Body Image and Self-Esteem in Patients With Cancer

A cancer diagnosis usually means a whirlwind of changes and challenges that were unexpected. This can include long-term or short-term treatment for adverse events (AEs). Some AEs include hair loss, fatigue, weight changes, surgery scars, loss of body parts, rashes, or the need for an ostomy.¹ These physical changes can affect the way patients feel about their appearance and body image.

The realization for patients that their look is going to be altered for a short period of time or for the remainder of their lives can cause a decrease in self-esteem. One of the things we hear, specifically among women, is how unprepared they are to lose their hair due to their treatment regimen. For AEs like hair loss, there are options such as wigs and other head coverings to mediate the change. But there are also other changes caused by cancer that are not as easy to hide, such as an ostomy or scars from surgery.

Self-esteem is defined as “the confidence in one’s worth or abilities”² and is one of the many aspects of a patient’s life that is affected by cancer treatment. Self-esteem can be high or low and in patients with cancer, and it is important to maintain self-esteem that is closer to the high end rather than the low. Patients with lower self-esteem have been linked to having more depressive symptoms and decreased social support.³ When patients look in the mirror, they want to be happy and proud of what is staring back at them, and that is not always what happens. As a result, they need support during the times that they don’t feel like themselves, especially when their bodies start changing right before their eyes.

Nurses are in an important position to have conversations with patients about self-esteem and body image. It would be ideal to discuss body image and self-esteem with every patient during every encounter.⁴ Here are tips to make this more feasible when nurses see patients:

• Encourage the patient to give themselves time to adjust to the change. Certain changes, such as scars, are unavoidable. Over time, for many patients, they adapt to the new reality and a new normal. Encouraging the patient to take time to adjust allows the patient to integrate what happened. Being encouraged to be kind to themselves in the process allows them to mourn the change so they can better integrate it into who they are now.
• Suggest support services. Talking with others living with cancer about how the changes are affecting them, patients can find support hearing others have had similar experiences. Sharing feelings with other patients can provide an opportunity for hope and understanding. Talking with a professional on a one on one basis can provide patients a safe space to be open about their feelings and learn new ways to cope. This can help them better understand their own feelings.¹
• Provide alternatives. When appropriate, alternatives to some physical changes can be provided, like in the case of hair loss. In the case of losing one or both breasts, there are various prosthesis options. Inform patients about reconstructive surgeries and other cosmetic solutions.
• Encourage activity. When possible encourage patients to remain active since physical activity allows patients to feel more energetic and once again engaged.

Climate also plays a part in how patients feel about body image/self-esteem. In warmer months, there is a possibility that nurses will encounter more patients with anxiety about their appearance because of increased outdoor activities when more skin is exposed. At the same time, the heat poses another layer of concern. For patients with skin cancers or who are on certain medications, they have to be mindful of sun exposure. In colder months, it is a lot easier to cover up changes to the body with a layering of clothes like turtlenecks, hats, and additional accessories to hide some side effects the treatment has had on their bodies.

When nurses speak to patients and their loved ones, remember to provide as much support as possible. Let the patients know that they are not alone and that there are people ready and willing to help. Nurses can also let patients know that organizations like CancerCare provide many free services like counseling and support groups. Patients can call 1-800-813-HOPE (4673) to speak with one of CancerCare’s oncology social workers.

References

• Self-Image and Cancer. (2019, January 08). Retrieved April 23, 2019, from https://www.cancer.net/coping-with-cancer/managing-emotions/self-image-and-cancer
• Self-esteem. 2019. In Merriam-Webster.com Retrieved April 23, 2019, from https://www.merriam-webster.com/dictionary/self-esteem
• Schapmire T, Faul A. Cancer and Older Adults (65 Plus). Handbook of Oncology Social Work Psychosocial Care for People with Cancer (p. 530). 2015. New York: Oxford Universtiy Press.
• Messner, C., Kornhauser, C., & Canosa, R. The Biopsychosocial Implications of the Site of the Cancer. Handbook of Oncology Social Work Physchosocial Care for People with Cancer (p. 77). 2015. New York: Oxford University Press.