PhD in Nursing Science Program

Bethany A. Rhoten

Body Image, Disfigurement, Depressive Symptoms, and Neck-Related Functional Status in Patients with Head and Neck Cancer


Dissertation under the direction of Professor Sheila Ridner


More than 40,000 individuals are diagnosed with head and neck cancer in the United States each year.  Disfigurement and physical dysfunction resulting from the disease and treatment often occur in these patients, making them particularly susceptible to body image disturbance. The purpose of this study was to examine the trajectory of body image in patients with head and neck cancer as well as examine the associations between body image and disfigurement, depressive symptoms, and neck-related functional status. A novel conceptual framework was utilized in this study. The framework proposed that HNC therapy results in two main tumor/treatment related physical effects: 1) disfigurement and 2) alterations in function (dysfunction). A convenience sample of 50 patients with newly diagnosed head and neck cancer was examined prospectively prior to treatment, at the end of treatment, and every six weeks until forty-eight weeks following the end of treatment. Demographic and disease and treatment information were collected at baseline. Participants completed the Body Image Quality of Life Inventory, Neck Disability Index, and Center for Epidemiological Studies Depression Scale at all visits. Cervical range of motion was assessed at each visit. Additionally, photographs were taken at each visit, and participants’ level of disfigurement was assessed using a 9-point observer rated scale. Participants were mainly male, Caucasian, and married or partnered. The average age of participants was 57 years, although participants’ age ranged from 31-78 years. Most had a history of tobacco use and alcohol use. Thirty-eight percent of participants had an HPV related tumor. Three distinct trajectories of body image were identified. Additionally, a statistically significant increase in body image was found from 6 to 12 weeks post treatment. No relationship was found between body image and disfigurement or body image and neck-related functional status. Body image and depressive symptoms were inversely associated. Deficits in cervical range of motion were observed at every time point. It is important that body image be assessed early so that problematic symptom clusters can be identified, and at risk patients can receive intervention.