Body image in cancer survivors: a systematic review of case-control studies

Purpose: There is common consensus that cancer and its treatment can impair the body, but combined evidence of the previous literature in cancer survivors is missing. Therefore, we reviewed body image in cancer survivors and focused on case-control studies, in order to draw conclusions as to whether body image might be altered due to cancer. Methods: Medline, Cinahl, Embase, and PsycInfo were searched and after duplicate extraction, 1932 hits were retrieved and screened for eligibility. Included studies were rated on selection, measurement, and reporting bias. Results: Twenty-five studies were identified using 19 different scales to measure body image. Ten studies reported a more negative body image in survivors, nine found no differences, three reported mixed findings, and three reported a more positive body image in survivors. Potential bias was common and 16 studies had at least three sources of potential bias. Less-biased studies (i.e., ≤2 sources of bias) hinted to weak differences between survivors and controls, favoring healthy controls. A meta-analysis could not be performed. Conclusions: This review was long overdue and indicates a somewhat more negative body image in cancer survivors than healthy controls. However, numerous problems potentially biasing study results have been detected and firm conclusions cannot be drawn. Implications for Cancer Survivors: Future studies should recruit larger samples, match samples, and pay attention to how body image is conceptualized and measured in order to draw reliable conclusions as to whether body image is impaired in cancer survivors