A Study Of The Relationship Between Trajectories Of Psychosocial Adjustment Changes And Body Imagery In Breast Cancer Patients

Objective1.To analyze the levels of psychosocial adjustment and body imagery in breast cancer patients at 3 different time points: initial diagnosis,surgical period and chemotherapy period.2.To analyze whether there are heterogeneous subgroups of trends in psychosocial adjustment and body imagery development and to name them.3.To analyze the correlation between the levels of psychosocial adaptation and body imagery status at 3 different time points of breast cancer patients’ initial diagnosis,surgery period and chemotherapy period and the relationship between the trends of psychosocial adaptation changes and body imagery in different subgroups.Methods In this study,patients diagnosed with breast cancer requiring surgery and chemotherapy at the First People’s Hospital of Kunshan from August 2021 to December 2022 were selected through a longitudinal study design using a convenience sampling method.The general information questionnaire,the psychosocial adjustment questionnaire and the body imagery and relationship scale were used to investigate the psychosocial adjustment and body imagery of breast cancer patients at three time points: the initial diagnosis(T1: within three days after the patient’s diagnosis),the surgery period(T2: within three days after the patient’s surgery)and the chemotherapy period(T3: within three days after the patient’s second chemotherapy),and the latent category growth statistics were used to analyze the psychosocial adjustment and body imagery of breast cancer patients.The trajectories of psychosocial adjustment and body imagery of breast cancer patients and different categories of psychosocial adjustment and body imagery were analyzed by using latent category growth statistics.To analyze the correlation between psychosocial adjustment and body imagery of breast cancer patients at three different time points: initial diagnosis,surgery and chemotherapy,using multivariate logistic regression and generalized estimating equations.Results1.The total psychosocial adjustment scores of breast cancer patients were(141.28±32.57)and(138.90±31.59)after initial diagnosis and surgery,respectively,which were lower than the mean score of psychosocial adjustment after chemotherapy(154.70±30.83),and the difference was statistically significant(P<0.05).2.The differences between the mean scores of the dimensions of body imagery at the initial diagnosis and after surgery were not statistically significant and were all higher than the mean scores after chemotherapy(P<0.05).The total body imagery scores were(74.32±22.74) and(75.10±22.98)at the initial diagnosis and after surgery,respectively,both of which were higher than the mean score after chemotherapy(68.72±23.97),with statistically significant differences(P<0.05).3.psychosocial adaptation Individuals within the 3 category groups enjoyed exactly the same growth trajectory and showed different growth patterns.Category group 1,with 51individuals(30.9% of the total),had intercept and slope means of 176.85(P<0.001)and-0.032(P=0.977),respectively,and was named the "highly adaptive stable group".Category group 2,with 54 individuals(32.7% of the total)with mean values of intercept and slope of 142.77(P<0.001)and-1.78(P=0.381),respectively,was named as "moderate adaptation decline group".The mean values of intercept and slope were 105.04(P<0.001)and 13.13(P<0.001),respectively,for the category group of 3,60(36.4% of the total),which was named "low adaptation elevation group".4.Body imagery Individuals in the 3 category groups enjoyed identical growth trajectories and showed different growth patterns.Category group 1,with 71 individuals(43.03%),had an intercept and slope of 56.59 and-2.45,respectively,and was named the "low distress declining group".Category 2,58(35.15%),with intercepts and slopes of 79.36 and-1.37,respectively,was named the "moderately disturbed stable group".The mean values of intercept and slope were 107.44 and-2.36 for category group 3 of 36(21.82%),which was named as "highly disturbed declining group".5.The results after stepwise regression showed that monthly income,pathological stage,surgical modality,and initial diagnosis body imagery score were factors influencing the developmental trajectory of psychosocial adjustment in breast cancer patients.6.Among patients in the low-distress declining group of body imagery developmental trajectory,the proportion of patients in the high-adjustment stable group of psychosocial adaptation developmental trajectory was higher than that in the moderate-adjustment declining group and low-adjustment elevated group(64.71% vs.35.19% and 31.67%,P<0.05),while among patients in the high-distress declining group of body imagery developmental trajectory,there were no patients in the high-adjustment stable group of psychosocial adaptation developmental trajectory.developmental trajectory of high adaptation stability group,both lower than the moderate adaptation decline group and low adaptation elevation group(0.00%vs.29.62% and 33.33%,P<0.05).In the generalized estimating equation,the OR(95% CI)was1.15(1.08 to 1.23)and 1.28(1.20 to 1.36)for the moderately disturbed stable and low disturbed declining groups,respectively,in the univariate analysis,after adjusting for possible confounders,with the moderately disturbed stable and low disturbed declining groups having higher psychosocial likelihood of a 14%(OR=1.14,95% CI: 1.06 to 1.22)and 25%(OR=1.25,95% CI: 1.16 to 1.34)increase in total adjustment score,respectively.Conclusion1.The average level of psychosocial adjustment of breast cancer patients at initial diagnosis,after surgery,and after chemotherapy was at a low level of moderate adjustment.The overall body imagery of breast cancer patients was on average at a moderate level at initial diagnosis,after surgery,and after chemotherapy.2.The developmental trajectories of psychosocial adaptation in breast cancer patients corresponded to three qualitatively different category models,namely,high adaptation stable group,moderate adaptation decreasing group,and low adaptation increasing group.The trajectories of physical imagery development in breast cancer patients corresponded to 3qualitatively different category models,namely,high distress decline group,moderate distress stability group and low distress decline group.3.There is an inverse relationship between body imagery and psychosocial adaptation of breast cancer patients.4.Monthly income,pathological stage,surgical modality and level of body imagery at first diagnosis can be used as predictors of patients’ psychosocial adjustment for targeted early intervention.Effective intervention strategies in terms of physical imagery of breast cancer patients can be adopted to minimize the impact of shape change on patients and promote breast cancer patients to enhance their psychosocial adjustment level and improve their quality of life.