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:
- Hair Loss & Appearance – BC Cancer Agency
- Hair loss – Canadian Cancer Society
- Managing Body Image Problems after Cancer Treatment (PDF) – University Health Network Patient Education Network
- A patient’s body image can change after cancer diagnosis even if there are no lasting physical changes. Read more about negative and positive body image on Livestrong’s Body Image section.
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.
