Body Image Issues for Cancer Patients

M. D. Anderson Cancer Center
Date: January 04, 2010

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Body Image Issues for Cancer Patients

Michelle C. Fingeret, Ph.D., Assistant Professor in the Department of Behavioral Science with joint appointments in the Departments of Plastic Surgery and Head and Neck Surgery at the University of Texas M. D. Anderson Cancer Center discusses her innovative line of research centering on body image issues for oncology patients.

Lisa Garvin:

Welcome to Cancer Newsline, a weekly podcast series from the University of Texas MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention providing the latest information on reducing your family's cancer risk. I am your host Lisa Garvin. Today, our guest is Dr. Michelle Fingeret who is an Assistant Professor in Behavioral Sciences here at MD Anderson. Welcome Dr. Fingeret.

Michelle Fingeret:

Thank you.

Lisa Garvin:

Michelle’s area of expertise is psychosocial issues that surround body image or body changes that are wrought by cancer treatment. Let's talk about how you focus on head and neck cancers and also breast, let's talk about breast reconstruction first. It is a common cancer. It is a surgery that a lot of women are considering. What are the body image issues obviously of losing a breast or both breasts?

Michelle Fingeret:

Well, I think a big part of it that patients experience is just trying to understand what kind of life they can have for themselves after the reconstruction. So, they want and a lot of them are deciding whether they even want to have reconstruction because obviously that is an optional procedure that patients don't have to undergo. And so for them I think it is trying to figure out how they can move on with their lives because in most cases there is a very good prognosis for patients. But, because it such an issue with femininity and sexuality and not feeling whole without a breast or complete, patients really struggle with what are their options and there are a lot of options in terms of reconstruction that they have to consider. Most women have more than one viable option that is presented to them by the doctor and what is different for them is that they in the end have to make an autonomous treatment decision. It is not something that the doctors tell them or gear them towards one direction or another. They really just present the option and the patient is left to make that decision on her own, and sometimes it is very overwhelming for them.

Garvin:

And they are deciding whether they want to have breast reconstruction or not, I know that, I think the last I heard 80% of reconstruction procedures are done at the time of the mastectomy here at MD Anderson, so they kind of have to make that decision fairly quickly.

Fingeret:

Oftentimes they are making it at the same time that they are making other treatment decisions with respect to their mastectomy. What type of mastectomy, you know, there is also new procedures that are coming online now with the nipple-sparing mastectomy, and so they are having to make a lot of decisions at once. So, it is very difficult for them and the body image issues a lot of times really can affect the way they make these treatment decisions. It is based on what they want to see for themselves and what is important to them. And most of them are coming in with issues or concerns about their body image before they ever had cancer because that is so common in our society the way society is set up for women. So, I am coming in at a time where trying to help patients understand what are some of the longer term body image issues they have had before they ever had cancer and how does that affect the way they want to live their lives as a cancer survivor.

Garvin:

Are you hoping to catch these women as far as therapy and counseling in this whirlwind of treatment decision making?

Fingeret:

Well, it really depends on the individual patient. I think this is a relatively new thing that I am working with patients because I do a lot of research in this area as well. And part of that is figuring out what is the optimal time to try to provide counseling and support for patients. And so there are a number of patients that I work with from that very initial stage with the difficult treatment decisions. Other patients don't feel that they really need these services until after the reconstruction is complete or even in the process of reconstruction because that can be, you know, up to a year that these patients undergo different procedures for their reconstruction. And they don't feel that they need so much help in the beginning, but more adjusting as time goes on. So, it just depends on the individual person.

Garvin:

So Dr. Fingeret, are these body image issues common amongst breast cancer patients?

Fingeret:

You know obviously, I see the patients and get referred patients who are having particular difficulties and struggling, but I would say that the vast majority of patients, the body image issues play a very large role. Even though this is a cancer that you can't necessarily detect from, you know that is not visible to the outside observer. There is something that is very unique about a breast cancer patient and the issues that she has with body image. And I think that the plastic surgeons who I work with here at MD Anderson can speak to that much better because obviously they see everybody who comes in and they are only referring me a portion of their patients. And so some of what I try to do is work with their staff and the doctors as well to help them in the clinic. So, they don't need me for every single patient that they see, but just to give them some avenues and some ways that they could help patients feel more comfortable and know that this is a common issue. You are not alone if you experience these types of concerns. I think I would venture to say it is actually more atypical for a patient not to be concerned about their body image with breast cancer than it would be you know for them to be concerned, more common for them to be concerned.

Garvin:

And I guess no matter how much you tell them about the different reconstruction procedures they really don't know how it is going to turn out. I mean, they may not realize that they will never have sensation in their nipples again if they lose their nipples and that kind of thing. So, I guess that kind of plays into the whole thing.

Fingeret:

Sure. I mean, a big part of it is during the consultation process, they are given so much information that it is almost hard for them to digest everything and understand that certain procedures can potentially result in certain outcomes, where other procedures would be very different. And so they have to make a choice not really knowing what the final outcome is going to be and a lot of questions are raised during that process of, well how does it really going to look, because it is different for every woman. And you can't necessarily show them pictures of other women or look at other -- you know a lot of our patients will try to get as much information as they can online or from their friends or from this or from that. And some of that information is not relevant to them and so we have to really work with them to help them understand that their outcomes are dependent on a lot of individual factors, their cosmetic outcomes. So, they have to be patient as they go through this process and sometimes they really need the support and help of somebody who can help them deal with the emotional issues that they are dealing with. The doctors do a great job of working with them on their treatment but you know I try to come in and help deal with some of the more emotional factors or the social factors.

Garvin:

Let's talk about your research. Apparently you are trying to develop a decision making tool for breast reconstruction patients, tell us more.

Fingeret:

So, I have a new project that has been funded by the American Cancer Society and I work with several of the plastic surgeons here at MD Anderson. I also work with some biomedical engineers that are at the University of Texas and the University of Houston and we have a research tea and that is the ultimate goal. We are still in the initial stages because there is a lot of things we have to do and learn before we can actually developed the tool itself. So, the project that we are working on right now is trying to take 2D images of patients, so just with a regular digital camera. And we also have collaborators in other projects where we are also taking three dimensional photographic images, so we are getting a lot more information about the dimensions of the breast. And we are trying to help use those images to understand what are the actual changes that people go through during the process of reconstruction. So, if there might be several procedures they have to go through, each time they are going to have an appearance changed. And we want to be able to find a way to measure that change with a number, have you know like if you are using -- if you want to say a ruler. So, you can really get a numerical difference of what it was like before and what it was like after. That type of information can be used in some of the models that we want to generate, this computer models to help show patients how their breast have changed over time and the goal would be that we would be better at making a tool that actually shows patients, okay for you based on all of your individual factors. We can have a model that shows you what your breasts will look like if you choose reconstruction that has an implant versus a reconstruction that uses living tissue. So, those are the two basic types of reconstructions. So, we have a long way to go before we get to that point, but it is very exciting and kind of cutting edge and something we hope to be able to develop here for our patients at MD Anderson.

Garvin:

I also understand Dr. Fingeret that you are working with head and neck cancers and mid-face cancers, much bigger body image issue obviously because their disfigurement or body changes are quite obvious. Tell us about that.

Fingeret:

So, I wouldn't necessarily agree with the fact that they are bigger, more of the changes are bigger the body image issues are bigger for head and neck patients, so just very different. Yes, it is true that for somebody who has cancer on their facial region, or in their head and neck that it is visible to other people. But, I find that a lot my breast cancer patients are equally, if not sometimes more distressed about their body image, which is surprising, but a lot of that has to do with research that we know just because you have a more obvious or a more extensive defect does not mean that you adjust poorly to that. And that just really speaks to I think individual differences, so the resiliency of certain patients. I might have a head and neck patient who has lost an eye or lost part of their face that has to be reconstructed with skin from other parts of their body and they might actually adjust quite well and have a very positive outlook on life, whereas somebody who has a very small scar might have a really tough time. What is so interesting about my work is there is a lot of I think individual psychological factors that that go into play here. It is not just about how you look to somebody else. It is about how you feel, so it is that subjective nature of body image that is really important for us to understand more about. So, the work I do with head and neck patients is different, but also very rewarding in the sense that I think these patients, these group of patients, traditionally has not had as much attention given to them in terms of research and in terms of psychosocial. There has been a lot done with the breast patients and not as much with head and neck and so it is very equally rewarding I think to work with both groups.

Garvin:

So, tell me about the service. You have got one in the breast center and one for head neck patients. What sort of services do you provide to them?

Fingeret:

Well, this is a program that started in November of 2008 and it is a very small program because about 75% of my time is devoted to research and only 25% of my time is devoted to seeing patients. And so, what I do is I take referrals from either the surgeons, the nurses, the physician's assistants, I have a very good working relationship with I think all the different providers in the clinics, as well as some of the other services like the speech and language services here. They also send me referrals because and really anybody on the team can identify a patient that has body image concerns. And I see them individually for counseling. I don't necessarily go to the head and neck center or the plastic surgery center. I try to see them right now in the clinic that we have, the behavioral science and they come to me and I work with them, mostly individually I will see a patient. Sometimes, I will work with the family members or the spouse if that is warranted in the clinical situation.

Garvin:

Do you find that patients are willing to refer themselves or do sometimes they have like a partner or loved one or a health care team member pushes them into this kind of therapy?

Fingeret:

I see everything. The Volunteer Endowment Patient Support program has provided some funding for us for this year, and so we have developed some promotional fliers that we put in the clinic. And patients can just pick them up in the waiting area which is great because one of the things about the body image issues that patients' experience is there is oftentimes shame or guilt associated with that. They don't feel comfortable talking to the health care provider, after all you know I should just be grateful I am alive, why should I be worried so much about my body image. And so we want to give patients a way to get help without necessarily having to acknowledge or discuss these issues with their health care providers if they don't feel comfortable. So, that is one avenue and I have had the spouse call me about her husband to be in the program and I have had patients call me themselves. I also have -- I have some of my patients who I work with refer other patients. So, there is really a ton of ways that people can gain access to this program, but unfortunately it is limited at least at this moment to just those two centers, the plastic surgery center and the head neck center and that is because of the way my job is structured.

Garvin:

But it is important for people to seek advice, counseling, and support.

Fingeret:

I think so. I think it can be extremely beneficial to patients as they are going through the process of treatment and recovery from treatment and even into long term survivorship.

Garvin:

Great! Thank you very much Dr. Fingeret. If you have any questions about anything you have heard today on Cancer Newsline, contact askMDAnderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline, tune in next week for the next podcast in our series.

 

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