Body image in head and neck cancer patients treated with radiotherapy: the impact of surgical procedures

Abstract

Background: In this study, we aimed to investigate the impact of surgical procedures on the body image of head and neck cancer patients treated with radiotherapy and with or without radical surgery.

Methods: A cross-sectional survey of 150 patients with head and neck cancer was conducted. Sixty patients had nasopharyngeal cancer treated with definitive radiotherapy without surgery, and 90 patients had oral cavity cancer treated with radical surgery plus adjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction. Among all patients, the socio-demographic and clinical variables were age, gender, partnership, education, employment, and radical surgery. In surgically-treated patients, the clinical variables were facial skin sacrificed, mouth angle sacrificed, glossectomy, maxillectomy, and mandibulectomy. ANOVAs, t-tests, and multiple regressions were used to evaluate the relationships between these variables and BIS results.

Results: In all patients, radical surgery was the strongest independent predictor of BIS scores. Surgically-treated patients had significantly worse BIS scores than the patients without surgery. In surgically-treated patients, facial skin sacrificed, mouth angle sacrificed, maxillectomy, and mandibulectomy were significantly associated with body image. According to multivariable analyses, inferior maxillectomy and segmental mandibulectomy were independent prognosticators of a poor BIS score in surgically-treated patients.

Conclusion: Radical surgery for head and neck cancer patients has a significant impact on their body image, especially for those undergoing facial bone destructive surgery.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the Human Research Ethics Committee of Chang Gung Memorial Hospital Institutional Review Board with the reference number 102-0527B. An informed consent to participate was obtained from each patient in this study.

Consent for publication

Not applicable, none patient’s personal data is included.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Body image dissatisfaction of the surgically treated patients based on different surgical procedures: (a) surgically-treated patients with intact facial skin (n = 48) or facial skin sacrificed (n = 42), p = 0.001; (b) surgically-treated patients with mouth angle preserved (n = 64) or mouth angle sacrificed (n = 26), p = 0.006; (c) surgically-treated patients with inferior maxillectomy (n = 24) or no maxillectomy (n = 66), p = 0.002; (d) surgically-treated patients with marginal mandibulectomy (Marginal, n = 24), segmental mandibulectomy (Segmental, n = 27), or no mandibulectomy (n = 39), p = 0.004; (e) surgically-treated patients with partial glossectomy (n = 25), total glossectomy (n = 19), or other surgery (n = 46, underwent wide local excision of buccal/gingival/retromolar tumors), p = 0.001

Fig. 2

Body image dissatisfaction of all patients (n = 150) divided by radical surgery and the three surgical procedures*: No OP (n = 60, the patients who did not receive radical surgery), OP I (n = 20, surgically-treated patients who had partial glossectomy but without inferior maxillectomy or segmental mandibulectomy), OP II (n = 31, surgically-treated patients who had one of the three surgical procedures*), OP III (n = 32, surgically-treated patients who had two of the three surgical procedures*), and OP IV (n = 7, surgically-treated patients who had all three surgical procedures*), p < 0.001. *Three surgical procedures were inferior maxillectomy, segmental mandibulectomy, and not partial glossectomy (total glossectomy or wide local excision of buccal/gingival/retromolar tumors)