Understanding the role of self-image in cancer recovery

In the fall of 2012, doctors diagnosed Williams with triple-negative breast cancer. She underwent a bilateral mastectomy and had a follow-up surgery to remove lymph nodes. Williams has only just begun to cope with many of the physical changes that come with cancer treatment -- from disfiguring surgeries, to hair loss, to dry and itchy skin from chemotherapy. But with each physical change she encounters, she has found a little makeup can go a long way in making her look and feel healthy.

We all have a self-image: that picture in our heads of what we look like. If we get sick, our bodies change, our appearance changes, and so does our self-image -- often taking quite a blow. While there is no evidence to suggest that looking good will speed a cancer patient's recovery, a growing body of research indicates that understanding and effectively dealing with the appearance changes that occur during cancer treatment may help patients better cope with their disease. A 2011 study of head and neck cancer patients at University of Texas MD Anderson Cancer Center found that 75 percent of participants acknowledged "concerns or embarrassment about one or more types of bodily changes at some point during treatment." Some of these patients also voiced that they were dissatisfied with the care they received regarding their body image issues and would have liked additional resources to help them cope.

Depending on the patient, coping with appearance changes may take many forms: physical activity, therapy, or basic makeup application. A study by Look Good…Feel Better, a program of the American Cancer Society and the Personal Care Products Council Foundation, found that "86 percent of women cancer patients said that looking good helps them feel better and gives them more confidence to cope with their disease." The Look Good…Feel Better program offers free sessions to female cancer patients in more than 3,000 hospitals and community centers across the country. Makeup artists, aestheticians, hair stylists, and wig experts volunteer their services to give women a step-by-step beauty tutorial. The two-hour group sessions "help women understand what they can do to manage and control their appearance related side effects," says Louanne Roark, executive director of the Personal Care Products Council Foundation. "It gives them an opportunity to address the issue in a proactive way."

When a friend suggested that Colleen Williams attend Look Good…Feel Better, she did not hesitate. For Williams, finding a sense of normalcy during her cancer treatment has been key. And while she has attempted to take everything in stride, appearance changes can be a bit shocking, both to the patient and her friends and family. "When you are out and about, you don't want to look different because that is really when it happens," says Williams. "When you lose the eyebrows and the eyelashes it is hard to make them look real. It is hard to look like your normal self anymore."

Understanding how facial changes affect the lives of cancer patients has been a major undertaking for Michelle Cororve Fingeret, Ph.D., director of the Body Image Therapy Program at MD Anderson, one of the 67 NCI-designated Cancer Centers. The majority of Fingeret's patients have had a disfiguring surgery due to their cancer. She noticed that many of her patients who had undergone changes to the face were in a great deal of distress. "The face is a very socially significant part of the body. It is very visible and difficult to hide."

For many cancer patients, simply talking about body image is a challenge. And it is particularly difficult for patients to bring these concerns to a doctor without a tinge of guilt. "They are embarrassed or ashamed because these are people who are surviving cancer and are, by most accounts, doing well," says Fingeret. "They have a decent prognosis. So, they feel that they should not be complaining about this." But the many treatments and surgeries that come with various cancers may not just alter the physical, but one's mental views of his or herself as well.

That's where the Body Image Therapy Program comes in. "[Someone] can have the surgery to remove the cancer; they can have the radiation and the chemotherapy and they can survive," says Fingeret. "But sometimes they realize there is more that they need to address." In her specialized program, which includes both a clinical and a research component, Fingeret sees patients before and after surgery, often helping them manage and adjust their expectations for their cosmetic outcome.

The biggest problem Fingeret encounters with patients is social isolation. "That social isolation could be due to having concerns about a disfigurement or a physical change or it could be due to an embarrassment about being out in public and speaking around other people or eating around other people," says Fingeret.

Colleen Williams has struggled with isolation, sometimes because she is simply too exhausted to leave the house. "Obviously, it is a difficult thing," says Williams. "Sometimes you just don't have the energy to put on any makeup. People that are going through cancer treatment look different. You can't deny that. You can't escape that."

For Williams and many other women undergoing various cancer treatments, makeup or a good wig may be the trick to looking and feeling like their normal selves for a little while. "Looking good may not always be something that is in the forefront of your mind when you are going through the process of starting cancer treatment," says Williams. "But even if it is in the back of your mind, you throw the lipstick in your bag and you swipe it on before you go into the store. It can make a big difference."