cutaneous:100 | Mohs S: 100 | BIQ | Female sex (+) Younger age (+) |
Preoperative lesion size
(−) Repair type (−) Size of scar (1) |
Fair | |
| Chen et al23 | 2018 | Taiwan | Cross-sectional | Posttreatment (mean, 30 months; range, 3-67 months) | 105 | 100 | OC: 31 OP: 2 HP: 3 LX: 2 NP: 53 Other: 9 |
S ± RT/CRT: 29 RT/CRT: 71 |
BIS | Younger age (−) Single (−) |
NP location (−) Advanced AJCC stage (−) Surgical treatment(1) (β, 0.33; 95% CI, 0.06–0.60) |
Fair | |
| Chen et al21 | 2015 | Taiwan | Cross-sectional | Posttreatment (mean [SD], 17 [1.8] months) | 130 | 3 | OC: 59 OP: 4 HP: 14 LX: 24 |
S ± RT/CRT: 100 | BISc | OC location (+) Advanced AJCC stage (1) Requires reconstructive surgery (1) |
Speech difficulties (+) (aOR, 21.8; 95% CI,1.4-350) | Fair | |
| Clarke et al 40 | 2014 | United Kingdom | Prospective longitudinal | 1. Posttreatment (>6 months) 2. 9-month followup after initial evaluation |
1.49 2. 20b |
37 | OC: 25 OP: 6 LX: 35 Cutaneous: 35 |
S ± RT/CRT: 92 RT/CRT: 8 |
DAS-24 | Female sex (+) Younger age (−) Single (−) |
Fair | ||
| Deng et al53 | 2013 | United States | Cross-sectional | Posttreatment (mean, 27 months; range, 3–156 months) | 103 | 31 | OC: 15 OP: 48 HP: 4 LX: 18 NP: 3 Other: 14 |
S ± RT/CRT: 56 RT/CRT: 44 |
BIS | Single (+) Urban (1) |
Lymphedema (+) | Fair | |
| Fingeret et al43 | 2013 | United States | Cross-sectional | 1. Presurgery = > 1 year postsurgery | 280 | 36 | OC: 34 Cutaneous: 41 Other: 25 |
S ± RTor CRT: 82 Before surgery: 18 |
BIS | Overall QOL (+) Speech difficulties (+) Eating difficulties (+) Cognitive difficulties (+) Behavioral difficulties(+) |
Fair | ||
| Fingeret et al5 | 2012 | United States | Cross-sectional | 1. Presurgery = > 1 year postsurgery | 280 | 36 | OC: 34 Cutaneous: 41 Other: 25 |
S ± RTor CRT: 82 Before surgery: 18 |
BIS | Female sex (−) Younger age (+) (β, 0.05; 95% Cl, 0.01 −0.09)d |
OC location (−) | Overall QOL (+) | Fair |
| Fingeret et al44 | 2010 | United States | Cross-sectional | Presurgery | 75 | 44 | OC: 100 | Presurgery | BIS, BSS, | Female sex (−) Younger age (−) Single (−) Lower education (−) |
Depression (+) | Fair | |
| Hung et al24 | 2017 | Taiwan | Cross-sectional | Posttreatment | 150 | 15 | OC: 40 NP: 60 |
S ± RT/CRT: 60 RT/CRT: 40 |
BIS | Female sex (−) Younger age (−) Single (−) Lower education (+) (α3.63; 95% Cl, 0.9–6.4)e |
Surgical treatment (α, 6.9; 95% Cl,4.6–9.2) | Fair | |
| Katre et al54 | 2008 | United Kingdom | Cross-sectional | Postsurgery (range,0–14 years) | 252 | 45 | OC: 87 Other: 13 |
S ± RT/CRT: 100 | DAS-24 | Younger age (+) | Advanced T stage(+) S + adjuvant treatment (+) |
Overall QOL (+) | Fair |
| Liu45 | 2008 | Taiwan | Cross-sectional | Postsurgery from 0–6 months | 97 | 9 | OC: 87 Other: 13 |
S ± RT/CRT: 100 | BASS of the MBSRQ | Female sex (−) Younger age (+) Lower education (−) |
S + adjuvant treatment (1) |
Fair | |
| Moschopoulou et al55 | 2018 | United kingdom | Cross-sectional | Posttreatment | 93 | 42 | OC: 56 OP: 24 HP: 2 LX: 2 NP: 4 Other: 12 |
S ± RT/CRT: 87 RT/CRT: 12 Other: 1 |
DAS-24 | PTSD (−) (aOR, 1.04;95% CI, 0.95-1.14) | Fair | ||
| Rhoten et al41 | 2014 | United States | Prospective longitudinal | 1. Pretreatment AND 2. Immediately posttreatment AND 3. 6 weeks posttreatment AND 4. 12 weeks posttreatment |
1. 43 2. 43 3. 43 4. 43 |
28 | OC: 21 OP: 42 LX: 12 NP: 7 Other: 19 |
S ± RT/CRT: 49 RT/CRT: 51 |
BIQLI | Depression (+) | Fair | ||
| Teo et al20 | 2016 | United States | Cross-sectional/exploratory factor analysis | Pre- and posttreatment | 140 | 32 | OC: 54 OP: 4 Cutaneous: 36 Other: 27 |
S ± RT/CRT: 100 | BIS, BIDQ,ASWAP | Female sex (−) | Fair | ||
Abbreviations: AJCC, American Joint Committee on Cancer; aOR, adjusted odds ratio; ASWAR Adapted Satisfaction with Appearance Scale; BASS, Body Area Satisfaction Scale; BID, body image disturbance; BIDQ, Body Image Disturbance Questionnaire; BIQ, Body Image Questionnaire; BIQLI, Body Image Quality of Life Inventory; BIS, Body Image Scale; BSS, Body Satisfaction Scale; Cl, confidence interval; CRT, chemoradiotherapy; DAS-24, Derriford Appearance Scale-24; FNAES, Fear of Negative Appearance Scale; HN, head and neck; HR hypopharynx; LX, larynx; MBSRQ, Multidimensional Body-Self Relationship Questionnaire; NR nasopharynx; OC, oral cavity; OR oropharynx; PROM, patient-reported outcome measure; PTSD, posttraumatic stress disorder; QOL, quality of life; RT, radiotherapy; S, surgery; SD, standard deviation; T, tumor.
aOR and β regression coefficients with confidence intervals were reported in the table when available from the study. If no aOR or β regression coefficient was listed in the table, statistical significance was reported by P value or regression coefficient alone without associated odds ratios or confidence intervals in the original study.
Patients were lost to follow-up and/or BID was not assessed at follow-up appointments.
BIS-m was used in the study, which was a 9-question version of the original 10-question BIS.
Age reported as a negative association with BID in the study. Thus, β and confidence intervals were adjusted from negative to positive values.
Education reported as a negative association with BID in the study. Thus, β and confidence intervals were adjusted from negative to positive values.