Temporal Trajectory of Body Image Disturbance in Patients with Surgically Treated Head and Neck Cancer

Otolaryngol Head Neck Surg. 2020 Mar;162(3):304-312. doi: 10.1177/0194599819898861. Epub 2020 Jan 7.


Objectives: To characterize the temporal trajectory of body image disturbance (BID) in patients with surgically treated head and neck cancer (HNC).

Study design: Prospective cohort study.

Setting: Academic medical center.

Subjects and methods: Patients with HNC who were undergoing surgery completed the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, pretreatment and 1, 3, 6, 9, and 12 months posttreatment. Changes in BIS scores (ΔBIS) relative to pretreatment (primary endpoint) were analyzed with a linear mixed model. Associations between demographics, clinical characteristics, psychosocial attributes, and persistently elevated BIS scores and increases in BIS scores ≥5 points relative to pretreatment (secondary endpoints) were analyzed through logistic regression.

Results: Of the 68 patients, most were male (n = 43), had oral cavity cancer (n = 37), and underwent microvascular reconstruction (n = 45). Relative to baseline, mean ΔBIS scores were elevated at 1 month postoperatively (2.9; 95% CI, 1.3-4.4) and 3 (3.2; 95% CI, 1.5-4.9) and 6 (1.8; 95% CI, 0.02-3.6) months posttreatment before returning to baseline at 9 months posttreatment (0.9; 95% CI, -0.8 to 2.5). Forty-three percent of patients (19 of 44) had persistently elevated BIS scores at 9 months posttreatment relative to baseline, and 51% (31 of 61) experienced an increase in BIS scores ≥5 relative to baseline.

Conclusions: In this cohort of patients surgically treated for HNC, BID worsens posttreatment before returning to pretreatment (baseline) levels at 9 months posttreatment. However, 4 in 10 patients will experience a protracted course with persistent posttreatment body image concerns, and half will experience a significant increase in BIS scores relative to pretreatment levels.

Keywords: body image; disfigurement; head and neck cancer; patient reported outcomes; quality of life; survivorship.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Body Image*
  • Female
  • Head and Neck Neoplasms / psychology*
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Plastic Surgery Procedures
  • Prospective Studies
  • Quality of Life / psychology*
  • Time Factors