title: Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes.
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.
authors.affiliation: 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. wwtlam@hku.hk
authors.forename: Wendy W T
authors.initials: WW
authors.lastname: Lam
authors.forename: Wylie W Y
authors.initials: WW
authors.lastname: Li
authors.forename: George A
authors.initials: GA
authors.lastname: Bonanno
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Mancini
authors.forename: Miranda
authors.initials: M
authors.lastname: Chan
authors.forename: Amy
authors.initials: A
authors.lastname: Or
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology; D001828:Body Image; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D015233:Models, Statistical; D011788:Quality of Life; D019529:Sexuality