title: Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer.
abstract: OBJECTIVE
  Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress.
  
  
  METHODS
  Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), controlling for relevant covariates. Measures included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-CR38) Diarrhea, GI Symptoms, and Body Image subscales and Brief Symptom Index Depression and Anxiety subscales.
  
  
  RESULTS
  Women averaged 55 years old (SD = 11.6), White (79 %), and were 4 years post-treatment. Greater Depression was related to poorer Body Image (r = -.61) and worse Diarrhea (r = .35) and GI Symptoms (r = .48). Greater Anxiety was related to poorer Body Image (r = -.42) and worse GI Symptoms (r = .45), but not Diarrhea (r = .20). Body Image mediated the effects of bowel and GI symptoms on Depression, but not on Anxiety.
  
  
  CONCLUSIONS
  Long-term bowel and GI dysfunction are distressing and affect how women perceive and relate to their bodies, exacerbating survivorship difficulties. Interventions to improve adjustment post-treatment should address treatment side effects, but also target body image problems to alleviate depressive symptoms. Reducing anxiety may require other strategies. Body image may be a key modifiable factor to improve well-being in this understudied population. Longitudinal research is needed to confirm findings.
authors.affiliation: Department of Medicine, North Shore-Long Island Jewish Health System, 600 Community Drive, Manhasset, NY, 11030, USA. cbenedict@nshs.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Benedict
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA.
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Rodriguez
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th St, New York, NY, 10065, USA.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carter
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th St, New York, NY, 10065, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Temple
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Nelson
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave. 7th Floor, New York, NY, 10022, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: DuHamel
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000523:psychology; D001007:Anxiety; D001828:Body Image; D003863:Depression; D003967:Diarrhea / Q000523:psychology; D005260:Female; D005767:Gastrointestinal Diseases / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Anal cancer; Body image; Bowel dysfunction; Gastrointestinal symptoms; Psychological distress; Rectal cancer