Introduction
A cancer diagnosis during childhood and its intensive treatment
requiring frequent hospitalizations and invasive procedures raises a
broad range of medical and psycho-social challenges for the affected
children.1 Despite
steadily increasing survival rates, reaching 85% in
Switzerland,2 childhood
cancer survivors have a lifelong increased risk of chronic health
conditions.3,4The treatment’s immediate impact on the body, visible and invisible late
consequences such as scars, amputations or endocrine problems such as
growth hormone deficiency may interfere with survivors’ psycho-sexual
development and body
image.5-7 Growth hormone
deficiency is a common consequence of childhood cancer treatment and has
been previously shown to impair linear growth, reduce cardiac muscle
mass, and increase fat
mass.8 The cancer
experience may further disrupt social interactions with peers and
survivors may perceive their bodies as something that has failed them or
as a source of pain.9 A
healthy body image is of particular importance during adolescence which
is a critical developmental period characterized by many challenges such
as puberty, establishing autonomy, first partner relationships, and
realization of own
sexuality.10-12
Understanding the impact of childhood cancer on the body image of
adolescent survivors is critical to guide adequate support strategies
and to mitigate adverse consequences on survivors’ future quality of
life and psycho-social
well-being.13,14Qualitative studies suggest negative effects of childhood cancer on
survivors’ body
image.15-18 However, a
systematic review from 2009 concluded that there is no consistent
evidence regarding differences in body image between children and
adolescents with cancer and healthy
controls.19 A recent
study from Sweden indicated higher body image disturbance in adult women
who survived childhood cancer compared to the cancer-free
women20 while another
study from the Netherlands found no
differences.9 However,
evidence from studies including adolescent childhood cancer survivors is
sparse and it remains unclear how chronic health conditions affect the
body image of long-term survivors. In this study, we therefore aimed to
compare the body image between adolescent cancer survivors and their
siblings and to determine whether survivors’ body image is associated
with socio-demographic characteristics, clinical characteristics, and
chronic health conditions.