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A systematic review of body image measures for people diagnosed with head and neck cancer (HNC)

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Abstract

Purpose

Head and neck cancer (HNC) is a relatively common cancer which causes a significant health burden, impacting individuals physically and psychologically. HNC treatment may result in facial disfigurement, eating and communication difficulties, and body image disturbances. We aimed to (1) identify HNC-specific patient-reported outcome measures (PROMs) used to assess body image, (2) evaluate their conceptual coverage, (3) appraise their development process and psychometric properties, and (4) determine appropriate body image PROM(s) for use in the HNC setting.

Methods

Online databases were searched (July 2007–July 2017) for studies that assessed body image in patients with HNC. Studies were screened for eligibility. In addition, we searched three PROM databases for relevant PROMs. From available body image frameworks, we compiled a conceptual schema consisting of 18 clinically relevant body image issues important in the HNC setting, against which PROMs were assessed. Selected measures were appraised for psychometric characteristics, content, and readability.

Results

A total of 245 records were retrieved. 18 studies with PROMs met our inclusion criteria, reporting eight PROMs. The PROM databases searched yielded 62 measures. After screening, eleven measures were short-listed and appraised. The Derriford Appearance Scale (DAS)-59, DAS-24, and body image scale (BIS) cover > 55% of issues within the body image conceptual schema; were developed based on literature, patient interviews, and clinician opinions; and have evidence of internal consistency (Cronbach alpha > 0.7), validity, and responsiveness.

Conclusions

We recommend the DAS-24 and BIS as having adequate coverage of HNC-related issues, and suitable for use in future research.

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Acknowledgements

We thank Rhiannon Ashleigh for her assistance with data extraction.

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Authors and Affiliations

  1. Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia

    Chindhu Shunmuga Sundaram, Haryana M. Dhillon & Phyllis N. Butow

  2. Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia

    Chindhu Shunmuga Sundaram, Haryana M. Dhillon & Phyllis N. Butow

  3. Radiation Oncology Network, Western Sydney Local Health District, Sydney, Australia

    Puma Sundaresan

  4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Puma Sundaresan

  5. Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia

    Claudia Rutherford

  6. Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia

    Claudia Rutherford

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  1. Chindhu Shunmuga Sundaram
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  2. Haryana M. Dhillon
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Correspondence to Claudia Rutherford.

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Shunmuga Sundaram, C., Dhillon, H.M., Butow, P.N. et al. A systematic review of body image measures for people diagnosed with head and neck cancer (HNC). Support Care Cancer 27, 3657–3666 (2019). https://doi.org/10.1007/s00520-019-04919-6

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