A cognitive behavioral therapy-based intervention to address body image in patients with facial cancers: Results from a randomized controlled trial.

OBJECTIVES: Body image adjustment is a crucial issue for patients with facial cancer, but body image-specific interventions are scarce. We report results of a novel psychotherapeutic intervention to address body image concerns during acute postoperative recovery following facial reconstructive surgery. Our primary aims were to evaluate the intervention's feasibility, acceptability, and efficacy on body image concerns, psychological distress, and quality of life (QOL). METHODS: Adults with facial cancers who endorsed body image concerns were recruited to participate in a randomized controlled trial. The intervention group participated in 4 in-person counseling sessions. The control group received an educational booklet and a brief phone call. Participants completed measures of body image, distress, and QOL at baseline and at the 4-week follow-up to assess the impact of the intervention. Intervention outcomes were assessed with 2 sample t-tests or Mann-Whitney U tests as appropriate. RESULTS: Twenty-nine participants completed both the baseline and follow-up assessments. The intervention demonstrated good feasibility with a high retention rate (79%), visit completion rate (81%), and high satisfaction scores (75% reported mean satisfaction score of >3). Intervention did not result in an observed statistically significant difference in reduction in body image dissatisfaction and disturbance, psychological distress, or improvement in QOL compared with the control group. However, intervention resulted in statistically significant difference in perceived social impact (-1 vs. -8.3, p = 0.033) compared to control group. SIGNIFICANCE OF RESULTS: Our study highlights the potential clinical benefits of a novel psychotherapeutic intervention that targets body image concerns and suggests the need for further evaluation.

A qualitative assessment of body image in adolescents and young adults (AYAs) with cancer.

CONTEXT: Among adolescents and young adults (AYAs), cancer and its treatment can disturb body image in distinct ways compared to younger or older individuals. OBJECTIVE: Since AYA body image is not well understood, this study was designed to develop a conceptual framework for body image in AYAs with cancer. METHODS: Concept elicitation interviews were conducted with 36 AYA patients [10 adolescents (15-17 years), 12 emerging adults (18-25 years), 14 young adults (26-39 years)] and health care providers (n = 36). The constant comparative method was used to analyze for themes and properties, with themes considered saturated if they were present and salient across participant sets. RESULTS: Twenty themes emerged from participant data. Three themes illustrate a shared understanding of patients' experience of body image: (1) physical changes produce shifts in identity and experience of self; (2) precancer body image shapes how the AYA experiences cancer-related physical changes, and (3) changes to the body are upsetting. Nine themes were unique to patients while eight themes were unique to providers. Patient body image experiences were found to evolve over time, largely affected by concerns about how others view them. Providers appeared attuned to AYA patient body image but recognized that it is not systematically addressed with patients. CONCLUSION: More striking than differences between patient groups is the consistency of themes that emerged. The conceptual framework of body image developed from these data offers an important step toward addressing body image concerns for AYA patients.

Feasibility and efficacy of a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy: a randomized controlled pilot study.

PURPOSE: Weight gain is common among breast cancer patients and may contribute to poorer treatment outcomes. Most programs target breast cancer survivors after the completion of therapy and focus on weight reduction. This study examined the feasibility and preliminary efficacy of an intervention designed to prevent primary weight gain among women receiving neoadjuvant chemotherapy for breast cancer. METHODS: Thirty-eight newly diagnosed stage II or III breast cancer patients were randomized to the BALANCE intervention or usual care within 3 weeks of starting neoadjuvant chemotherapy. The intervention used a size acceptance-based approach and encouraged home-based resistance and moderate-intensity aerobic exercise as well as a low energy-dense diet to prevent weight gain. Assessments were conducted at baseline, mid-chemotherapy (3 months), and post-chemotherapy (6 months). Intervention feasibility, acceptability, and preliminary effects on anthropometric, quality of life, and circulating biomarker measures were evaluated. RESULTS: Intervention participant retention (100%) and in-person session attendance (80%) were high during the intervention period, although attendance dropped to 43% for telephone-delivered sessions. The majority of participants reported being satisfied with the intervention during chemotherapy (88%). Participants in the intervention group had greater reductions in waist circumference (p = .03) and greater improvements in self-reported vitality scores (p = .03) than the control group at the end of chemotherapy. Significant effects on biomarkers were not observed. CONCLUSIONS: A size acceptance weight management program is feasible during neoadjuvant chemotherapy among breast cancer patients and may have beneficial effects on waist circumference and patient vitality. TRIAL REGISTRATION: This study was registered as a clinical trial at www.clinicaltrials.gov (NCT00533338).

Observers' response to facial disfigurement from head and neck cancer.

OBJECTIVE: Our long-term goal is to develop a normative feedback intervention to support head and neck cancer patients in forming realistic expectations about how other people in non-social group settings will respond to their appearance. This study aimed to evaluate the relationship between observer ratings of facial disfigurement and observer ratings of emotional response when viewing photographs of faces of head and neck cancer patients. METHODS: Seventy-five (75) observers rated their emotional response to each of 144 facial photographs of head and neck cancer patients using the Self-Assessment-Manikin and rated severity of facial disfigurement on a 9-point scale. Body image investment of the observers was measured using the Appearance Schemas Inventory-Revised. A standardized multiple regression model was used to assess the relationship between observer ratings of facial disfigurement and observer ratings of emotional response, taking into consideration the age and sex of the patient depicted in the stimulus photograph, as well as the age, sex, and body image investment of the observer. RESULTS: Observers who had a strong emotional response to a patient's facial photograph tended to rate the patient's facial disfigurement as more severe (standardized regression coefficient ß = 0.328, P < 0.001). Sex and age of the observer had more influence on the rating of facial disfigurement than did the patient's demographic characteristics. Observers more invested in their own body image tended to rate the facial disfigurement as more severe. CONCLUSIONS: This study lays the groundwork for a normative database of emotional response to facial disfigurement.

Body image dissatisfaction in patients undergoing breast reconstruction: Examining the roles of breast symmetry and appearance investment.

OBJECTIVE: Reconstruction as part of treatment for breast cancer is aimed at mitigating body image concerns after mastectomy. Although algorithms have been developed to objectively assess breast reconstruction outcomes, associations between objectively quantified breast aesthetic appearance and patient-reported body image outcomes have not been examined. Further, the role of appearance investment in explaining a patient's body image is not well understood. We investigated the extent to which objectively quantified breast symmetry and patient-reported appearance investment were associated with body image dissatisfaction in patients undergoing cancer-related breast reconstruction. METHODS: Breast cancer patients in different stages of reconstruction (n = 190) completed self-report measures of appearance investment and body image dissatisfaction. Vertical extent and horizontal extent symmetry values, which are indicators of breast symmetry, were calculated from clinical photographs. Associations among breast symmetry, appearance investment, body image dissatisfaction, and patient clinical factors were examined. Multi-variable regression was used to evaluate the extent to which symmetry and appearance investment were associated with body image dissatisfaction. RESULTS: Vertical extent symmetry, but not horizontal extent symmetry, was associated with body image dissatisfaction. Decreased vertical extent symmetry (ß = -.19, P < .05) and increased appearance investment (ß = .45, P < .001) were significantly associated with greater body image dissatisfaction while controlling for clinical factors. CONCLUSIONS: Breast symmetry and patient appearance investment both significantly contribute to an understanding of patient-reported body image satisfaction during breast reconstruction treatment.

2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue-challenges and opportunities.

The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the "Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right" was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward.

Longitudinal analysis of patient-reported outcomes and cosmesis in a randomized trial of conventionally fractionated versus hypofractionated whole-breast irradiation.

BACKGROUND: The authors compared longitudinal patient-reported outcomes and physician-rated cosmesis with conventionally fractionated whole-breast irradiation (CF-WBI) versus hypofractionated whole-breast irradiation (HF-WBI) within the context of a randomized trial. METHODS: From 2011 to 2014, a total of 287 women with American Joint Committee on Cancer stage 0 to stage II breast cancer were randomized to receive CF-WBI (at a dose of 50 grays in 25 fractions plus a tumor bed boost) or HF-WBI (at a dose of 42.56 grays in 16 fractions plus a tumor bed boost) after breast-conserving surgery. Patient-reported outcomes were assessed using the Breast Cancer Treatment Outcome Scale (BCTOS), the Functional Assessment of Cancer Therapy-Breast, and the Body Image Scale and were recorded at baseline and 0.5, 1, 2, and 3 years after radiotherapy. Physician-rated cosmesis was assessed at the same time points. Outcomes by treatment arm were compared at each time point using a 2-sided Student t test. Multivariable mixed effects growth curve models assessed the effects of treatment arm and time on longitudinal outcomes. RESULTS: Of the 287 patients enrolled, 149 were randomized to CF-WBI and 138 were randomized to HF-WBI. At 2 years, the Functional Assessment of Cancer Therapy-Breast Trial Outcome Index score was found to be modestly better in the HF-WBI arm (mean 79.6 vs 75.9 for CF-WBI; P = .02). In multivariable mixed effects models, treatment arm was not found to be associated with longitudinal outcomes after adjusting for time and baseline outcome measures (P≥.14). The linear effect of time was significant for BCTOS measures of functional status (P = .001, improved with time) and breast pain (P = .002, improved with time). CONCLUSIONS: In this randomized trial, longitudinal outcomes did not appear to differ by treatment arm. Patient-reported functional and pain outcomes improved over time. These findings are relevant when counseling patients regarding decisions concerning radiotherapy. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2886-2894. © 2016 American Cancer Society.

Body image and quality of life of breast cancer patients: influence of timing and stage of breast reconstruction.

OBJECTIVE: The process of cancer-related breast reconstruction is typically multi-staged and can take months to years to complete, yet few studies have examined patient psychosocial well-being during the reconstruction process. We investigated the effects of reconstruction timing and reconstruction stage on body image and quality of life at specific time points during the breast reconstruction process. METHODS: In this cross-sectional study, 216 patients were grouped into four reconstructive stages: pre-reconstruction, completed stage 1, completed stage 2, and final stages. Multiple regression analyses examined the roles of reconstruction timing (immediate vs delayed reconstruction) and reconstruction stage as well as their interaction in predicting body image and quality of life, controlling for patient age, BMI, type of reconstruction, chemotherapy, radiation therapy, and major complication(s). RESULTS: A difference in pattern of body image was observed across the reconstructive stages, with those receiving delayed reconstruction showing significant decrease in body image dissatisfaction compared with those with immediate reconstruction. At pre-reconstruction, patients awaiting delayed reconstruction reported significantly lower social well-being compared with those awaiting immediate reconstruction. Reconstruction stage predicted emotional well-being, with higher emotional well-being observed in those who had commenced reconstruction. CONCLUSIONS: Timing and stage of reconstruction are important to consider when examining psychosocial outcomes of breast cancer patients undergoing reconstruction. Those waiting to initiate delayed reconstruction appear at particular risk for body image, emotional, and social distress. Our findings have implications for delivery of psychosocial treatment to maximize body image and quality of life of patients undergoing cancer-related breast reconstruction.Copyright © 2015 John Wiley & Sons, Ltd.

Examining pain, body image, and depressive symptoms in patients with lymphedema secondary to breast cancer.

OBJECTIVE: Depression and reduced quality of life are often reported in patients with upper-extremity lymphedema secondary to breast cancer treatment. Little is known about how pain and body image influence depression in patients with lymphedema. The current study examined the association of pain intensity and body integrity beliefs with depressive symptoms and the extent to which body image dissatisfaction mediated these associations. METHODS: A cross-sectional sample of patients with lymphedema secondary to breast cancer treatment completed self-report questionnaires of pain, body image, and depressive symptoms. Hierarchical regression analyses and tests of mediation were conducted to examine the associations among the variables of interest. RESULTS: Pain intensity and body integrity beliefs were positively associated with depressive symptoms. Further, body image dissatisfaction mediated the relationship between pain and depressive symptoms, indicating that higher levels of pain led to higher states of body image dissatisfaction, which, in turn, led to greater depressive symptoms. Body image dissatisfaction also mediated the relationship between body integrity beliefs and depressive symptoms, suggesting that greater body integrity beliefs led to higher dissatisfaction with one's body and subsequently to greater depressive symptoms. CONCLUSIONS: Our findings provide preliminary evidence that pain intensity and body image are important factors in understanding depressive symptoms in patients with lymphedema. Clinical implications include screening for pain and body image concerns in this population to identify patients who are in distress. Counseling interventions targeting body image dissatisfaction can also be potentially helpful for patients with lymphedema.

Body image: a critical psychosocial issue for patients with head and neck cancer.

Increasing attention is being given to evaluating and treating body image difficulties of patients undergoing cancer treatment. Head and neck cancer significantly alters physical appearance and bodily functioning and therefore directly impacts body image. Research involving body image in head and neck cancer patients is growing, and this review considers published findings from 2013 to 2014. Primary attention is given to discussing recent advancements in body image assessment, qualitative studies, descriptive research, and psychosocial intervention studies relevant to body image. Limitations and necessary advancements in this field are noted, and a commentary is provided on the state of the current literature.

Eigen-disfigurement model for simulating plausible facial disfigurement after reconstructive surgery.

BACKGROUND: Patients with facial cancers can experience disfigurement as they may undergo considerable appearance changes from their illness and its treatment. Individuals with difficulties adjusting to facial cancer are concerned about how others perceive and evaluate their appearance. Therefore, it is important to understand how humans perceive disfigured faces. We describe a new strategy that allows simulation of surgically plausible facial disfigurement on a novel face for elucidating the human perception on facial disfigurement. METHOD: Longitudinal 3D facial images of patients (N = 17) with facial disfigurement due to cancer treatment were replicated using a facial mannequin model, by applying Thin-Plate Spline (TPS) warping and linear interpolation on the facial mannequin model in polar coordinates. Principal Component Analysis (PCA) was used to capture longitudinal structural and textural variations found within each patient with facial disfigurement arising from the treatment. We treated such variations as disfigurement. Each disfigurement was smoothly stitched on a healthy face by seeking a Poisson solution to guided interpolation using the gradient of the learned disfigurement as the guidance field vector. The modeling technique was quantitatively evaluated. In addition, panel ratings of experienced medical professionals on the plausibility of simulation were used to evaluate the proposed disfigurement model. RESULTS: The algorithm reproduced the given face effectively using a facial mannequin model with less than 4.4 mm maximum error for the validation fiducial points that were not used for the processing. Panel ratings of experienced medical professionals on the plausibility of simulation showed that the disfigurement model (especially for peripheral disfigurement) yielded predictions comparable to the real disfigurements. CONCLUSIONS: The modeling technique of this study is able to capture facial disfigurements and its simulation represents plausible outcomes of reconstructive surgery for facial cancers. Thus, our technique can be used to study human perception on facial disfigurement.

Associations between psychosocial functioning and smiling intensity in patients with head and neck cancer.

Increasing attention is being given to developing quantitative measures of facial expression. This study used quantitative facial expression analysis to examine associations between smiling intensity and psychosocial functioning in patients with head and neck cancer (HNC). Smiling intensity of 95 HNC patients was measured using 48 quantitative measures calculated from facial photographs with and without a smile. We computed a composite smiling intensity score for each patient representing the degree of similarity to healthy controls. A lower composite score indicates that the person is less expressive, on average, than healthy controls. Patients also completed self-report measures assessing domains of body image and quality of life (QOL). Spearman rank correlations were computed to examine relationships between composite scores and psychosocial functioning. Composite scores were significantly correlated with multiple measures of body image and QOL. Specifically, decreased smiling intensity was associated with feelings of dissatisfaction with one's body, perceived negative social impact of body image, increased use of avoidance as a body image-coping strategy, reduced functional well-being, and greater head and neck cancer-specific issues. To the best of our knowledge, this is the first study to demonstrate associations between an objectively quantified facial expression (i.e. smiling) and psychosocial functioning. Most previous studies have measured facial expression qualitatively. These findings indicate that smiling intensity may serve as an important clinical indicator of psychosocial well-being and warrants further clinical investigation.

Managing body image difficulties of adult cancer patients: lessons from available research.

BACKGROUND: Body image is a critical psychosocial issue for patients with cancer because they often undergo significant changes to appearance and functioning. The primary purpose of this review article was to identify empirically-supported approaches to treat body image difficulties of adult cancer patients that can be incorporated into high-quality comprehensive cancer care. METHODS: An overview was provided of theoretical models of body image relevant to cancer patients, and findings were presented from published literature on body image and cancer from 2003 to 2013. These data were integrated with information from the patient-doctor communication literature to delineate a practical approach for assessing and treating body image concerns of adult cancer patients. RESULTS: Body image difficulties were found across patients with diverse cancer sites, and were most prevalent in the immediate postoperative and treatment period. Age, body mass index, and specific cancer treatments have been identified as potential risk factors for body image disturbance in cancer patients. Current evidence supports the use of time-limited cognitive-behavioral therapy interventions for addressing these difficulties. Other intervention strategies also show promise but require further study. Potential indicators of body image difficulties were identified to alert health care professionals when to refer patients for psychosocial care, and a framework was proposed for approaching conversations about body image that can be used by the oncologic treatment team. CONCLUSIONS: Body image issues affect a wide array of cancer patients. Providers can use available evidence combined with information from the health care communication literature to develop practical strategies for treating body image concerns of patients with cancer.

Body image screening for cancer patients undergoing reconstructive surgery.

OBJECTIVES: Body image is a critical issue for cancer patients undergoing reconstructive surgery, as they can experience disfigurement and functional impairment. Distress related to appearance changes can lead to various psychosocial difficulties, and patients are often reluctant to discuss these issues with their healthcare team. Our goals were to design and evaluate a screening tool to aid providers in identifying patients who may benefit from referral for specialized psychosocial care to treat body image concerns. METHODS: We designed a brief four-item instrument and administered it at a single time point to cancer patients who were undergoing reconstructive treatment. We used simple and multinomial regression models to evaluate whether survey responses, demographic, or clinical variables predicted interest and enrollment in counseling. RESULTS: Over 95% of the sample (n = 248) endorsed some concerns, preoccupation, or avoidance because of appearance changes. Approximately one-third of patients were interested in obtaining counseling or additional information to assist with body image distress. Each survey item significantly predicted interest and enrollment in counseling. Concern about future appearance changes was the single best predictor of counseling enrollment. Sex, age, and cancer type were not predictive of counseling interest or enrollment. CONCLUSIONS: We present initial data supporting use of the Body Image Screener for Cancer Reconstruction. Our findings suggest benefits of administering this tool to patients presenting for reconstructive surgery. It is argued that screening and treatment for body image distress should be provided to this patient population at the earliest possible time point.

Long-term outcomes of a cell phone-delivered intervention for smokers living with HIV/AIDS.

BACKGROUND: People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) have a substantially higher prevalence of cigarette smoking compared to the general population. In addition, PLWHA are particularly susceptible to the adverse health effects of smoking. Our primary objective was to design and test the efficacy over 12 months of a smoking cessation intervention targeting PLWHA. METHODS: Participants were enrolled from an urban HIV clinic with a multiethnic and economically disadvantaged patient population. Participants received smoking cessation treatment either through usual care (UC) or counseling delivered by a cell phone intervention (CPI). The 7-day point prevalence abstinence was evaluated at 3, 6, and 12 months using logistic regression and generalized linear mixed models. RESULTS: We randomized 474 HIV-positive smokers to either the UC or CPI group. When evaluating the overall treatment effect (7-day abstinence outcomes from 3-, 6-, and 12-month follow-ups), participants in the CPI group were 2.41 times (P = .049) more likely to demonstrate abstinence compared to the UC group. The treatment effect was strongest at the 3-month follow-up (odds ratio = 4.3, P < .001), but diminished at 6 and 12 months (P > .05). CONCLUSIONS: Cell phone-delivered smoking cessation treatment has a positive impact on abstinence rates compared to a usual care approach. Future research should focus on strategies for sustaining the treatment effect in the long term.

The nature and extent of body image concerns among surgically treated patients with head and neck cancer.

BACKGROUND: The purpose of this study was to describe body image concerns for surgically treated patients with head and neck cancer and evaluate the relationship between body image concerns and quality of life outcomes. METHODS: Data were obtained from 280 patients undergoing surgical treatment for head and neck cancer. We used a cross-sectional design and obtained data from individuals at different time points relative to initiation of surgical treatment. Participants completed the Body Image Scale, the Functional Assessment of Cancer Therapy Scale-Head and Neck Version, and a survey designed for this study to evaluate disease-specific body image issues, satisfaction with care regarding body image issues, and interest in psychosocial intervention. RESULTS: Body image concerns were prevalent in the majority of participants with 75% acknowledging concerns or embarrassment about one or more types of bodily changes at some point during treatment. Significant associations were found between body image concerns and all major domains of quality of life. Age, gender, cancer type, time since surgery, and body image variables were significantly associated with psychosocial outcomes. A clear subset of participants expressed dissatisfaction with care received about body image issues and/or indicated they would have liked additional resources to help them cope with body image changes. CONCLUSIONS: These data provide useful information to document wide-ranging body image difficulties for this population and provide important targets for the development of relevant psychosocial interventions.

Social challenges of cancer patients with orbitofacial disfigurement.

PURPOSE: Patients who undergo orbital exenteration often experience social problems because of their facial disfigurement. The authors studied the interaction of cancer patients who had undergone orbital exenteration with family members and friends (primary groups) and with acquaintances and strangers (secondary groups) in small and large groups. METHODS: In-depth telephone interviews were conducted with 12 patients treated at a cancer center (7 men and 5 women aged 51-81 years) and 12 family members (8 spouses and 4 children or siblings). Three patients had adenoid cystic carcinoma of lacrimal gland, 3 had squamous cell carcinoma of conjunctiva/eyelid, and 1 each had conjunctival melanoma, eyelid sebaceous gland carcinoma, transitional cell carcinoma of lacrimal sac, adenocarcinoma of orbit, neuroendocrine carcinoma of orbit, and basal cell carcinoma of eyelid. Time from orbital exenteration to interview ranged from 8 months to 36 years (median, 44 months). RESULTS: Two patient groups were identified according to comfort in interactions with acquaintances and strangers. Always comfortable patients were always at ease. Occasionally comfortable patients were at ease in large groups in situations of "benign neglect" and in small groups when they received "sympathy"; were uncomfortable in large and small groups when episodes of "intrusion" occurred; and had mixed responses to benign neglect in small groups and sympathy in large groups. Both patient groups felt comfortable with family members and friends. CONCLUSIONS: Patients who will undergo orbital exenteration should be warned about possible difficulties with social interactions. Healthcare personnel should be trained to help patients and family members prepare for such difficulties.

Characterization of human female breast and abdominal skin elasticity using a bulge test.

Characterization of material properties of human skin is required to develop a physics-based biomechanical model that can predict deformation of female breast after cosmetic and reconstructive surgery. In this paper, we have adopted an experimental approach to characterize the biaxial response of human skin using bulge tests. Skin specimens were harvested from breast and abdominal skin of female subjects who underwent mastectomy and/or reconstruction at The University of Texas MD Anderson Cancer Center and who provided informed consent. The specimens were tested within 2 h of harvest, and after freezing for different time periods but not exceeding 6 months. Our experimental results show that storage in a freezer at -20 °C for up to about 40 days does not lead to changes in the mechanical response of the skin beyond statistical variation. Moreover, displacement at the apex of the bulged specimen versus applied pressure varies significantly between different specimens from the same subject and from different subjects. The bulge test results were used in an inverse optimization procedure in order to calibrate two different constitutive material models - the angular integration model proposed by Lanir (1983) and the generalized structure tensor formulation of Gasser et al. (2006). The material parameters were estimated through a cost function that penalized deviations of the displacement and principal curvatures at the apex. Generally, acceptable fits were obtained with both models, although the angular integration model was able to fit the curvatures slightly better than the Gasser et al. model. The range of the model parameters has been extracted for use in physics-based biomechanical models of the breast.

Considering Breast Reconstruction after Mastectomy: A Patient Decision Aid Video and Workbook.

Women report difficulty understanding and personalizing breast reconstruction information during the complex and time-limited period of cancer treatment planning. Patient decision aids can help patients become well informed, form realistic expectations, prepare to communicate with the surgical team, and be more satisfied with their decision-making process. METHODS: We engaged patients, providers, and stakeholders in a user-centered design process to develop an online patient decision aid video and interactive workbook for breast reconstruction after mastectomy. The video and workbook introduce breast reconstruction and compare the risks and benefits of 3 key decisions: reconstruction versus no reconstruction, immediate versus delayed, and tissue- versus implant based. Pilot testing using cognitive interviews and pre-/postdecision aid questionnaires assessed acceptability, knowledge, and decision-making values. RESULTS: After viewing the decision aid, patients (n = 20) scored 97.5% correct on a knowledge test; however, the factors driving their decisions were varied. All (n = 40) patients and providers/stakeholders provided over 80% positive acceptability ratings. 97.5% said they would recommend the video and workbook to other women with breast cancer. CONCLUSIONS: The Considering Breast Reconstruction after Mastectomy patient decision aid video and workbook show potential for improving informed decision-making. Delivery before the initial plastic surgery consultation was well supported as a way to give women time to process the information and prepare to talk with the surgical team about their options. The Personal Decision Worksheet shows potential for assessing patients' knowledge and the factors driving their personal decision-making process.

English and Spanish versions of the Body Shape Questionnaire: measurement equivalence across ethnicity and clinical status.

OBJECTIVE: We evaluated the psychometric properties and measurement equivalence of various forms of the Body Shape Questionnaire (BSQ) (Cooper et al., Int J Eat Disord, 6, 485-494, 1987) in American and Spanish women with and without an eating disorder diagnosis. METHOD: Participants included four groups of women: Euro-American (n = 505), Hispanic-American (n = 151), and Spanish (n = 445) females without an eating disorder and Spanish women being treated for an eating disorder (n = 177). RESULTS: Single and multigroup confirmatory factor analyses using maximum likelihood estimation with robust standard errors tested the data for configural and metric invariance. Goodness-of-fit statistics indicated that the original and all alternate forms of the BSQ fit the data well across groups. Most factor loadings were similar across groups. We also developed a 10-item version that appeared to be invariant across groups. CONCLUSION: Results strongly support configural invariance and offer some support for metric invariance.