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Changes in physical appearance and body image

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Changes in physical appearance that may result from cancer and its treatment may produce some psychological distress, depending on the patient, their age, personality, gender and culture. Some cancer patients may be more troubled by changes in appearance, while others may be more troubled by changes in body function.
One change in physical appearance is hair loss from radiation therapy or chemotherapy treatments. Hair loss can happen gradually and the patient may notice it when washing or brushing their hair. Whether hair loss occurs depends on the chemotherapy type, dose or the area of radiation. Usually hair loss is temporary, but in some cases (such as direct radiation to the head) it can be permanent.

Individuals who struggled with their body image before cancer diagnosis may have an even harder time coping with changes in appearance. The reaction of partners and others can affect the way a person adjusts to the changes, too. For some people, the physical changes may add to psychological distress since they are a concrete reminder of a cancer diagnosis. Some changes only last a short time while others are permanent.

Potential appearance changes include:

  • scars from surgery
  • hair loss due to chemotherapy or radiotherapy
  • surgical modification of body parts
  • weight gain/loss
  • skin changes such as redness, itching, more sensitivity, or pain in the area that was treated
  • loss of muscle mass or muscle weakness
  • enlargement of breasts in men (gynecomastia)
  • lymphedema
  • changes in sexual functioning

Vocational implications

Patients’ individual comfort level with changes in physical appearance may have a profound impact on how they relate to others. Certain types of cancer and its treatment, such as head and neck cancer, may produce more visible body changes. Breast cancer treatment can involve removal of a breast. Changes in the body, whether visible or not, may affect patients both physically and psychologically. That, in turn, may affect how comfortable they feel working with others or the public.

What patients can do

Encourage your patient to tell you about any concerns that they have about changes in their physical appearance so that you can suggest interventions. For example, reconstructive surgery following surgical treatment of cancer, appropriate diet and exercise may help to address some concerns. Management of lymphedema can reduce the swelling associated with this condition.

Body image problems are real concerns for cancer patients that can impact self-esteem and mental health. If this is a significant issue for your patient, particularly if it negatively impacts their feelings about return to work, it is helpful to refer to counselling and support groups at your local cancer centre.

Hair loss can be especially distressing. Speak to your patient about how they can retain their hair during treatment, and when they can expect the hair to grow back. Suggest that they consider visiting one of the many Canadian cancer centres that have wig banks or a branch of the organization Look Good Feel Better in the local community. The organization offers advice about hair care, hair loss, wig styling, scarf tips, and more. There is also the Canadian Alopecia Areata Society, which offers support and strategies for dealing with permanent hair loss.

Additional information on hair loss and body image:

Also consider:

  • Counselling services to share concerns and receive advice and support
  • Education and support for partners of those affected by cancer and its treatment

Job accommodations

Modify the work environment:

  • Request sensitivity training for co-workers and supervisors.
  • Suggest a diversity policy for the workplace to spread the message that the employer values all kinds of diversity.
  • Find out whether the workplace has an anti-harassment policy and how to make a complaint if necessary.
  • If the patient serves the public:
    • As long as the patient feels comfortable and supported at work, having an employee with a visible difference serving the public sends the message that the employer values diversity. Hopefully, this will lead the public to accept the person as they would any other employee.
    • Put up signs in places where the public is served saying that rudeness or harassment towards staff will not be tolerated.

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