Skip to main content
Download PDF

Assessing the factors associated with body image perception and quality of life of Palestinian women undergoing breast cancer treatment: a cross-sectional study

BMC Women's Health volume 24, Article number: 565 (2024) Cite this article

Abstract

Background

Worldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy. Breast cancer poses a significant burden on the health and quality of life of women and can lead to substantial physical burdens and significant psychological problems, including distress, anxiety, depression, and sexuality-related issues, including negative body image. This study was conducted to assess how women diagnosed with, treated, and/or receiving treatment for breast cancer perceived their body image.

Methods

A cross-sectional study design was used to assess body image perceptions among Palestinian women diagnosed with breast cancer. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care in the period between November 2023 and March 2024. An interviewer-administered questionnaire was used to collect the data. Body perception was assessed using the body image self-rating questionnaire for breast cancer (BISQ-BC).

Results

In this study, 376 women with breast cancer completed the interviewer-administered questionnaire (response rate = 75.2%. The mean age of the women was 44.0 ± 5.3 years. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Multiple linear regression showed that younger age, employment status, living in cities, marital status, educational level, presence of comorbidities, and longer time passes since diagnosis with breast cancer were associated with the different aspects of body image perception and behavior.

Conclusion

The findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

Peer Review reports

Background

Worldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy [1]. In 2020, more than 2.3 million new cases were diagnosed with breast cancer and more than 685,000 patients died as a result of breast cancer [1, 2]. In Palestine, breast cancer is the most common cancer among Palestinian women [3]. In 2015, 244 new cases of breast cancer were diagnosed which accounted for 36% of all cancer cases in Palestine [4]. In the period between 2017 and 2021, there were 2,502 registered invasive breast cancer cases with an age-standardized incidence rate of 29.6 per 100,000 people [5].

It has been estimated that more than 89% of patients diagnosed with breast cancer survive for at least 5 years following diagnosis [6]. Moreover, the incidence of breast cancer in younger women is increasing, with an estimated 33.6% of new breast cancer cases occurring annually among women aged 54 years or younger [7, 8]. Breast cancer poses a significant burden on the health and quality of life of women and can lead to significant physical burden and psychological problems, including distress, anxiety, depression, and sexuality-related problems, including negative body image [7].

It is noteworthy to mention that body image is a picture that one forms in their mind that can be associated with the expression of emotions, imitation, identification, beauty, and social aspects [7]. In women, the concept of body image has three dimensions, including feeling feminine/attractive (affective), avoiding people because of appearance (behavioral), and satisfaction with appearance (cognitive) [9]. It has been suggested that women cope better with breast cancer when they have a better conceptualization of their body images [10]. Among young women, body image concerns could be linked to surgical removal of breasts, scarring, and other physical changes that result from adjuvant treatments. This can lead to significant deterioration of the quality of life and negative body image perceptions [7, 11]. Moreover, it is widely thought that holding a negative body image can inversely affect the physical and psychological health of women with breast cancer and their relationships [7].

Previous studies have reported that patients with different types of cancer hold a negative body image compared to the general population [12,13,14]. Among breast cancer patients, a systematic review of 36 studies showed that women who underwent radical surgeries, chemotherapy, and radiation therapy, and those who were in advanced stages of breast cancer reported higher dissatisfaction with their body images compared to those who received less aggressive treatments and those who were in early stages of breast cancer [7]. In addition, perception of one’s body image and self-acceptance among women with breast cancer were also influenced by sociodemographic variables, including educational level, relationship satisfaction, and cancer-specific anxiety and distress [7, 11,12,13]. However, another study reported that the type of cancer, type of treatment, and time passed since diagnosis with cancer did not affect the negative body image among the patients [14].

Cancer care in the Palestinian territories is highly fragmented and prioritizes treatment over the other components of the cancer care continuum, including diagnosis, screening, prevention, and support [4]. For instance, there is an absence of a cancer control strategy for preventable cancers. In addition, little psychological and mental health support is provided to patients with cancer [4, 15, 16]. This lack of specialist psychological and mental health support for breast cancer patients poses a problem in delivering adequate care for cancer patients. Because the number of women diagnosed or living with breast cancer is expected to increase, the burden of cancer care is also expected to increase, given constraints in the financial and infrastructural resources, together with the political instabilities.

Little research was conducted to assess the perceptions of Palestinian women with breast cancer of their body image. Additionally, little is known about the sociodemographic and clinical factors that could be associated with the different dimensions of body image among Palestinian women with breast cancer. Therefore, this study was conducted to assess how women diagnosed with, treated, and/or ongoing treatment for breast cancer perceived their body image. Another objective was to assess the associations between the sociodemographic and clinical variables of the women with their perceptions of their body image.

Methods

Study design and settings

To achieve the objectives of this research, a cross-sectional design was used. Cancer diagnosis, treatment, and care services are provided in four hospitals in the West Bank of Palestine [4, 15]. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care. The study was conducted in the period between November 2023 and March 2024.

Population

The study population was Palestinian women with breast cancer who received treatment or visited different hospitals and outpatient clinics for follow-up visits. The patients were recruited when they were females, diagnosed with breast cancer, in the age range 35–50 years, resided in the West Bank, received treatment or were receiving treatment for breast cancer, and were cooperative and expressed willingness to participate in the study. The patients were excluded when they were male and diagnosed with breast cancer, under the age of 35 years, or older than 50 years.

Sample size and sampling method

The age-standardized incidence rate of breast cancer was estimated by the Palestinian Ministry of Health at 29.6 per 100,000 people [5]. Additionally, the number of invasive breast cancer cases registered in the period between 2017 and 2021 was 2,502. In recent years, 500 to 600 new cases of breast cancer have been annually reported in Palestine [17, 18]. The five-year survival rate of breast cancer patients was estimated by the Palestinian Ministry of Health at 74%. Based on these statistical data, about 2,035 women were living with breast cancer in Palestine by late 2023.

The sample size needed for this study was calculated using a sample size calculator (http://www.raosoft.com). The sample size was calculated at a 95% confidence interval, tolerating a margin of error of 5%, and assuming a default response distribution of 50%. The sample size needed for this study was 324 women with breast cancer. During the study period, the field researchers were able to meet 500 women with breast cancer.

The field researchers who were final year medical students with the help of the oncologists and nurses identified the potential study participants during their follow-up care visits. The women with breast cancer were approached and invited to participate in the study by the field researchers. The field researchers explained the objectives of the study to the potential study participants and obtained their informed consent.

Study tool, variables, and data collection

The data were collected during face-to-face interviews using an interviewer-administered questionnaire. The women with breast cancer were interviewed by the field researchers who were trained during their medical education/training to interview patients to systematically gather information, including patients’ medical, surgical, and medication histories, presenting health complaints, and relevant signs and symptoms associated with illnesses. The questionnaire used in this study was developed after a thorough review of the relevant literature [7, 13, 19,20,21,22,23,24]. The questionnaire collected the sociodemographic and clinical variables of the women with breast cancer including age, employment status, marital status, educational level, satisfaction with household income, place of residence, time passed since diagnosis with breast cancer, and presence of comorbidities. Educational level, employment status, and household income were previously reported to affect healthcare-seeking behaviors and access to healthcare services, notably in low-income countries [25, 26].

Because cancer care in Palestine is highly fragmented, the majority of the women with breast cancer receive different treatment modalities, including surgery, radiation therapy, chemotherapy, and hormonal therapy [4, 15, 17]. Therefore, we did not include the type of treatment in this study. Additionally, the study tool contained the body image self-rating questionnaire for breast cancer (BISQ-BC) [19]. The BISQ-BC assessed self-cognition, behavior change, arm change, sexual activity change, role change, psychological change, and social change related to body image.

The questionnaire is provided in the supplementary materials as Supplementary Table S1.

The dependent variable was the perception of women with breast cancer of their body image. The independent and background variables included age, employment status, marital status, educational level, satisfaction with income, place of residence, time passed since diagnosis with breast cancer, and presence of comorbidities.

Validity and reliability

The validity of the questionnaire was previously established using the Delphi technique among experts who were academicians or clinical staff who cared for breast cancer patients [19]. Patients with breast cancer also participated in the Delphi rounds. The questionnaire had acceptable internal consistency, convergent validity, and discriminant validity. The Cronbach’s alpha values of the originally developed for all domains of the BISQ-BC were acceptable. In this study, the Cronbach’s alpha of all BISQ-BC items was 0.88. Similarly, Cronbach’s alpha values for the different domains of the BISQ-BC were > 0.65 which indicated good internal consistency. The Cronbach’s alpha values for the different domains of the BISQ-BC are shown in Supplementary Table S2.

Statistical analysis

Statistical Package for Social Sciences (IBM SPSS) v.21.0 for Windows was used for data entry and analysis. Descriptive statistics like frequencies (n) and percentages (%) were tabulated. The continuous variables were compared using t-tests, analysis of variance (ANOVA), or Pearson’s correlation as appropriate. To control confounding factors, the variables that were significantly associated in the t-tests, ANOVA, or Pearson’s correlation were retained in multiple linear regression models. Tolerance and variance inflation factor (VIF) values were used as diagnostics for multicollinearity issues. Tolerance values of > 0.02 and VIF < 5 indicated the absence of multicollinearity issues. A p-value of less than or equal to 0.05 was considered statistically significant.

Results

Sociodemographic characteristics of women with breast cancer

Of the 500 women with breast cancer encountered, 376 women completed the interviewer-administered questionnaire, giving a response rate of 75.2%. The flowchart of the recruitment process is shown in Supplementary Figure S1. The mean age of the women with breast cancer was 44.0 ± 5.3 years. Of the women with breast cancer, 247 (65.7%) were unemployed, 298 (79.5%) were married, 145 (38.6%) had a university degree, 311 (82.7%) were satisfied with their household income, 194 (51.6%) lived in cities, and 111 (29.5%) had comorbid diseases. The mean time passed since diagnosis with breast cancer was 3.5 ± 3.0 years. The detailed sociodemographic and health characteristics of the women with breast cancer are shown in Table 1.

Table 1 Sociodemographic and health characteristics of the women with breast cancer (n = 376)
Full size table

Perceptions of women with breast cancer of their body image

Table 2 details the answers of the women with breast cancer on each item of the BISQ-BC. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Similarly, 52.4% of the women agreed or strongly agreed that they cared about the treatment-related body image changes and 70% of the women reported checking the appearance of their breasts repeatedly. While 55.6% of the women agreed or strongly agreed that they were satisfied with the appearance of their arm, 33.7% of the women also agreed or strongly agreed that arm swelling and pain affected the routine of their lives. Of the women, 42.8% felt that body image changes made them lose their feminine charm and 35.6% reported that the body image changes influenced the quality of their sexual life. Of the women, 24.2% reported the influence of body image changes on their original work/social roles and 19.9% reported the influence of body image on their family roles. More than half of the women (56.1%) reported that felt like their body was “breaking down” and were worried about relapse. One-fourth of the women reported trying to avoid participating in social activity due to body image change.

Of the women, 281 (74.7%) reported that they had a sex life and 95 (25.3%) reported that they did not have a sex life. The reasons for not having a sex life are provided in Supplementary Table S3.

Table 2 Perceptions of women with breast cancer of their body image as assessed using the BISQ-BC
Full size table

Associations between the characteristics of the women with their body image perception

Associations between the different sociodemographic and health variables of the patients with the body-image-related self-cognition, behavior change, arm change, sexual activity change, role change, psychological change, and social change scores are shown in Supplementary Table S4.

The variables that were significantly associated in the t-tests, ANOVA, or Pearson’s correlation were included in multiple linear regression models. Factors predicting higher body image perception scores are shown in Table 3. Higher self-cognition scores could be predicted by being employed, divorced or married, and having other diseases. Moreover, behavior change scores could be predicted by younger age, living in cities, not having comorbidities, and longer time passes since diagnosis with breast cancer. In addition, higher arm change scores could be predicted by being single, having a respiratory disease and longer time passes since diagnosis with breast cancer. Furthermore, higher sexual activity change scores could be predicted by younger age, living in cities, not having comorbidities and longer time passes since diagnosis with breast cancer. Additionally, higher role change scores could be predicted by having gout. Moreover, higher psychological change scores could be predicted by older age, having a basic school education, living in cities, not having comorbidities, and longer time passes since diagnosis with breast cancer. Finally, higher social change scores could be predicted by not having other diseases and shorter time passes since diagnosis with breast cancer.

Table 3 Factors predicting body image perception scores
Full size table

Discussion

Breast cancer and its treatment can impact how patients perceive their body image [7, 11, 27]. This study was the first exploration of how Palestinian women with breast cancer perceived their body image. Additionally, the study identified the sociodemographic and health factors predicting body image perception. The findings of this study showed that women with breast cancer in Palestine were concerned about their body image. These findings are of paramount importance for oncologists, onco-surgeons, psychiatrists, psychologists, social workers, and other providers of care services for women with breast cancer in the Palestinian healthcare system.

The findings of this study showed that breast cancer affected the self-cognition of women with breast cancer. These effects were evident from the ratings of the four-body image-related self-cognition items. While a considerable proportion of the women reported caring about their body image, however, 43.1% were dissatisfied with their body image, 58.7% did not think that their body image was attractive, and 48.7% avoided showing their body image through dressing and hairstyles. These findings indicated that a considerable proportion of the women with breast cancer had negative perceptions of their body images. The results reported in this study were consistent with those reported among women with breast cancer elsewhere, including the United States, China, Europe, South Korea, Australia, and Iran [7, 28,29,30]. Women with breast cancer also had negative perceptions of their body images. These findings indicate a heavy burden posed by breast cancer on the self-cognition. Taken together, these findings indicate that healthcare providers and decision-makers in the Palestinian healthcare system should consider screening for psychosocial issues among women with breast cancer. Additionally, providing tailored and personalized psychosocial support and counseling should be included in the care plans for women with breast cancer. These counseling sessions could be beneficial in improving the psychosocial well-being of the women with breast cancer who receive care services in the Palestinian healthcare system.

Similarly, a considerable proportion of the women expressed concerns about the treatment-related body image changes. In this study, the women reported making efforts to hide their bodies and avoid any exposure. These findings indicate that breast cancer and its treatment changed the behaviors of the affected women and posed a burden to hide their bodies and limit contact with others. These findings were not surprising as women with breast cancer were reported to express shame about their body image as a result of treatment [7, 30]. Undergoing radical surgeries, the use of intensive chemotherapy, radiation therapy, and having more advanced-stage cancers were associated with higher dissatisfaction with body image compared to more conservative and reconstructive approaches and using less aggressive treatment strategies [7, 11]. These findings indicate that healthcare providers should educate and counsel patients about the available therapeutic options and their expected outcomes. Moreover, breast cancer patients should be more engaged in deciding on the therapeutic options along with their caring clinicians. Educational and counseling materials and sessions should be personalized and adapted to the particular needs of the individual patients, notably those who are scheduled to undergo radical surgeries, use intensive chemotherapy, and radiation therapy, and have more advanced-stage cancers. Healthcare providers might encourage women with breast cancer to express their feelings about their body image. In addition, potential physical and body image changes because of the disease and treatment might be discussed. Moreover, healthcare providers might consider discussing the availability of surgical and reconstructive surgical options, when possible. Women with breast cancer who hold significantly negative body image perception could be candidates for referral to psychosocial support and cognitive behavioral therapy. Moreover, women with breast cancer might benefit from appropriately designed nutritional and physical activity interventions. These options could promote self-acceptance and reduce negative perceptions of one’s body image.

In this study, breast cancer and its treatment had impacts on the arm, sexual activity, role, psychological, and social functioning. The findings reported in this study highlight the heavy burden of breast cancer and its treatment on the different dimensions of the lives and functioning of the affected patients. Many previous studies have reported a significant negative impact of breast cancer and its treatments on the various aspects of the quality of life of the affected patients [11, 27, 31,32,33,34,35]. Together, these findings indicate that there is a need for highly effective self-esteem-boosting interventions among breast cancer after receiving diagnosis, during, and after treatment. These interventions need to be tailored and personalized to the individual needs of the patients.

In this study, age, residing in urban areas, comorbidities, and duration since diagnosis of breast cancer were associated with the different aspects of body image perceptions. These findings substantiate the need for tailored and personalized psychosocial interventions to improve the quality of life of the affected patients [32]. Our findings indicate that healthcare providers should use more culturally sensitive approaches, educational/counseling, and holistic care approaches to improve the well-being and outcomes of breast cancer patients who receive care in the Palestinian healthcare system.

Limitations

This study has some limitations that need to be acknowledged. First, Although the use of a cross-sectional design allowed for establishing correlations, however, the use of this design limited the establishment of causal relationships between the variables of the women and their perceptions of body image. Second, the data collected in this study were self-reported. Therefore, there is a potential for desirability and recall bias. Third, this study used a quantitative approach to collect and analyze the data. The collection of qualitative data could have provided further a more holistic understanding of the different dimensions of the phenomenon. Fourth, the impact of treatment modality was not assessed in this study. Future studies should consider comparing the effects of different treatment modalities on the perception of women with breast cancer of their body image.

Conclusion

The findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Healthcare providers should address the psychosocial well-being of women with breast cancer who receive treatment and care in the Palestinian healthcare system. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

Data availability

All data analyzed in this study were included in the manuscript and supplementary materials. The datasets used in the analysis or entered into statistical software can be obtained from the corresponding author upon making a reasonable request.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

    Article  Google Scholar 

  2. Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, Vignat J, Gralow JR, Cardoso F, Siesling S, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast. 2022;66:15–23.

    Article  PubMed Central  Google Scholar 

  3. Factsheets. [https://gco.iarc.fr/today/en]

  4. Halahleh K, Gale RP. Cancer care in the Palestinian territories. Lancet Oncol. 2018;19(7):e359–64.

    Article  PubMed  Google Scholar 

  5. Center PHI. Cancer in Palestine: 5-Year cancer report 2017–2021. In. Ramallah. Palestine: Ministry of Health; 2023.

    Google Scholar 

  6. Campbell ID, Scott N, Seneviratne S, Kollias J, Walters D, Taylor C, Webster F, Zorbas H, Roder DM. Breast cancer survival in New Zealand women. ANZ J Surg. 2015;85(7–8):546–52.

    Article  PubMed  Google Scholar 

  7. Paterson CL, Lengacher CA, Donovan KA, Kip KE, Tofthagen CS. Body image in younger breast Cancer survivors: a systematic review. Cancer Nurs. 2016;39(1):E39–58.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Anastasiadi Z, Lianos GD, Ignatiadou E, Harissis HV, Mitsis M. Breast cancer in young women: an overview. Updates Surg. 2017;69(3):313–7.

    Article  PubMed  Google Scholar 

  9. Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189–97.

    Article  PubMed  CAS  Google Scholar 

  10. Han J, Grothuesmann D, Neises M, Hille U, Hillemanns P. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet. 2010;282(1):75–82.

    Article  PubMed  Google Scholar 

  11. Rodrigues ECG, Neris RR, Nascimento LC, de Oliveira-Cardoso ÉA, Dos Santos MA. Body image experience of women with breast cancer: a meta-synthesis. Scand J Caring Sci. 2023;37(1):20–36.

    Article  PubMed  Google Scholar 

  12. Brederecke J, Heise A, Zimmermann T. Body image in patients with different types of cancer. PLoS ONE. 2021;16(11):e0260602.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Rezaei M, Elyasi F, Janbabai G, Moosazadeh M, Hamzehgardeshi Z. Factors influencing body image in women with breast Cancer: a Comprehensive Literature Review. Iran Red Crescent Med J. 2016;18(10):e39465.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bahrami M, Mohamadirizi M, Mohamadirizi S, Hosseini SA. Evaluation of body image in cancer patients and its association with clinical variables. J Educ Health Promotion. 2017;6:81.

    Article  Google Scholar 

  15. Kharroubi AT, Abu Seir RY. Cancer Care in Palestine. In: Cancer Care in Countries and Societies in Transition: Individualized Care in Focus. edn. Edited by Silbermann M. Cham: Springer International Publishing; 2016: 77–97.

  16. Mitwalli S, Hammoudeh W, Giacaman R, Harding R. Access to advanced cancer care services in the West Bank-occupied Palestinian territory. Front Oncol. 2023;13:1120783.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Salem HS. Cancer status in the occupied Palestinian territories: types; incidence; mortality; sex, age, and geography distribution; and possible causes. J Cancer Res Clin Oncol. 2023;149(8):5139–63.

    Article  PubMed  Google Scholar 

  18. AlWaheidi S. Promoting cancer prevention and early diagnosis in the occupied Palestinian territory. J Cancer Policy. 2023;35:100373.

    Article  PubMed  Google Scholar 

  19. Zhou K, He X, Huo L, An J, Li M, Wang W, Li X. Development of the body image self-rating questionnaire for breast cancer (BISQ-BC) for Chinese mainland patients. BMC Cancer. 2018;18(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Helms RL, O’Hea EL, Corso M. Body image issues in women with breast cancer. Psychol Health Med. 2008;13(3):313–25.

    Article  PubMed  Google Scholar 

  21. Przezdziecki A, Sherman KA, Baillie A, Taylor A, Foley E, Stalgis-Bilinski K. My changed body: breast cancer, body image, distress and self-compassion. Psychooncology. 2013;22(8):1872–9.

    Article  PubMed  Google Scholar 

  22. Collins KK, Liu Y, Schootman M, Aft R, Yan Y, Dean G, Eilers M, Jeffe DB. Effects of breast cancer surgery and surgical side effects on body image over time. Breast Cancer Res Treat. 2011;126(1):167–76.

    Article  PubMed  Google Scholar 

  23. Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579–94.

    Article  PubMed  Google Scholar 

  24. Rosenberg SM, Tamimi RM, Gelber S, Ruddy KJ, Kereakoglow S, Borges VF, Come SE, Schapira L, Winer EP, Partridge AH. Body image in recently diagnosed young women with early breast cancer. Psychooncology. 2013;22(8):1849–55.

    Article  PubMed  Google Scholar 

  25. Sobri FB, Bachtiar A, Panigoro SS, Ayuningtyas D, Gustada H, Yuswar PW, Nur AA, Putri R, Widihidayati AD. Factors affecting delayed presentation and diagnosis of breast Cancer in Asian developing Countries women: a systematic review. Asian Pac J cancer Prevention: APJCP. 2021;22(10):3081–92.

    Article  Google Scholar 

  26. Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465–77.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Miaja M, Platas A, Martinez-Cannon BA. Psychological impact of alterations in sexuality, fertility, and body image in young breast Cancer patients and their partners. Rev Invest Clin. 2017;69(4):204–9.

    PubMed  Google Scholar 

  28. Zhou K, Wang W, Li M, An J, Huo L, He X, Li J, Li X. Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):163.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhu F, Zhang W, Liu C, Qiang W, Lu Q. Association of self-compassion and body image disturbance among young breast cancer patients: mediating effect of body surveillance and body shame. Asia Pac J Oncol Nurs. 2023;10(4):100199.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zhu F, Liu C, Zhang W, Qiang W, Yin X, Lu Q. The mediating effect of coping styles between self-compassion and body image disturbance in young breast cancer survivors: a cross-sectional study. BMC Nurs. 2023;22(1):178.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Montagnese C, Porciello G, Vitale S, Palumbo E, Crispo A, Grimaldi M, Calabrese I, Pica R, Prete M, Falzone L et al. Quality of life in women diagnosed with breast Cancer after a 12-Month treatment of lifestyle modifications. Nutrients 2020, 13(1).

  32. Morales-Sánchez L, Luque-Ribelles V, Gil-Olarte P, Ruiz-González P, Guil R. Enhancing self-esteem and body image of breast Cancer women through interventions: a systematic review. Int J Environ Res Public Health 2021, 18(4).

  33. Kołodziejczyk A, Pawłowski T. Negative body image in breast cancer patients. Adv Clin Exp Med. 2019;28(8):1137–42.

    Article  PubMed  Google Scholar 

  34. Lovelace DL, McDaniel LR, Golden D. Long-Term effects of breast Cancer surgery, treatment, and Survivor Care. J Midwifery Womens Health. 2019;64(6):713–24.

    Article  PubMed  Google Scholar 

  35. Rosenberg SM, Dominici LS, Gelber S, Poorvu PD, Ruddy KJ, Wong JS, Tamimi RM, Schapira L, Come S, Peppercorn JM, et al. Association of breast Cancer surgery with quality of life and Psychosocial Well-being in young breast Cancer survivors. JAMA Surg. 2020;155(11):1035–42.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the women who participated in this study. An-Najah National University is acknowledged for making this study possible.

Funding

This study did not receive any specific funding.

Author information

Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Bayan Omari, Sabila Abu Riash, Atef Arfat, Riad Amer & Sultan Mosleh

  2. An-Najah National University Hospital, Nablus, Palestine

    Riad Amer & Sultan Mosleh

  3. Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Ramzi Shawahna

  4. Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine

    Ramzi Shawahna

Authors
  1. Bayan Omari
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Sabila Abu Riash
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Atef Arfat
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Riad Amer
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Sultan Mosleh
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Ramzi Shawahna
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Riad Amer, Sultan Mosleh, and Ramzi Shawahna were involved in the conception and design of the work, analysis and interpretation of data, and drafting and final approval of the manuscript. Bayan Omari, Sabila Abu Riash, and Atef Arfat were involved in the data acquisition, analysis, drafting of the work and final approval of the version to be published. All authors approved the final manuscript.

Corresponding authors

Correspondence to Riad Amer, Sultan Mosleh or Ramzi Shawahna.

Ethics declarations

Ethics approval and consent to participate

The study was carried out in accordance with ethical standards, and the Declaration of Helsinki. An ethical approval was taken from the Institutional Review Board (IRB) at An-Najah National University to proceed with the study (Approval #: Med.Oct. 2023/26). Approvals were also taken from the hospitals and clinics from where the data were collected. All patients provided written informed consent. All data were treated as confidential and used for research purposes only. Anonymity was kept by using codes during the analysis.

Consent to publish

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Omari, B., Riash, S.A., Arfat, A. et al. Assessing the factors associated with body image perception and quality of life of Palestinian women undergoing breast cancer treatment: a cross-sectional study. BMC Women's Health 24, 565 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-024-03402-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-024-03402-7

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us