Body Image As a Mediator Between Bowel Dysfunction Symptoms and Psychological Outcomes Among Patients with Colorectal Cancer

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2025 Feb 28

PMID 40019604

Authors

Van Du Phung

Su-Ying Fang

Affiliations

Soon will be listed here.

Abstract

Background: Colorectal cancer (CRC) survivors commonly experience bowel dysfunction symptoms because of treatment, leading to psychological distress. While previous studies have focused on managing physical symptoms and the impact of a stoma on psychological outcomes, CRC patients without a stoma may also suffer from psychological distress, including body image distress due to their bowel dysfunction symptoms. Body image distress may mediate the relationship between bowel dysfunction symptoms and psychological outcomes in CRC patients.

Objectives: This study aims to (1) identify bowel dysfunction symptoms, body image distress, and psychological outcomes in CRC survivors and (2) examine the mediating role of body image in the relationship between bowel dysfunction symptoms and psychological outcomes.

Methods: A cross-sectional and correlational design was employed, and CRC survivors completed the Low Anterior Resection Syndrome (LARS) Score, Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS) questionnaires. The mediated role of body image was examined using Hayes' PROCESS macro.

Results: A total of 193 CRC patients provided data, with 65.8% reporting experiencing bowel dysfunction symptoms, 44.6% reporting body image distress, and 40.4% experiencing anxiety and depression. Body image was found to partially mediate the effect of bowel dysfunction symptoms on both anxiety (β = 0.0446, 95% CI = 0.0061, 0.0968) and depression (β = 0.0411, 95% CI = 0.0034, 0.0941).

Conclusion And Implications: The significant mediating role of body image underscores the importance of addressing both bowel dysfunction symptoms and body image distress. Healthcare professionals should integrate both physical and psychological aspects to promote psychological well-being.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Kotronoulas G, Papadopoulou C, Burns-Cunningham K, Simpson M, Maguire R . A systematic review of the supportive care needs of people living with and beyond cancer of the colon and/or rectum. Eur J Oncol Nurs. 2017; 29:60-70. DOI: 10.1016/j.ejon.2017.05.004. View

Cunningham D, Atkin W, Lenz H, Lynch H, Minsky B, Nordlinger B . Colorectal cancer. Lancet. 2010; 375(9719):1030-47. DOI: 10.1016/S0140-6736(10)60353-4. View

Stein A, Atanackovic D, Bokemeyer C . Current standards and new trends in the primary treatment of colorectal cancer. Eur J Cancer. 2011; 47 Suppl 3:S312-4. DOI: 10.1016/S0959-8049(11)70183-6. View

Mols F, Lemmens V, Bosscha K, Van Den Broek W, Thong M . Living with the physical and mental consequences of an ostomy: a study among 1-10-year rectal cancer survivors from the population-based PROFILES registry. Psychooncology. 2014; 23(9):998-1004. DOI: 10.1002/pon.3517. View

Stuhlfauth S, Melby L, Helleso R . Everyday Life After Colon Cancer: The Visible and Invisible Challenges. Cancer Nurs. 2017; 41(6):E48-E57. DOI: 10.1097/NCC.0000000000000506. View

Taylor C, Richardson A, Cowley S . Restoring embodied control following surgical treatment for colorectal cancer: a longitudinal qualitative study. Int J Nurs Stud. 2010; 47(8):946-56. DOI: 10.1016/j.ijnurstu.2009.12.008. View

Han C, Yang G, Syrjala K . Symptom Experiences in Colorectal Cancer Survivors After Cancer Treatments: A Systematic Review and Meta-analysis. Cancer Nurs. 2020; 43(3):E132-E158. PMC: 7182500. DOI: 10.1097/NCC.0000000000000785. View

Mols F, Schoormans D, de Hingh I, Oerlemans S, Husson O . Symptoms of anxiety and depression among colorectal cancer survivors from the population-based, longitudinal PROFILES Registry: Prevalence, predictors, and impact on quality of life. Cancer. 2018; 124(12):2621-2628. PMC: 6033166. DOI: 10.1002/cncr.31369. View

10.

Sun L, Liang J, Lin C, Sun S, Kao C . Risk of mood disorders in patients with colorectal cancer. J Affect Disord. 2017; 218:59-65. DOI: 10.1016/j.jad.2017.04.050. View

11.

Bayat Z, Taylor E, Bischof D, McCart J, Govindarajan A . Impairments in Bowel Function, Social Function and Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol. 2019; 27(1):124-131. DOI: 10.1245/s10434-019-07385-w. View

12.

Benedict C, Rodriguez V, Carter J, Temple L, Nelson C, DuHamel K . 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. Support Care Cancer. 2015; 24(4):1795-802. PMC: 4862400. DOI: 10.1007/s00520-015-2976-2. View

13.

Lim C, Laidsaar-Powell R, Young J, Kao S, Zhang Y, Butow P . Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl). 2021; 30(4):e13421. DOI: 10.1111/ecc.13421. View

14.

Calman L, Turner J, Fenlon D, Permyakova N, Wheelwright S, Patel M . Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study. Colorectal Dis. 2021; 23(12):3234-3250. PMC: 9298990. DOI: 10.1111/codi.15949. View

15.

Tsui H, Huang X . Experiences of Losing Bowel Control After Lower Anterior Resection With Sphincter Saving Surgery for Rectal Cancer: A Qualitative Study. Cancer Nurs. 2021; 45(6):E890-E896. DOI: 10.1097/NCC.0000000000001036. View

16.

van Heinsbergen M, den Haan N, Maaskant-Braat A, Melenhorst J, Belgers E, Leijtens J . Functional bowel complaints and quality of life after surgery for colon cancer: prevalence and predictive factors. Colorectal Dis. 2019; 22(2):136-145. DOI: 10.1111/codi.14818. View

17.

Song L, Pang Y, Zhang J, Tang L . Body image in colorectal cancer patients: A longitudinal study. Psychooncology. 2021; 30(8):1339-1346. DOI: 10.1002/pon.5688. View

18.

Emmertsen K, Laurberg S . Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012; 255(5):922-8. DOI: 10.1097/SLA.0b013e31824f1c21. View

19.

Juul T, Battersby N, Christensen P, Janjua A, Branagan G, Laurberg S . Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis. 2015; 17(10):908-16. DOI: 10.1111/codi.12952. View

20.

Nikoletti S, Young J, Levitt M, King M, Chidlow C, Hollingsworth S . Bowel problems, self-care practices, and information needs of colorectal cancer survivors at 6 to 24 months after sphincter-saving surgery. Cancer Nurs. 2008; 31(5):389-98. DOI: 10.1097/01.NCC.0000305759.04357.1b. View