Presentation on theme: "Yeong-Yuh Juang M.D. Consultation-Liaison Psychiatric Service Department of Psychiatry, Chang Gung Memorial Hospital at Linkou 12.Nov.2011 16th RRI Conference."— Presentation transcript:
Yeong-Yuh Juang M.D. Consultation-Liaison Psychiatric Service Department of Psychiatry, Chang Gung Memorial Hospital at Linkou 12.Nov.2011 16th RRI Conference
How you see yourself when you look in the mirror or when you picture yourself in your mind. What you believe about your own appearance (including your memories, assumptions, and generalizations). How you feel about your body, including your height, shape, and weight. How you sense and control your body as you move.
Diagnosis and treatment of breast cancer can affect psychological, sexual and physical functioning to a great extent QoL includes, the patients’ subjective view of their physical, social, emotional and cognitive functioning psychological parameters of fear, body image, satisfaction with health care towards the cosmetic result of the surgical treatment
women treated with mastectomy felt less attractive more self-conscious, did not like their overall appearance, dissatisfied with their scar avoided contact with people Journal of Clinical Psychology in Medical Settings. 16(4):311-21, 2009.
Patients underwent mastectomy showed a significantly less favorable body image compared with those treated with BCT Stage I was associated with the most favorable body image, stage IIIB with the least favorable. Younger patients reported a better cosmetic result, compared with older patients. Patients with a disease-free interval <1 year reported a significant better body image than patients with a longer disease-free interval Annals of Oncology 14: 1064–1071, 2003
mastectomy patients had significantly lower body image, role, and sexual functioning scores and their lives were more disrupted than BCT patients. Even patients > or =70 years of age reported higher body image and lifestyle scores when treated with BCT. Body image, sexual functioning, and lifestyle disruption scores did not improve over time. Breast Journal. 10(3):223-31, 2004
Body image was an important factor in treatment decisions for 31% of women. Women selecting conservative therapy often have a more positive body image than do those undergoing mastectomy Women who received breast conservation had better body image 2 years after treatment body image, in turn, predicted 2-year mental health J Clin Oncol 2004;22:4002-4009. Cancer 2010;116;3549–57.
body image was related to perceived losses and influences. Losses included missing body parts (mastectomy), loss of menses, loss of sexual sensation, and ultimately, loss of womanhood (perceived femininity) “influences” related to the quality of relationships before the diagnosis of cancer and the amount of control and information the patient had
evidence suggests that changes in body image after breast cancer and its treatment may have direct effects on sexuality, sexual response, sexual roles, and relationships. Most studies have found that survivors who had a good sexual relationship before therapy continued to have a satisfying relationship after surgery for breast cancer. AJN 2006 (106), No. 3 Supplement 32-38.
Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis. Half of the pt experienced at least one problem much of the time. Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction poorer mental health, lower self-esteem, and partner's difficulty understanding one's feelings. Psycho-Oncology. 15(7):579-94, 2006
Women's depressive symptoms and men's marital satisfaction predicted women's self- acceptance, but not women's perceptions of their partners' acceptance of their appearance. Female's relationship satisfaction and perspective on common dyadic coping predicted women's perceptions of their partner's acceptance of their appearance Psycho-Oncology. 19(10):1061-8, 2010 Oct.
Understanding and support from the partner were also critical for the survivor to be able to obtain and maintain healthy sexual roles and relationships. A baseline assessment is critical in developing a plan to address the sexual and emotional needs of a person with cancer and her partner. Working with a couple, facilitate an effective dialogue between them and explore strategies to minimize the impact on their current relationship AJN 2006 (106), No. 3 Supplement 32-38.
dream of a wonderful future unexpected reality struggling to accept balancing vanity with life priorities coming to terms: no regret Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010
Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations. This ambivalence, combined with a culture that values selflessness and the placement of family first, resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010
need more preoperative information about what changes in body image to expect after surgery a mastectomy proved to be associated with higher body shame and less satisfaction with appearance breast conserving surgery is associated with a better body image, because of their less mutilating effects European Journal of Oncology Nursing 14 (2010) 263-270
efforts to improve physical attractiveness to provide women with a sense of control over their appearance changes, can lead to lower levels of depression later on. psycho-educational group intervention ： Addressing intimacy and partner communication The sexual life reframing program focused on the physical, psychological, and relational aspects of sexual health elements, H. Sackey et al. EJSO 2010;36:756-762. Cancer Nursing 2011;34(2): 142-149.
increase hope and therefore the support for the psychosocial adjustment of patients should play a vital role in increasing their quality of life. Beauty treatment physical exercise significantly improve psychosocial wellbeing, individual body image, and physical fitness. treated for depression Surgical intervention Asian Pacific Journal of Cancer Prevention, Vol 12, 2011 Onkologie 2011;34:248–253