Medical Psychology Unit, Dept of Medicine
University of Sydney, NSW
This issue contains two short papers providing insight into the impact of cancer on women’s bodies and self-image. The first paper is a sociological exploration of the meaning of breasts and their loss, while the second paper reports an evaluation of the Look Good…Feel Better program, a free cosmetic workshop for women undergoing chemotherapy and/or radiotherapy for cancer.
Body image is a component of self-concept and involves the perception and evaluation of one’s body, appearance and functioning. Early studies indicated that mastectomy scars, prostheses and the development of lymphoedema had a devastating impact on the lives of almost one in four women with breast cancer1, while more recent data suggest that these problems often continue for years after treatment has ceased2. Similar effects have been reported in other cancers, with specific issues arising as a result of the site and treatment of the cancer.
Issues associated with appearance are important for many women, at any age, when making treatment decisions and in adjusting to their cancer diagnosis and treatment. The Psychosocial Clinical Practice Guidelines produced by the National Breast Cancer Centre and endorsed by the National Health and Medical Research Council recommend that clinicians be alert to a woman’s body image concerns before, during and after treatment3. The guidelines suggest that clinicians directly ask about body image concerns, assess their nature, severity and impact, and appropriately refer when needed.
The first paper in this issue by C Boyd, provides an historical overview of the literature on the value and meaning of breasts and their loss, with quotes from the Bible, Shakespeare and art historians. The author argues that by showing an understanding of the personal, cultural and societal value and meaning of the breast, health professionals can provide better individualised care to their patients.
The second paper reports a pre and post program evaluation of the Look Good…Feel Better program that has been offered in Australia since 1990. The evaluation showed significant improvements in body and self image three days and one month after the course, although these are hard to interpret without a control group. Nevertheless, the paper provides useful information on the range of concerns reported by women receiving chemotherapy or radiotherapy, including their facial appearance, the feel and look of their skin, the eye area and unsurprisingly, their hair. Many women reported that their body image affected their self-confidence, and that the program had provided benefits for both their body image and their self-image.
1. GP Maguire, A Tait, M Brokke, et al. “Effect of counselling on the psychiatric morbidity associated with mastectomy”. Br Med J 281 (1920):1454-1456.
2. S Burke, DW Kissane. Psychosocial support for breast cancer patients provided by members of the treatment team: A summary of the literature 1976-1996. National Breast Cancer Centre, 1998.
3. National Breast Cancer Centre. Psychosocial Clinical Practice Guidelines: information, support and counselling for women with breast cancer. National Health and Medical Research Council, 1999.