"At one point in my therapy, I came to a very big conclusion -- cancer had taken enough from me," Angela Gass says.
Now 36, she has spent 12 years fighting cancer, which claimed one-third of her tongue and three-fourths of her jaw, leading to body image issues.
"It had taken my ability to eat, speak clearly and be confident about my appearance," Gass says. "I decided that I wasn't going to let it take anything else. Instead of focusing on the things that I had lost, I put my energy into all the things that I am: a wife, mother, woman and survivor."
Understanding body image
"Body image is very subjective and personal. It is not just about physical appearance. Body image involves perceptions, feelings and thoughts about the entire body and its functioning," says Michelle Cororve Fingeret, Ph.D., assistant professor in MD Anderson's departments of Behavioral Science, Head and Neck Surgery and Plastic Surgery.
Cancer can affect body image by:
- Changing physical appearance
- Changing how the body functions
"A strong emotional component undercuts both the physical and functional body changes associated with cancer and its treatment," Fingeret says.
Letting fear rule
Most cancer patients experience concerns about body image changes that result from their illness and treatment. However, the degree to which these concerns interfere with quality of life can vary. Some patients, like Gass, show clear signs of having difficulty adjusting to body image changes.
- Feeling ashamed or highly self-conscious in social situations
- Avoiding or limiting social activities
- Difficulty being intimate with a partner
- Becoming highly preoccupied with appearance concerns or other body changes
- Routinely camouflaging or trying to hide aspects of your appearance
- Experiencing significant emotional difficulties that interfere with daily activities
Gass rarely left the comfort and security of her home in Phoenix, Ariz. But, as a stay-at-home mother of two young daughters, she couldn't entirely avoid being in public. When she had to venture out, she would hide her mouth behind her hand or a tissue, keep her head down and rarely speak.
"It was the first time in my life that people would stare at me when I was out in public, and I had no idea how to handle the unwanted attention," Gass says. "I avoided being in public as much as possible."
Addressing painful emotions
The Body Image Therapy Service (BITS) program at MD Anderson, is currently only available to patients being seen in the Head and Neck Center and Center for Reconstructive Surgery. Fingeret hopes to be able to offer her services across MD Anderson in the future.
She meets with patients individually to discuss their body image concerns and how they are impacting their daily life. Then, she designs an individualized treatment plan.
As part of the BITS program, Fingeret works with patients to help them:
- Learn coping strategies to promote body image acceptance
- Focus on ways to increase self-confidence in social situations
- Discuss treatment decisions they need to make that will affect their bodies
- Set realistic expectations for body- and appearance-related changes
- Communicate more effectively with others about appearance and body changes
"Struggling with body image issues is a very personal and private experience, and survivors can find it difficult to ask for help and talk about painful emotions," Fingeret says.
Once in the BITS program, it was tough for Gass to admit to her body image struggles.
"No matter how depressed or angry I was that this had happened to me, I knew deep down that I was one of the lucky ones," she says. "I felt extremely guilty because I knew I wasn't really living, even though I was lucky enough to still have a life to live."
Fingeret told Gass that it was "OK to mourn everything she had lost." This gave her a huge sense of relief and the breakthrough she needed to move forward.
Beginning to live again
Together with Fingeret, Gass set up goals for the next six months to help her be in public without feeling stressed or uncomfortable.
Her first goal was to go to the grocery store without hiding her mouth.
"The very thought absolutely terrified me," she says.
Like she discussed with Fingeret, Gass held her head high, kept her hands away from her face and walked into the store. She was amazed at how much she blended into the crowd -- especially without the usual tissue covering her mouth.
From then on, Gass pushed herself to do new things, and with each success her confidence grew.
"I won't say that all of my body image issues have been resolved, but I'm in a much better place," Gass says. "I'm finally able to start living the life that I fought so hard to keep."
Q&A: Body Image Therapy Service