Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Psychooncology. 2018 Jan;27(1):216-222. doi: 10.1002/pon.4439. Epub 2017 May 31.
To examine the potential mediating role of body image dissatisfaction on the association between treatment-related scarring/disfigurement and psychological distress in adult survivors of childhood cancer.
Participants included 1714 adult survivors of childhood cancer (mean [SD] age at evaluation = 32.4 [8.0] years, time since diagnosis = 24.1 [8.1] years) enrolled in the St. Jude Lifetime Cohort Study. Survivors completed measures of body image, emotional distress, and posttraumatic stress symptoms (PTSS). Body image dissatisfaction (BID) was categorized into 2 groups (cancer-related and general) based on factor analysis. Using causal mediation analysis, we estimated the proportion of psychological distress associated with treatment-related scarring/disfigurement that could be eliminated by resolving BID through a hypothetical intervention.
Among survivors with scarring/disfigurement of the head, a sizable proportion of the relative excess of psychological distress could be eliminated if BID was successfully treated (males: [cancer-related BID: depression: 63%; anxiety: 100%; PTSS: 52%]; [general BID: depression: 70%; anxiety: 100%; PTSS: 42%]; females: [cancer-related BID: depression: 20%; anxiety; 36%; PTSS: 23%]; [general BID: depression: 32%; anxiety: 87%; PTSS: 38%]). The mediating effect of BID was less pronounced for the association between scarring/disfigurement of the body and psychological distress for both males and females.
Body image dissatisfaction mediates the association treatment-related scarring/disfigurement and psychological distress among adult survivors of childhood cancer, particularly among survivors with scarring/disfigurement of the head and male survivors. Successful treatment of body image dissatisfaction has the potential to eliminate a substantial proportion of psychological distress related to scarring/disfigurement among adult survivors of childhood cancer.
探讨身体意象不满在儿童癌症幸存者治疗相关瘢痕/畸形与心理困扰之间的中介作用。
参与者包括 1714 名儿童癌症成年幸存者（评估时的平均[标准差]年龄为 32.4[8.0]岁，诊断后时间为 24.1[8.1]年），他们参加了圣裘德终身队列研究。幸存者完成了身体意象、情绪困扰和创伤后应激症状（PTSS）的测量。根据因子分析，将身体意象不满（BID）分为 2 组（癌症相关和一般）。使用因果中介分析，我们估计通过假设干预解决 BID 可以消除与治疗相关的瘢痕/畸形相关的心理困扰的比例。
在头部有瘢痕/畸形的幸存者中，如果 BID 得到成功治疗，可以消除相当一部分的心理困扰（男性：[癌症相关 BID：抑郁：63%；焦虑：100%；PTSS：52%]；[一般 BID：抑郁：70%；焦虑：100%；PTSS：42%]；女性：[癌症相关 BID：抑郁：20%；焦虑：36%；PTSS：23%]；[一般 BID：抑郁：32%；焦虑：87%；PTSS：38%]）。对于男性和女性，瘢痕/畸形与心理困扰之间的关联，BID 的中介作用不太明显。
身体意象不满中介了治疗相关的瘢痕/畸形与儿童癌症成年幸存者的心理困扰之间的关系，尤其是在头部有瘢痕/畸形的幸存者和男性幸存者中。成功治疗身体意象不满有可能消除儿童癌症成年幸存者中与瘢痕/畸形相关的大部分心理困扰。
