Virginia M. Boquiren

Objectives: Body image (BI) remains a significant survivorship challenge among breast cancer (BC) survivors. We describe an 8‐week group intervention—restoring body image after cancer (ReBIC)—developed to target BI distress for BC survivors.Methods: The intervention was informed by interviews with BC survivors and by a descriptive, exploratory approach which adapted guided imagery exercises to address BI. Educational material was selected to address sociocultural factors that may contribute to BI distress and affect adjustment. Videotape reviews and content analyses further refined the intervention.Results: The intervention incorporates three active components: psychotherapeutic group principles; guided imagery exercises to address BI; and psychoeducation on relevant socialization factors and gender‐based messages internalized by women in Western society. The therapeutic group was a supportive and effective way to assist BC survivors to gain insight on BI impacts, their histories, and relevant sociocultural factors contributing to BI distress. The group also facilitated the working through of grief over multiple losses. Guided imagery was well‐received, and appeared to help survivors identify negative and emerging self‐schema, as well as facilitate new self‐views. Specific themes included negative emotions associated with an altered body and self, grief and loss, isolation, difficulties with sexual intimacy, relationship challenges, and uncertainty around sense of self and future.Conclusion: An empirically tested group therapy intervention is described and has implications for survivorship programs to help address BI‐related challenges. Future work could consider testing a similar approach tailored for other cancer populations.

Arm morbidity (AM) arising from breast cancer (BC) treatment can detrimentally impact quality of life; often limiting a survivor’s ability to participate in valued activities. The present study explored (a) the developmental time course of AM [restricted range of motion (ROM), pain, and arm volume changes], negative affect, and perceived disability in the immediate years post-surgery, and (b) the mediating role of perceived disability on the relationship between AM and negative affect over time. In this 5-year longitudinal study, BC survivors from four Canadian oncology clinics (n = 431) completed five annual clinical assessments, where differences in ROM (shoulder abduction, external rotation) and arm volume between the affected and non-affected arm were measured. The profile of mood states (POMS), disability of arm, shoulder, hand, and McGill Pain Questionnaire-Short form were completed. Results from general linear modeling showed that AM, negative affect, and perceived disability were greatest 1-year post-surgery, declined, and with the exception of arm volume changes, were significantly lower 5 years later. Negative affect was significantly associated with restrictions in shoulder abduction and external rotation (average r = −0.15; p < 0.05) and present arm pain (average r = 0.28, p < 0.01) at most assessments. The mediating role of perceived disability on the relationship between AM and negative affect was statistically significant in a majority of assessments. Perceived disability is the underlying factor driving the relationship between AM and mood disturbance over time. Rehabilitative therapy to improve survivors’ functional well-being might mitigate the negative impacts of AM on emotional health.

Background: Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group.Methods: A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy – Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health‐related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF.Results: Eighty‐three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire – Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = −0.23), and overall SF (r = −0.25). Vaginal dryness (β = −0.50), body stigma (β = −0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF.Conclusion: Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues. Copyright © 2015 John Wiley & Sons, Ltd.

Objective: This study aimed to explore the relationships between gender‐role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post‐treatment.Methods: A total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI‐related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender‐Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy‐Breast Quality‐of‐Life Instrument (FACT‐B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT‐B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance.Results: Significant positive correlations were found between the two BI scales and (a) GRSS (average r = 0.53, p < 0.000), (b) Body Shame (average r = 0.53, p < 0.000) and Surveillance (average r = 0.48, p < 0.000). The BIS and BIBCQ were negatively associated with the FACT‐B (r = −0.62, −0.73, respectively; p < 0.000). Results from the path analysis demonstrated support for the proposed model.Conclusion: Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self‐surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post‐treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment. Copyright © 2013 John Wiley & Sons, Ltd.