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Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes

  • Epidemiology
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Abstract

We examined degree and determinants of change in body image and sexuality over the first year following breast cancer diagnosis to differentiate body image and sexuality trajectories, and then explored if differences in trajectories predicted 6 years’ psychosocial outcomes. 363/405 (90%) Chinese women receiving surgery for BC were assessed at 5-days (Baseline), 1-month, 4-months, and 8-months post-surgery. Psychological distress, treatment decision making (TDM) difficulties, satisfaction with treatment outcome, optimism, and self-efficacy were assessed at Baseline. Self-image and sexuality were recorded at each follow-up assessment. Latent growth mixture modeling identified trajectories of self-image and sexuality. Multinominal logistic regression identified factors predicting trajectory patterns. Six years later 211/363 (58%) of the original patients were successfully traced and their psychosocial status assessed. Three distinct trajectories of self-image and sexuality were identified: high-stable, recovery, and high-deteriorating. Most women (64% self-image; 58% sexuality) showed stable levels of self-image and sexuality scores. TDM difficulties, satisfaction with treatment outcomes, physical symptom and psychological distress predicted trajectory patterns. Self-image trajectories over the first year diagnosis predicted 6-years psychosocial outcomes. Women with high-stable level of self-image had the best 6-year self-image and sexuality; women with initial low level of self-image had significantly greater long-term psychological distress. Low TDM difficulties and high treatment outcome satisfaction predicted high and stable self-image and sexuality. Type of surgery showed little impacts on self-image and sexuality. Self-image during acute illness phase predicted long-term outcomes. Interventions should focus on minimizing self-image decrement.

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Acknowledgements

This project was supported by grants from the Hong Kong Government Health (Services Research Committee (HSRC # 213022 and HHSRF # 05060581), and the Hong Kong Cancer Fund Scholarship in Psycho-Oncology awarded to the first author in 2001–2002. We thank Lucy C.D. Fielding, Ella Y. Y. Ho, Pheebie Kwok, and many others who worked with us or facilitated this work through patient recruitment, data collection, data entry and data cleaning over the many years of this project, and the very many women who kindly and patiently participated at a most difficult time in their lives.

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Authors and Affiliations

  1. Centre for Psycho-Oncology Research & Training, Department of Community Medicine & Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokulam, Hong Kong

    Wendy W. T. Lam, Wylie W. Y. Li & Richard Fielding

  2. Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA

    George A. Bonanno

  3. Department of Psychology, Pace University, New York, NY, USA

    Anthony D. Mancini

  4. Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong

    Miranda Chan & Amy Or

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  1. Wendy W. T. Lam
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  2. Wylie W. Y. Li
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  3. George A. Bonanno
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  4. Anthony D. Mancini
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  5. Miranda Chan
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  6. Amy Or
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  7. Richard Fielding
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Correspondence to Wendy W. T. Lam.

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Lam, W.W.T., Li, W.W.Y., Bonanno, G.A. et al. Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes. Breast Cancer Res Treat 131, 957–967 (2012). https://doi.org/10.1007/s10549-011-1798-2

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  • DOI: https://doi.org/10.1007/s10549-011-1798-2

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