Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: Body image distress (BID) is a multidimensional construct characterized by disfigurement and functional impairment-related issues that affects at least 25% of head and neck cancer (HNC) survivors and results in debilitating psychosocial morbidity. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that improves overall HNC-related BID. However, the effect of BRIGHT on key subdomains of HNC-related BID (e.g., other-oriented appearance concerns, personal dissatisfaction with appearance, distress with functional impairment, and social avoidance) is unknown.
Objective: To evaluate the preliminary efficacy of BRIGHT in reducing HNC-related BID across its underlying domains.
Design, Setting, and Participants: In this randomized clinical trial at a single US academic medical center, adult HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose-and delivery-matched survivorship education (attention control [AC]).
Main Outcomes and Measures: Domains of HNC-related BID were assessed at baseline and 1- and 3-months post-intervention using IMAGE-HN (Inventory to Measure and Assess imaGe disturbancE–Head and Neck), a validated patient-reported outcome of HNC-related BID with four independent sub-scales measuring (1) other-oriented appearance concerns, (2) personal dissatisfaction with appearance, (3) distress with functional impairment, and (4) social avoidance. The model-based treatment effect of BRIGHT on the 1-month and 3-month change scores for each IMAGE-HN subdomain was estimated using ANACOVA with change score (1 [or 3]-month score – baseline score) modeled as a function of treatment group (AC, BRIGHT & Therapist A, BRIGHT & Therapist B), with adjustment for baseline scores.
Results: Among 44 HNC survivors with BID randomized to BRIGHT or AC, the median (range) age was 63 (41-80) years; 61% (n=27) identified as female, 50% (n=22) had oral cavity cancer, and 61% (n=27) underwent surgery followed by adjuvant (chemo)radiation. BRIGHT improved other oriented-appearance (OOA) concerns at 1- and 3-months relative to AC (mean model-based difference in Δ IMAGE-HN OOA score = -3.0 [90% CI -5.5 to -0.4] and -5.3 [90% CI -8.2 to -2.3], respectively). BRIGHT decreased personal dissatisfaction with appearance (PDA) (mean model-based difference in Δ IMAGE-HN PDA score = -3.2; 90% CI -5.5 to -0.9) and distress with functional impairment (DFI) (mean model-based difference in Δ IMAGE-HN DFI score = -3.8, 90% CI -6.6, -0.9) at 3-months relative to AC. BRIGHT also reduced social avoidance (SA) at 1- and 3- months relative to AC (mean model-based difference in Δ IMAGE-HN SA score = -3.3 [90% CI -5.9 to -0.7] and -4.1 [90% CI -6.5 to -1.7], respectively).
Conclusions: In this RCT among HNC survivors with BID, BRIGHT improved BID across all key subdomains, including other-oriented appearance concerns, personal dissatisfaction with appearance, distress with functional impairment, and social avoidance with greater impact at 3 months for some domains. These promising preliminary data support further efficacy testing of BRIGHT as an evidence-based treatment for HNC survivors with BID.