By Seattle Cancer Care Alliance's Vicki Evans, associate director of Supportive Care; Vanessa Skay, mastectomy fitter at Shine cancer specialty store; and Katie Seitz, Women's Center social worker
Body image is a complicated subject, embedded in physicality, emotions, spirituality and sexuality. It can encompass much breadth and depth, and it doesn't mean the same thing to all people. At its heart, body image is really about self-acceptance and self-care—whether or not you've had cancer.
Cancer and its treatment can affect our physical appearance and how we feel about ourselves. It is normal for different people to be focused on different aspects of change in response to their cancer treatment. Some cancer survivors can be very focused on the physical aspects, feeling as if their bodies have been damaged. Others are more concerned about issues like sexual interest, sexual response or fertility. Some may worry about how such changes impact current relationships or may affect their ability to find a future partner.
When we screen for distress as people are going through comparable cancer treatments, such as blood stem cell or bone marrow transplants, men may minimize emotions around anxiety, depression and problems with sleep. Women more often share these concerns, as they are culturally more encouraged to be aware of and open with others about how they feel. Men tend to focus more on roles than appearance—being able to still function as a husband, father and employee has a big impact on how they perceive themselves. Losing sexual function, athletic ability, a job or a limb can be more significant issues for men than appearance. Culturally, women are taught to pay more attention to their appearance, so they may be more focused on these physical changes.
If the outcome of treatment isn't what we expect, it can be difficult to readjust expectations to the reality of the situation, to find a way to accept that and move on to finding rewards in what is, instead of how we wish things were. This is very difficult for a lot of people.
Generally, survivors feel a lot of pressure to go back to the way things were before cancer. After treatment, some people in their lives (and maybe themselves) may expect them to act and live as if they've never had cancer, or as if it's over. Many people attempt to do that but find it's not possible—that they've changed somehow. Common concerns include: "My partner is different and we don't connect anymore," "Sex is painful," "I just don't feel like myself," and "I can't seem to relate to people in the same way anymore." It's often easiest to process these questions and feelings by seeking ways to connect with others who have been through cancer themselves.
There's a grief process that many survivors go through after treatment when the hurried pace and worry start to subside, and there's time to reflect and realize what cancer has meant. They think about their bodies, body changes, feelings about their bodies, and they may reformulate how they look at life. It's normal to have some grief over those changes. We all anticipate as we get older that our looks, physical abilities and mental acuity will change, but we don't expect the changes to be sudden, and don't really anticipate having something like cancer. The sudden changes brought on by cancer sometimes render us unrecognizable to ourselves. Some say, "I look in the mirror and I don't recognize myself." Lives are really impacted. We know people can go through a very serious, traumatic event and, while some emerge unscathed, others have more difficulty. Grief can be a normal part of moving through recognition to acceptance of changes in one's body and body image, without losing a sense of one's self and feelings of attractiveness. It's important to acknowledge those feelings instead of trying to skip over them.
For some women who have had mastectomies, getting reconstruction or prostheses to restore body symmetry or to enable activities like swimming without feeling self-conscious can be very important on the road to recovery and a more positive self-image. With hair loss, some people find it easier to minimize their changes with wigs or other products to normalize their appearance for other people in their lives. This is often the case for younger women with children if the kids are afraid because mom doesn't have any hair and they don't understand why.
When treating anxiety and depression after cancer, we work to help people to figure out what the experience means to them and help them get some control over how they want to be in their new experience. Talking it out helps people discover the person they are now and see their strengths and resources. It is helpful to focus on some of the positive aspects of getting past cancer without ignoring what's difficult. There are a lot of free or low-cost resources and support groups (see Frequently Asked Questions). Everyone has different needs and interests. For some people, support groups don't resonate at all; they really want individual mentoring, but for others, feeling connected in a community is crucial.
Patients who have a sense of their lives' broader meaning and purpose in the world have an easier time adjusting to the "new normal" of life after cancer than those just focused on their bodies or appearance. If people don't have a sense of the place that this whole experience has in their life, it can create anxiety. If you don't have an answer to "What does this mean?" make yourself a priority and take time to process the experience.
Cancer survivors often show great strength, tenacity and ability to rebound from cancer and the different impacts of radiation, surgery, chemotherapy and resulting weight, energy, muscle and body losses, and hair changes. Many people are quite resilient. It's a reminder of how much people can tolerate yet still find things to be grateful for in their lives, including their health, the physical functions they do have, their mental capacity, and other personal attributes like humor.
Sometimes, cancer forces a shift from what I look like to who I am. In the loss of the body being the way it used to be, there's more focus on other things in which people find value. Many find meaning in intensified relationships with family and friends and a deeper sense of spirituality or connection with their faith and spiritual beliefs. They might find they feel more comfortable with themselves. Returning to important activities that have meaning and are a part of who you are, or finding new activities, often brings more day-to-day pleasure.
How can you take this journey you've been on and somehow shape it to be something that can bring meaning, self-acceptance, and something that can help you move forward? Those responses can help define your quality of life as a survivor and help you to move past the physical changes you've experienced.
A broad range of services exist in the greater Seattle area to help with body image concerns during and after cancer treatment:
Most people would probably benefit from talking to others about their cancer experience; there’s such richness in connecting with people when we go through a major life event. If anything you’re experiencing as a survivor becomes overwhelming and negatively impacts your quality of life, it’d be good to seek some help. For example, if you stop sleeping, or sleep too much, experience behavioral or emotional changes that persist, have ongoing sadness or relationship issues (like you can’t connect to another person in a deep, emotional and/or physical way), resort to negative coping mechanisms like drinking, smoking, overeating, or avoid activities that used to be important or meaningful. Pay close attention if other people are saying, "You don’t seem like yourself." Other friends and family members are often good litmus tests of our well-being.