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Cited by 101Cancer survivorship and careHead and Neck Cancer StudiesBody Image and Dysmorphia Studies

Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer

Open access
Fingeret, Michelle Cororve, Vidrine, Damon J., Reece, Gregory P., Gillenwater, Ann M., Gritz, Ellen R.·2010·Head & Neck
DOI 10.1002/hed.21181PMC PMC2821979
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Abstract

Background.: Body image is a critical psychosocial issue for patients facing treatment for oral cancer, yet there is limited research conducted in this area. This study uses a multidimensional approach to body image assessment and evaluates relationships between body image, demographic, health, and psychosocial variables. Methods.: Newly diagnosed patients with oral cancer completed self‐report questionnaires and a structured clinical interview. Results.: Most participants identified current and/or future body image concerns primarily related to impending surgery. Adequate psychometric properties were demonstrated on a range of body image measures. Depression was the strongest and most consistent predictor of body image outcomes. Conclusions.: Preliminary evidence supports the importance of evaluating body image concerns in oral cancer patients prior to surgical intervention. Our findings have implications for developing validated body image tools and can be used to guide psychosocial interventions targeting body image disturbance. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

Integrity signals

Registry

Crossref · 10.1002/hed.21181

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 30 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    On the BSS, patients with T2 tumors reported the lowest body image concerns compared with all other patients.

    “Unique findings for disease stage were demonstrated with the BSS where patients with T2 tumors reported the lowest body image concerns compared to all other patients.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The link between body image concerns and depressive symptoms was present before surgery.

    “In this study, the association between body image concerns and depressive symptoms was found prior to surgical intervention”
    Quote in the paperSubstantial claim
  • Findingown data

    Among those with appearance-related concerns, the time spent thinking about appearance and the distress associated with it varied considerably.

    “Among participants identifying appearance-related concerns, there was considerable variability in the amount of time spent thinking about and the degree of distress associated with these concerns.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The structured clinical interview developed for this study adequately captures the multidimensional nature of body image concerns in oral cancer patients.
  • Findingown data

    About 36% (20/56) of those naming specific appearance concerns reported at least moderate distress from appearance thoughts.

    “Approximately 36% (20 out of 56) reported at least moderate levels of distress associated with thoughts about appearance.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The structured clinical interview developed for this study adequately captures the multidimensional nature of body image concerns in oral cancer patients.
  • Findingown data

    All body image outcomes were significantly associated with the BSI measure of psychosocial distress.

    “For all body image outcomes, significant associations were found with the BSI, a measure of psychosocial distress (see Table 5).”
    Quote in the paperSubstantial claim
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Findingown data

    Among participants who named specific appearance concerns, 25% (14/56) reported spending more than 1-3 hours daily thinking about appearance, and four reported more than 8 hours daily.

    “Among those identifying specific aspects of body image they were concerned or dissatisfied with, 25% (14 out of 56) indicated spending more than 1–3 hours a day thinking about their appearance with four participants spending greater than 8 hours a day in this activity.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The structured clinical interview developed for this study adequately captures the multidimensional nature of body image concerns in oral cancer patients.

  • May combine two claims.

    Findingown data

    Except for the ASI-R, the body image measures were positively skewed, which the authors interpreted as generally low body image concerns.

    “With the exception of the ASI-R, all other measures were positively skewed. This suggests that as a whole, scores reflected relatively low levels of body image concerns.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Significant associations with race/ethnicity, employment status, and/or disease stage appeared for some body image measures.

    “Depending on the measure, significant associations were found with race/ethnicity, employment status, and/or disease stage.”
    Quote in the paperNot a substantial claim

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    Findingown data

    The BSI depression subscale correlated with every body image outcome; the anxiety subscale correlated with all outcomes except the ASI-R and FNAES.

    “The depression subscale was significantly correlated with all body image outcomes and the anxiety subscale was significantly correlated with all outcomes except for the ASI-R and FNAES.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this sample of newly diagnosed oral cavity cancer patients assessed before surgery, 77% (58/75) reported current and/or future appearance-related concerns, mainly about impending surgery.

    “Most participants identified current and/or future body image concerns primarily related to impending surgery.”
    • Also stated in: § Results · hedged
      “Results from the clinical interview indicated that 77% (N=58) of participants identified current and/or future appearance-related concerns. These concerns were primarily related to impending surgery and involved future scarring/disfigurement at the surgical site, loss of teeth, loss of hair, and speech concerns.”
    • Also stated in: § Discussion · plain
      “over 75% identified current and/or future appearance related concerns, primarily related to changes anticipated as a result of impending surgical treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The structured clinical interview developed for this study adequately captures the multidimensional nature of body image concerns in oral cancer patients.

  • May combine two claims.

    Findingown data

    The body image instruments used in this sample showed adequate psychometric properties, with high internal consistency and evidence of convergent validity.

    “Adequate psychometric properties were demonstrated on a range of body image measures.”
    • Also stated in: § Results · plain
      “Internal consistency for all scales was high, and measures were significantly associated with one another in the expected direction (see Table 3).”
    • Also stated in: § Discussion · hedged
      “The body image measures used here demonstrated covergent validity and high levels of internal consistency, thereby suggesting they are potentially useful with this population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The BSS had the most variance explained, with disease stage, sex, and depression each contributing significantly (F = 4.71, p < 0.05, R2=0.32).

    “The most variance explained was for the BSS, where disease stage, sex, and depression all significantly contributed to the model (F = 4.71, p < 0.05, R2=0.32).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Treatment at a comprehensive cancer center likely means more aggressive and unusual cases were included, which may reduce generalizability.

    “Because our participants were being treated at a comprehensive cancer center, it is likely that more aggressive and unusual cases present for treatment. This may limit the ability to generalize our findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Women in the general population are widely regarded as having greater body image dissatisfaction than men.

    “women are widely recognized as having higher levels of body image dissatisfaction compared to men.(27)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27]

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductnone given

    The findings, especially for sociodemographic, health behavior, and medical factors, need examination in a larger sample to improve power.

    “We acknowledge that our findings especially with regard to sociodemographic, health behavior, and medical factors must be examined with a larger sample to improve power to detect effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Research across head and neck cancer patients identifies psychosocial difficulties linked to appearance changes, including anxiety, depression, worsened partner relationships, and social isolation.

    “Research with a broad array of head and neck patients identifies a number of psychosocial difficulties associated with appearance changes including high levels of anxiety and depression, worsened relationships with partners and increased social isolation.(1, 2)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] source

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    Study design and conductreasoning

    The analyses did not adjust for multiple comparisons, a choice the authors attributed to the study's exploratory nature.

    “In addition, we conducted a number of analyses without controlling for multiple comparisons. This was due to the exploratory nature of our study”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All clinical interviews were conducted by a licensed psychologist, and responses were coded by frequency/severity.

    “All clinical interviews were conducted by a licensed psychologist and responses were coded in terms of frequency/severity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Nearly 60% of those patients also reported feeling discounted or stigmatized because of their cancer-related appearance.

    “Nearly 60% also reported feeling discounted or stigmatized because of their cancer-related appearance.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Body image is multidimensional, involving cognitions, behaviors, and emotions about the whole body and its functioning.

    “In the broader field of body image research, great attention is paid to the multidimensional nature of body image, which involves cognitions, behaviors, and emotions about the entire body and its functioning.(8)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies have found high rates of psychosocial distress related to appearance changes.

    “other studies have found high rates of psychosocial distress related to appearance changes.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10]

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    • cites [13] source

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  • May combine two claims.

    Premisecitation

    With head and neck patients, the HNS appearance subscale has shown convergent validity, good internal consistency (0.83), and very high test-retest reliability (0.96).

    “When used with head and neck patients, this subscale has demonstrated convergent validity with other related measures, good internal consistency (0.83), and very high test-retest reliability (0.96).(20)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Only 7% of approached participants declined, citing disinterest or feeling overwhelmed by the diagnosis.

    “Only 7% of participants approached declined to participate citing disinterest in the study or feeling too overwhelmed by their diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some research suggests many head and neck cancer patients adapt well to disfigurement.

    “Although some research suggests that many patients with head and neck cancer appear to adapt well to disfigurement,(10, 13)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10]

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    Study design and conductown data

    Smoking status was biochemically verified using a breath carbon monoxide test.

    “administered a breath carbon monoxide test (Bedfont Micro Smokerlyzer®) to biochemically verify smoking status.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Strauss's retrospective study of oral and maxillofacial cancer surgery patients reported that all had considerable presurgical anxiety, with surgical mutilation a prominent fear.

    “Strauss(15) conducted a retrospective study of patients receiving surgery for oral and maxillofacial cancer and reported that all patients had experienced considerable presurgical anxiety with surgical mutilation as a prominent fear.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

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  • May combine two claims.

    Premisecitation

    The cited authors concluded that body image issues are either not recorded or not properly addressed for many patients, since only seven charts directly mentioned the concern.

    “This concern was only directly mentioned in seven patient charts leading the authors to conclude that body image issues are either not being recorded or properly addressed for many patients.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

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  • May combine two claims.

    Premisecitation

    The BIS is considered applicable across cancer sites and therapies but had previously been validated only with breast cancer patients.

    “It is considered applicable for patients with any cancer site and form of therapy, but has only been previously validated with breast cancer patients(16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

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  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Body image experiences are subjective and need not match objective body changes visible to others.

    “It is critical to recognize that body image experiences are inherently subjective and not necessarily congruent with objective body changes readily observed by others.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [10]

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    • cites [11] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Body image investment-the importance placed on appearance and specific body ideals-directly influences a person's body image evaluation.

    “Body image investment, or the importance placed on appearance and valuing specific body ideals, is recognized as another critical component which directly influences one's body image evaluation.(9)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] source

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  • May combine two claims.

    Premisecitation

    In head and neck patients, anticipating disfiguring surgery and holding inaccurate views of postoperative appearance have been significantly linked to distress and poorer coping.

    “The anticipation of disfigurative surgery as well as inaccurate perceptions of postoperative appearance in head and neck patients have been significantly related to overall distress and low levels of coping effectiveness.(3–5)”
    Quote in the paperSubstantial claim0 of 3 sources checked
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    Study design and conductnone given

    The study protocol received Institutional Review Board approval.

    “The study protocol was approved by the Institutional Review Board.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The BSI has been psychometrically validated for cancer patients, with adult community and oncology patient norms available.

    “The BSI has been psychometrically validated for use with cancer patients, and both adult community norms and oncology patient norms are available.(21)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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28 of 28

  • The paper relies on this without support.

    Previous research on body image in head and neck cancer has generally not addressed the unique psychosocial concerns of oral cancer patients.

    “Previous work has typically been conducted with a broad array of head and neck patients and therefore has not considered the unique psychosocial concerns of oral cancer patients as they relate to bodily and appearance changes.”

  • The paper relies on this without support.

    The structured clinical interview developed for this study adequately captures the multidimensional nature of body image concerns in oral cancer patients.

    “a brief structured clinical interview was developed for this study. Content was based on a wide range of thoughts, behaviors, and emotions associated with individuals reporting appearance concerns in clinical populations with body image disturbance, which do not appear to be adequately tapped by other selected instruments.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Head and neck cancer disease and its treatment generate serious alterations of physical appearance.

    “the disease and its treatment generate serious alterations of physical appearance (e.g., asymmetry, altered muscle movement, and scarring)”

    From Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress (2022) · cites this paper as [4]

    The Introduction says oral cancer and its treatment can have devastating consequences involving disfigurement and functional impairment. The Discussion identifies scarring and other outward appearance changes, primarily resulting from treatment. The paper does not identify asymmetry or altered muscle movement as examples, so those specifics are not supported by our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Fingeret and colleagues found no gender differences in body image concerns in newly diagnosed head and neck cancer patients.

    “The study conducted by Fingeret and colleagues [4] on newly diagnosed HNC patients found no gender differences in body image concerns”

    From Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress (2022) · cites this paper as [4]

    The Results report no sex differences on any body image measure, and the Discussion reiterates that finding. The study examined newly diagnosed patients with oral cavity cancer, a subset of head and neck cancer, so the citation does not establish the finding across head and neck cancer patients generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Pruzinsky T, 1996, Basal and squamous cell carcinomas. Skin cancers of the head and neck, 357
  2. Streigel‐Moore RH, 2002, Body image: a handbook of theory, research, and clinical practice, 183
  3. Cash TF, 2002, Body image: a handbook of theory, research, and clinical practice

Cited by

Sorted by citations

Related

Authors
Fingeret, M. C., Vidrine, D. J., Reece, G. P., Gillenwater, A. M., & Gritz, E. R.
Affiliations
The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Fingeret, Michelle Cororve
ORCID
Venue
Head & Neck
Publisher
Wiley
Published
2009-07-22
Volume
32
Issue
3
Pages
301-309
ISSN
  • 1043-3074 (ISSN-L)
  • 1097-0347
DOI
10.1002/hed.21181
PMC
PMC2821979
OpenAlex
W2066073608
Cited by
101
References
26
Citations by year
2026: 2 · 2025: 5 · 2024: 9 · 2023: 4 · 2022: 18 · 2021: 4 · 2020: 7 · 2019: 8 · 2018: 8 · 2017: 7 · 2016: 4 · 2015: 2 · 2014: 9 · 2013: 7 · 2012: 3
FWCI
1.15
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Head & Neck (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R25CA057730)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
  • Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords
body image, oral cancer, newly diagnosed cancer, psychosocial distress, depression, body image assessment instruments, psychometric validation, psychosocial interventions
MeSH terms
Adult, Age Factors, Aged, Aged, 80 and over, Body Image, Female, Humans, Male, Middle Aged, Mouth Neoplasms, Psychometrics, Self-Assessment, Sex Factors, Socioeconomic Factors, Stress, Psychological, Reproducibility of Results, Cohort Studies, Health Behavior, Young Adult

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