Abstract
Background: Breast cancer is the most commonly diagnosed cancer globally and the second leading cause of death among US women. Advanced breast cancer (ABC) may lead to significant physical changes like fungating tumors, which can deeply affect body image and quality of life (QOL). Despite the prevalence of body image issues in patients with cancer, few studies examine these issues in the ABC population. Understanding this relationship is crucial to addressing patients’ psychosocial needs and improving overall QOL. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to assess the impact of body image on QOL in ABC patients. Searches in PubMed, Embase, and PsycInfo yielded four studies that met inclusion criteria, including both qualitative and quantitative designs. Results: The studies revealed that body image disturbances contribute to emotional distress, diminished intimacy, and social isolation. Quantitative studies showed statistically significant correlations between body image dissatisfaction and lower QOL, with greater body appreciation associated with improved emotional and cognitive functioning. Conclusion: Body image significantly influences QOL in ABC patients, but research in this area remains limited. Further studies are necessary to understand this relationship and develop interventions that address body image concerns, potentially improving QOL for this underserved population.
References
Álvarez-Pardo, S., De Paz, J. A., Montserrat Romero-Pérez, E., Portilla-Cueto, K. M., Horta-Gim, M. A., González-Bernal, J. J., Fernández-Solana, J., Mielgo-Ayuso, J., García-Valverde, A., & González-Santos, J. (2023). Factors associated with body image and self-esteem in mastectomized breast cancer survivors. International Journal of Environmental Research and Public Health, 20(6), 5154. https://doi.org/10.3390/ijerph20065154
American Cancer Society. (2025). Key statistics for breast cancer. https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
An, J., Zhou, K., Li, M., & Li, X. (2022). Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China. BMC Women’s Health, 22(1), 61. https://doi.org/10.1186/s12905-022-01635-y
Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P. (2015). Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. International Journal of Evidence-Based Healthcare, 13(3), 132–140. https://doi.org/10.1097/XEB.0000000000000055
Badwe, R., Hawaldar, R., Nair, N., Kaushik, R., Parmar, V., Siddique, S., Budrukkar, A., Mittra, I., & Gupta, S. (2015). Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: An open-label randomised controlled trial. The Lancet. Oncology, 16(13), 1380–1388. https://doi.org/10.1016/S1470-2045(15)00135-7
Begovic-Juhant, A., Chmielewski, A., Iwuagwu, S., & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of Psychosocial Oncology, 30(4), 446–460. https://doi.org/10.1080/07347332.2012.684856
Brunet, J., Sabiston, C. M., & Burke, S. (2013). Surviving breast cancer: Women’s experiences with their changed bodies. Body Image, 10(3), 344–351. https://doi.org/10.1016/j.bodyim.2013.02.002
Campbell-Enns, H., & Woodgate, R. (2015). The psychosocial experiences of women with breast cancer across the lifespan: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(1), 112–121. https://doi.org/10.11124/jbisrir-2015-1795
Cash, T. F., Santos, M. T., & Williams, E. F. (2005). Coping with body-image threats and challenges: Validation of the body image coping strategies inventory. Journal of Psychosomatic Research, 58(2), 190–199. https://doi.org/10.1016/j.jpsychores.2004.07.008
Davidson, A., & Williams, J. (2019). Factors affecting quality of life in patients experiencing facial disfigurement due to surgery for head and neck cancer. British Journal of Nursing, 28(3), 180–184. https://doi.org/10.12968/bjon.2019.28.3.180
Dropkin, M. J. (1999). Body image and quality of life after head and neck cancer surgery. Cancer Practice, 7(6), 309–313. https://doi.org/10.1046/j.1523-5394.1999.76006.x
Ettridge, K., Scharling-Gamba, K., Miller, C., Roder, D., & Prichard, I. (2021). Body image and quality of life in women with breast cancer: Appreciating the body and its functionality. Body Image, 40, 92–102. https://doi.org/10.1016/j.bodyim.2021.11.001
Favez, N., Antonini, T., Delaloye, J. F., & Notari, S. C. (2021). From breast cancer surgery to survivorship: Insecure attachment tendencies predict negative psychological outcomes. Health Psychology Open, 8(1), 2055102920987463. https://doi.org/10.1177/2055102920987463
Fingeret, M. C., Hutcheson, K. A., Jensen, K., Yuan, Y., Urbauer, D., & Lewin, J. S. (2013a). Associations among speech, eating, and body image concerns for surgical patients with head and neck cancer. Head & Neck, 35(3), 354–360. https://doi.org/10.1002/hed.22980
Fingeret, M. C., Nipomnick, S. W., Crosby, M. A., & Reece, G. P. (2013b). Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction. Cancer Treatment Reviews, 39(6), 673–681. https://doi.org/10.1016/j.ctrv.2012.12.010
Fingeret, M. C., Yuan, Y., Urbauer, D., Weston, J., Nipomnick, S., & Weber, R. (2012). The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psycho-Oncology, 21(8), 836–844. https://doi.org/10.1002/pon.1990
Frierson, G. M., Thiel, D. L., & Andersen, B. L. (2006). Body change stress for women with breast cancer: The breast-impact of treatment scale. Annals of Behavioral Medicine, 32(1), 77–81. https://doi.org/10.1207/s15324796abm3201_9
Ghaffari, F., Ghahramanian, A., Zamanzadeh, V., Onyeka, T. C., Davoodi, A., Mazaheri, E., & Asghari-Jafarabadi, M. (2020). Patient-centred communication for women with breast cancer: Relation to body image perception. Journal of Clinical Nursing, 29(23-24), 4674–4684. https://doi.org/10.1111/jocn.15508
Guedes, T., Dantas de Oliveira, N. P., Holanda, A. M., Reis, M. A., Silva, C. P., Rocha e Silva, B. L., Cancela, M. C., & de Souza, D. (2018). Body image of women submitted to breast cancer treatment. Asian Pacific Journal of Cancer Prevention: APJCP, 19(6), 1487–1493. https://doi.org/10.22034/APJCP.2018.19.6.1487
Heidary, Z., Ghaemi, M., Hossein Rashidi, B., Kohandel Gargari, O., & Montazeri, A. (2023). Quality of life in breast cancer patients: A systematic review of the qualitative studies. Cancer Control: Journal of the Moffitt Cancer Center, 30, 10732748231168318. https://doi.org/10.1177/10732748231168318
Hopwood, P., Fletcher, I., Lee, A., & Al Ghazal, S. (2001). A body image scale for use with cancer patients. European Journal of Cancer (Oxford, England: 1990), 37(2), 189–197. https://doi.org/10.1016/s0959-8049(00)00353-1
Institute of Medicine (US) and National Research Council (US) National Cancer Policy Board. (2024). Hewitt, M., Herdman, R., & Holland, J. (Eds.). Psychosocial needs of women with breast cancer (Chapter 3). In Meeting psychosocial needs of women with breast cancer. Washington, DC: National Academies Press.
Krigel, S., Myers, J., Before, C., Krebill, H., & Klemp, J. (2014). ‘Cancer changes everything!’ Exploring the lived experiences of women with metastatic breast cancer. International Journal of Palliative Nursing, 20(7), 334–342. https://doi.org/10.12968/ijpn.2014.20.7.334
Liu, Y., Liu, W., Ma, Y., Yang, X., Zhou, H., Zhang, T., & Shao, S. (2022). Research on body image cognition, social support and illness perception in breast cancer patients with different surgical methods. Frontiers in Psychology, 13, 931679. https://doi.org/10.3389/fpsyg.2022.931679
Maunsell, E., Brisson, J., & Deschenes, L. (1989). Psychological distress after initial treatment
for breast cancer: A comparison of partial and total mastectomy. Journal of Clinical Epidemiology, 42(8), 765-771. https://doi.org/10.1016/0895-4356(89)90074-7
McClelland, S. I., Holland, K. J., & Griggs, J. J. (2015). Quality of life and metastatic breast cancer: The role of body image, disease site, and time since diagnosis. Quality of Life Research, 24(12), 2939–2943. https://doi.org/10.1007/s11136-015-1034-3
Mehraj, U., Dar, A. H., Wani, N. A., & Mir, M. A. (2021). Tumor microenvironment promotes breast cancer chemoresistance. Cancer Chemotherapy and Pharmacology, 87(2), 147–158. https://doi.org/10.1007/s00280-020-04222-w
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ, 339, 1–8. https://doi.org/10.1136/bmj.b2535
Mosher, C. E., Johnson, C., Dickler, M., Norton, L., Massie, M. J., & DuHamel, K. (2013). Living with metastatic breast cancer: A qualitative analysis of physical, psychological, and social sequelae. The Breast Journal, 19(3), 285–292. https://doi.org/10.1111/tbj.12107
National Cancer Institute. (2024). Common cancer types. https://www.cancer.gov/types/common-cancers
Osório, C., Rodrigues, E. F., Santos, M., Santos, T., & Nora, M. (2023). Fungating breast wound: A rare manifestation of primary breast leiomyosarcoma. Cureus, 15(1), e33398. https://doi.org/10.7759/cureus.33398
Parker, P. A., Youssef, A., Walker, S., Basen-Engquist, K., Cohen, L., Gritz, E. R., Wei, Q. X., & Robb, G. L. (2007). Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Annals of Surgical Oncology, 14(11), 3078–3089. https://doi.org/10.1245/s10434-007-9413-9
Perry, S., Kowalski, T. L., & Chang, C. H. (2007). Quality of life assessment in women with breast cancer: Benefits, acceptability and utilization. Health and Quality of Life Outcomes, 5, 24. https://doi.org/10.1186/1477-7525-5-24
Rupert, K. L., & Fehl, A. J. (2020). A patient-centered approach for the treatment of fungating breast wounds. Journal of the Advanced Practitioner in Oncology, 11(5), 503–510. https://doi.org/10.6004/jadpro.2020.11.5.6
Sanson-Fisher, R., Mackenzie, L., Butow, P., Rankin, N., & Paul, C. (2012). Advancing the evidence base in cancer: Psychosocial multicenter trials. Trials, 13, 171. https://doi.org/10.1186/1745-6215-13-171
Surveillance Research Program, National Cancer Institute. (2025). SEER*Explorer. Breast cancer- Stage distribution of SEER incidence cases, 2013-2022 by sex, all races/ethnicities, all ages. https://seer.cancer.gov/explorer/
Shimozuma, K., Ganz, P. A., Petersen, L., & Hirji, K. (1999). Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recovery. Breast Cancer Research and Treatment, 56(1), 45–57. https://doi.org/10.1023/a:1006214830854
Sood, A., Daniali, L. N., Rezzadeh, K. S., Lee, E. S., & Keith, J. (2015). Management and reconstruction in the breast cancer patient with a fungating T4b tumor. Eplasty, 15, e39.
Stein, K. D., Syrjala, K. L., & Andrykowski, M. A. (2008). Physical and psychological long-term and late effects of cancer. Cancer, 112(11 Suppl), 2577–2592. https://doi.org/10.1002/cncr.23448.
Thakur, M., Sharma, R., Mishra, A. K., Singh, K., & Kar, S. K. (2022). Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: A cross-sectional study from a tertiary care centre in North India. The Lancet Regional Health. Southeast Asia, 7, 100077. https://doi.org/10.1016/j.lansea.2022.100077
Wood-Dauphinee, S. (1999). Assessing quality of life in clinical research: From where have we come and where are we going. Journal of Clinical Epidemiology, 52(4), 355–363. https://doi.org/10.1016/s0895-4356(98)00179-6.
Wu, Q., Yin, Y., Wang, Q., Wang, S., & Jia, X. (2021). Body image and hopelessness among early-stage breast cancer survivors after surgery in China: A cross-sectional study. Nursing Open, 8(6), 3384–3393. https://doi.org/10.1002/nop2.884
Zhao, W., Chong, Y. Y., & Chien, W. T. (2023). Effectiveness of cognitive-based interventions for improving body image of patients having breast cancer: A systematic review and meta-analysis. Asia-Pacific Journal of Oncology Nursing, 10(4), 100213. https://doi.org/10.1016/j.apjon.2023.100213
