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Survivors Cancer’s impact on work and strategies Changes in physical appearance

Changes in physical appearance

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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The changes in physical appearance that may result from cancer and cancer treatments may lead to some degree of psychological distress depending on the individual affected and can be influenced by age, personality, gender and culture. For example, some cancer patients may be more concerned about changes in appearance, and others may be more troubled with changes to their body function. Hair loss can be the result of specific cancer treatments. Hair loss can happen gradually, or you may notice your hair loss when washing or brushing your hair. Radiation therapy to the head can cause hair loss. Hair loss in both men and women can be from your chemotherapy treatment. Whether or not you will experience hair loss from your cancer treatment will depend on your chemotherapy type, dose, and area of radiation.1 Typically, hair loss is temporary but in some cases, it can be permanent such as with direct radiation to a site.2

Individuals with a struggling body image before 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 changes to their physical appearance, too.

For some people, the physical changes may add to psychological distress since they are a concrete reminder of a cancer diagnosis.

Potential physical changes include:

  • scars (if you had surgery)
  • hair loss due to chemotherapy or radiotherapy
  • surgical modification of body parts
  • weight gain/loss3 4
  • skin changes such as redness, itching, more sensitivity, or pain in the area where you received treatment
  • loss of muscle mass or muscle weakness
  • enlargement of breasts in men (gynecomastia)5
  • lymphedema
  • changes in sexual functioning

Some changes only last a short time while others are permanent. Talk to your doctor about these changes.

Vocational implications

Your comfort level with changes in physical appearance may have a profound impact on how you relate to others. Certain types of cancer may make your body changes more visible such as individuals diagnosed or treated for head and neck cancer. Others could see physical changes following the removal of the breast as part of their treatment for breast cancer. For all body changes incurred as a result of your cancer, these changes may affect you both physically and psychologically. That, in turn, may have an effect on how comfortable you feel working with others or the public.

What you can do

Speak to your healthcare team for advice about interventions to address the concerns that you have about changes in your physical appearance. Reconstructive surgery following surgical treatment of cancer, appropriate diet and exercise may help to address some concerns. The 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 you feel this significant for you and that it is having a negative impact on your feelings about return to work, it is helpful to reach out to counselling support at your local cancer centre. See if there are community-based cancer support counselling groups in your area.

We understand that hair loss can be distressing. Speak to your doctor to see how you can retain your hair during treatment, and when you can expect your hair to grow back. To help, think about visiting one of the many Canadian cancer centres that have wig banks. See if there is an organization in your community called “Look Good Feel Better.” They offer advice on hair care, hair loss, wig styling, and scarf tips among others.

For more information on hair loss during cancer, see New Hair Looks from Look Good Feel Better. The Canadian Alopecia Areata Society also offers support and strategies in dealing with permanent hair loss.

Additional information:

Your sense of body image can change even if you do not have any lasting physical changes. Cancer survivors describe both positive and negative changes in their body image. Read more about negative and positive body image in Managing Body Image Concerns after Cancer Treatment (PDF).

Also consider:

  • counselling services to share your concerns and receive advice and support
  • education and support for the partners of those affected by cancer and cancer treatments

Job accommodations

Modify your work tasks and how you work:

  • Ask to be able to complete work from home, in a private office, or to conduct meetings by telephone while you adapt to the changes in your appearance.
  • If you’d like, have a trusted colleague or manager disclose the changes in your appearance to your colleagues prior to your return to work. You may also request that they share your level of comfort discussing these changes in order to minimize unwanted questions.

Modify your work environment:

  • Ask for sensitivity training for co-workers and supervisors.



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