Beyond the Tumor: Addressing Body Image in Oncology

In the inaugural podcast episode created in collaboration with the American Psychosocial Oncology Society (APOS), Daniel C. McFarland, DO, and Michelle Fingeret, PhD, explored the critical, yet often overlooked, issue of body image in patients with cancer. McFarland opened the discussion by acknowledging the significant psychosocial challenges clinicians face and highlighted the therapeutic power of the patient-oncologist relationship, which extends beyond medical treatments.

Fingeret defined body image as a person’s total relationship with their body, encompassing not only appearance but also function and sensory experiences. She emphasized that body image changes are universal experiences for patients with cancer that affect all aspects of their lives. Despite their prevalence, Fingeret suggested that many clinicians feel ill-equipped to address these issues, and that patients are often reluctant to raise the topic due to feelings of shame or a desire not to "burden" their health care providers.

The discussion delved into the spectrum of body image concerns, ranging from mild distress to severe functional impairment. Fingeret distinguished between clinical body dysmorphic disorder and other changes patients experience, stressing that their distress is a valid reaction to actual bodily alterations. She provided a framework for clinicians to assess a patient's concerns, urging them to listen carefully to the language patients use. Patients may describe their bodies with inflammatory words like "deformed" or use avoidance strategies, such as refusing to look in a mirror. Fingeret noted how these are important cues that signal a need for a deeper conversation.

Practical advice was also offered on how to initiate these conversations. Instead of normalizing a patient’s concerns with platitudes like "Your hair will grow back," clinicians should validate their feelings by creating a safe space for them to talk openly. Simple, curious questions—such as "How does that make you feel?" or "Have you looked at yourself in the mirror?"—can open the door to a more meaningful dialogue. The goal of intervention, Fingeret explained, is not to force the patient to love their body, but to help them achieve a greater level of body image acceptance.

The conversation concluded with a focus on redefining success. McFarland noted that patients often hope to "go back to where they were before," an unrealistic goal. Fingeret reinforced this point, stating that a key part of the work is helping patients develop flexible, realistic expectations. Success is often found in incremental progress, such as reducing avoidance behaviors or finding more fulfillment in social relationships, rather than in the complete elimination of body image distress.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head and neck and lung cancer. He is also the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Fingeret is the founder of Fingeret Psychology Services and specializes in body image and cancer.