title: Association between body image dissatisfaction and weight loss among patients with advanced cancer and their caregivers: a preliminary report.
abstract: BACKGROUND
  No prospective studies have dealt with the impact of cachexia-related weight loss on patients' body image as well as the impact of patients' body image changes on the level of patient and family distress.
  
  
  OBJECTIVE
  Our aim was to examine associations between body mass index (BMI), weight loss, symptom distress, and body image for patients with advanced cancer and their caregivers.
  
  
  METHODS
  Outpatients with advanced cancer and different levels of BMI, along with their caregivers, were recruited. Patient assessments included BMI, precancer weight, Body Image Scale (BIS; 0-30), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and sexual interest and enjoyment as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Cancer Module 35. Caregivers were asked to assess the patient's body image, using the BIS; rate their own quality of life, using the Caregiver Quality of Life Index-Cancer; and rate their overall distress and distress regarding the patient's weight, using the Distress Thermometer (DT).
  
  
  RESULTS
  We included 81 patients and 30 caregivers. Forty-eight patients (59%) experienced weight loss of at least 10%. The mean BIS score was 11.23 (SD = 7.24). Body image dissatisfaction was correlated with weight loss (r = 0.31, P = 0.006), anxiety (HADS-A; r = 0.39, P < 0.001), depression (HADS-D; r = 0.46, P < 0.001), decreased sexual interest (r = 0.37, P = 0.001), decreased sexual enjoyment (r = 0.33, P = 0.004), ESAS score for pain (r = 0.25, P = 0.026), fatigue (r = 0.28, P = 0.014), drowsiness (r = 0.28, P = 0.014), shortness of breath (r = 0.27, P = 0.016), sleep disorders (r = 0.24, P = 0.036), and well-being (r = 0.29, P = 0.011). We found a significant association between the caregivers' evaluation of patients' body image dissatisfaction and patients' BIS score (r = 0.37, P = 0.049) and caregivers' distress regarding the patients' weight (DT; r = 0.58; P = 0.001).
  
  
  CONCLUSIONS
  Body image dissatisfaction was strongly associated with patients' weight loss and with psychosocial distress among patients and their caregivers. More research is necessary to better understand the association between the severity of body image dissatisfaction and the severity of other problems in patients with cancer.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.forename: Maryam
authors.initials: M
authors.lastname: Daneshmand
authors.forename: Julio
authors.initials: J
authors.lastname: Allo
authors.forename: Duck-Hee
authors.initials: DH
authors.lastname: Kang
authors.forename: Marilene
authors.initials: M
authors.lastname: Filbet
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Michelle Cororve
authors.initials: MC
authors.lastname: Fingeret
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D057215:Body Dysmorphic Disorders / Q000453:epidemiology* / Q000523:psychology; D015992:Body Mass Index; D002100:Cachexia / Q000453:epidemiology* / Q000523:psychology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology; D010865:Pilot Projects; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D013781:Texas / Q000453:epidemiology