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ESTRO 2020

Session Item

Poster highlights 19 CL : Breast
8270
Poster Highlights
Clinical
11:02 - 11:10
Body image after breast cancer treatment and determinants associated with impaired body image
Marilot Batenburg, The Netherlands
PH-0599

Abstract

Body image after breast cancer treatment and determinants associated with impaired body image
Authors: Marilot Batenburg.(UMC Utrecht- Utrecht University, Radiation Oncology, Utrecht, The Netherlands), Rhode M. Bijlsma.(UMC Utrecht- Utrecht University, Medical Oncology, Utrecht, The Netherlands), Annemiek Doeksen.(St. Antonius Ziekenhuis, Surgery, Nieuwegein, The Netherlands), Roxanne Gal.(UMC Utrecht- Utrecht University, Imaging Division, Utrecht, The Netherlands), Ernst J.P. Schoenmaeckers.(Meander Medisch Centrum, Surgery, Amersfoort, The Netherlands), Maartje Sier.(St. Antonius Ziekenhuis, Surgery, Nieuwegein, The Netherlands), Maartje Sier.(Ziekenhuis Rivierenland, Surgery, Nieuwegein, The Netherlands), Thijs van Dalen.(Diakonessenhuis, Surgery, Utrecht, The Netherlands), Iris van Dam.(UMC Utrecht- Utrecht University, Radiation Oncology, Utrecht, The Netherlands), Desiree H.J.G. van den Bongard.(Amsterdam University Medical Centre, Radiation Oncology, Amsterdam, The Netherlands), Lilianne E. van Stam.(UMC Utrecht- Utrecht University, Radiation Oncology, Utrecht, The Netherlands), Helena M. Verkooijen.(UMC Utrecht- Utrecht University, Imaging Division, Utrecht, The Netherlands), Arjen Witkamp.(UMC Utrecht- Utrecht University, Surgery, Utrecht, The Netherlands)
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Purpose or Objective

The purpose of this study was to assess to what extent irradiated breast cancer patients are dissatisfied with their body image in the first three years after diagnosis and which determinants were associated with an impaired body image.

Material and Methods

Patients enrolled between October 2013 and January 2019 in the prospective UMBRELLA cohort, consisting of breast cancer patients referred to the radiotherapy department at the University Medical Centre Utrecht, were selected. Female patients with >1 year follow-up and response to >2 questionnaires (including baseline) were selected. Different aspects of body image (i.e. body dissatisfaction, loss of femininity, feeling less attractive, difficulty to see yourself naked) were assessed by means of the EORTC QLQ-BR23 questionnaire on a 4-point Likert scale upon cohort inclusion, at 3, 6, 12, 18, and 24 months. Multivariable logistic regression was performed to identify which determinants were independently associated with poor body image at two years. This cut-off value was chosen, since body image scores stabilized after two years.

Results

Information from 1314 patients was available. The mean age was 58 years (SD 11). The majority of the patients was treated with breast conserving surgery (86.1%), 8.5% of the patients was treated with mastectomy and 5.2% of the patients underwent mastectomy followed by immediate breast reconstruction. Sentinel node procedure was performed in 84.0% of the patients. Twenty-five percent received chemotherapy and 47.5% received endocrine therapy.

Before the start of radiotherapy 10.9% (143/1312) patients felt (much) less attractive as a result of their treatment or disease. This proportion gradually decreased to 4.0% (20/503) after 36 months follow-up. Eight percent (109/1308) of the patients felt (much) less feminine due to their treatment or disease at baseline. During 36 months follow-up this proportion decreased to 2.4% (12/502). The proportion of patients who found it (very) difficult to see themselves naked was 6.3% (83/1308) at baseline and this decreased gradually to 3.0% (15/504) during 36 months follow-up. Prior to radiotherapy, 8.0% (104/1292) was (very) dissatisfied with their body. After 36 months follow-up, this proportion was 5.2% (26/492).

Poorer body image was independently associated with lower age (OR 0.97, 95%CI 0.95-0.99), mastectomy without direct reconstruction (OR 2.39 95%CI 1.17-4.62), chemotherapy (OR 2.05, 95%CI 1.16-3.64), and higher levels of anxiety at baseline as measured with the HADS questionnaire (OR 1.08, 95%CI 1.00-1.17).

Conclusion

Breast cancer patients experience poorer body image during and after breast cancer treatment in contrast to 3 years after treatment. However, the proportion of patients reporting poor body image is low. Lower age, systemic treatment and higher anxiety levels were associated with impaired body image.