Results
Of 882 eligible survivors aged 16-19 years, 794 received the
questionnaire (Figure 1 ). Of those, 543 completed the
questionnaire (response rate 68%). We excluded 39 (5%) survivors with
missing information on body image and finally included 504 (64%) in the
analysis. The final sibling population consisted of 136 participants.
Most survivors and siblings were from a German speaking region and did
not report a migration background (Table 1 ). Thirty percent of
survivors and siblings reported that they currently have a boyfriend or
girlfriend. Among survivors, median age at diagnosis was 5.8 years
(interquartile range [IQR] 2.6-9.9), median time since diagnosis
11.6 years (IQR 8.2-14.8), and median age at study 17.7 years (IQR
16.8-18.6). The most frequent cancer diagnoses were leukaemia (32%) and
CNS tumours (17%). Clinical characteristics were similar between
participating and non-participating survivors (Supplementary
table S1 ).
Chronic health conditions were reported by 354 (70%) survivors with 141
(28%) reporting 1 condition and 213 (42%) ≥ 2 conditions. Neurological
(33%), renal and digestive (23%), and musculoskeletal conditions
(23%) were most frequently reported (Table 2 ). The most
commonly reported symptoms within these conditions were balance
disorders (15%), chronic constipation or diarrhoea (9%), and prolonged
pain in bones or joints (9%). Growth hormone deficiency was reported by
49 (10%) of survivors.
Body image in adolescent childhood cancer survivors and
their
siblings
Survivors and siblings reported overall comparable levels of body image
(Figure 2; all p from chi-squared tests and ordered logistic
regression >0.05). Few survivors (4.6%) and siblings
(2.9%) completely disagreed with the statement I am satisfied
with my body image . Slightly more survivors than siblings completely
agreed with the statements I would like to change a few things
regarding my body (28.9% vs. 24.0%) and I would like to change
many things regarding my body (7.6% vs. 2.5%).
Determinants of a more negative body image in
survivors
In terms of socio-demographic determinants, we found that female
survivors were more likely to have a negative body image compared to
male survivors (Table 3 ). This was evident for all three body
image statements (all ORs ≥ 1.7). After adjustment for age at study and
sex, we further found that survivors from French or Italian-speaking
Switzerland (OR=1.6, 95%-CI: 1.1-2.3) and those with a migration
background (OR=1.5, 95%-CI: 1.0-2.1) more often would like to change
many things regarding their bodies. We identified cancer treatment as
the most important clinical determinant. Compared to surgery only,
survivors that received HSCT were more likely to have a negative body
image. This was observed for all three body image statements (all ORs ≥
2.2). CNS tumour survivors were less often satisfied with their body
image compared to leukaemia survivors (OR=1.6, 95%-CI: 1.0-2.7).
Survivors with ≥ 2 chronic health conditions were more likely to have a
negative body image compared to survivors without chronic health
conditions (Table 4 ). This was observed for all three body
image statements (all ORs ≥ 1.5). Survivors suffering from
musculoskeletal and endocrine conditions consistently reported a more
negative body image compared to survivors without such conditions. A
separate analysis of growth hormone deficiency revealed particularly
pronounced associations. Survivors with growth hormone deficiency were
less often satisfied with their body image (OR=3.4, 95%-CI: 1.9-6.0)
and more often would like to change few (OR=2.2, 95%-CI: 1.3-3.9) or
many things regarding their bodies (OR=2.3, 95%-CI: 1.3-4.1). Survivors
with renal and digestive conditions more often would like to change few
things regarding their bodies (OR=1.6, 95%-CI: 1.1-2.4). Survivors with
neurological conditions were less often satisfied with their body image
(OR=1.4, 95%-CI: 1.0-2.0). These associations remained virtually
unchanged after adjustment for age at study and sex.