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Indian Journal of Palliative Care Sep 2011The aim of this study was to evaluate the effect of disfigurement due to cancer and its treatments on quality of life.
AIM
The aim of this study was to evaluate the effect of disfigurement due to cancer and its treatments on quality of life.
MATERIALS AND METHODS
A total of 120 patients from the inpatient/outpatient department of oncology who had undergone various forms of treatment for cancer were included in this study. The WHOQuality of Life BREF (WHOQL-BREF) version was administered to the patients to assess their quality of life.
RESULTS
Patients' overall quality of life score ranged from 34 to 79 with an average of 53.18 (SD 11.94) and a large number of patients had scored from 40 to 54 on the WHOQOL-BREF.The study showed a significant difference between gender groups (t = 3.899, P < 0.05), with a significant difference in the mean quality of life between different categories of the prominent stigma (f = 4.018, P < 0.05) and the nature of stigma. Disfigurement clearly was a stressful experience for both sexes, but substantially more distressing for women. Majority of the patients experienced poor quality of life in all dimensions, namely, physical health, psychological health, social relationships, environmental health, and other sociodemographic variables.
CONCLUSION
Living with a disfiguring body which is visibly different is not always easy. A sudden change either due to cancer or its treatment or due to side effects leads to significant social maladjustment, elevated anxiety, depression, and poor quality of life among the cancer survivors with body disfigurement which calls for multiprofessional involvement in addressing various psychosocial issues.
PubMed: 22346042
DOI: 10.4103/0973-1075.92334 -
Transplant International : Official... Nov 2011Nonneoplastic mucocutaneous lesions are frequent in organ transplant recipients. Many of them are caused by a direct toxicity of immunosuppressive drugs, in particular... (Review)
Review
Nonneoplastic mucocutaneous lesions are frequent in organ transplant recipients. Many of them are caused by a direct toxicity of immunosuppressive drugs, in particular glucocorticoids and cyclosporine. The effects of these agents are dose- and time-dependent. Glucocorticoids can cause acne, Cushingoid appearance, irregular purpuric areas, friable skin, and wide and violaceous stripes. Cyclosporine can cause hypertrichosis, pilosebaceous lesions, and gum hypertrophy. Patients with esthetic changes may show poor adherence to treatment with these immunosuppressive agents that may lead to progressive graft dysfunction. Apart from this direct toxicity, vigorous immunosuppression may render the transplant recipients more susceptible to mucocutaneous infections. Fungal infection, viral warts, and bacterial folliculitis are the most frequent types of mucocutaneous infection. Some fungal infections, such as oral candidiasis and pityriasis versicolor, are relatively trivial, but other mycotic infections can cause severe or disfigurating lesions. Among viral infections, warts and condylomata caused by human papilloma virus are frequent and may favor the development of nonmelanoma skin cancer. Bacterial infections are usually trivial in the early period after transplantation, being represented almost exclusively by folliculitis. However, subcutaneous infections may cause a necrotizing fasciculitis which is a life-threatening disorder, usually sustained by polymicrobial pathogens.
Topics: Dermatomycoses; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Skin Diseases; Skin Diseases, Bacterial; Skin Diseases, Infectious; Skin Diseases, Parasitic; Transplants
PubMed: 21806688
DOI: 10.1111/j.1432-2277.2011.01308.x -
Psycho-oncology Jan 2018To examine the potential mediating role of body image dissatisfaction on the association between treatment-related scarring/disfigurement and psychological distress in...
The role of body image dissatisfaction in the association between treatment-related scarring or disfigurement and psychological distress in adult survivors of childhood cancer.
OBJECTIVE
To examine the potential mediating role of body image dissatisfaction on the association between treatment-related scarring/disfigurement and psychological distress in adult survivors of childhood cancer.
METHODS
Participants included 1714 adult survivors of childhood cancer (mean [SD] age at evaluation = 32.4 [8.0] years, time since diagnosis = 24.1 [8.1] years) enrolled in the St. Jude Lifetime Cohort Study. Survivors completed measures of body image, emotional distress, and posttraumatic stress symptoms (PTSS). Body image dissatisfaction (BID) was categorized into 2 groups (cancer-related and general) based on factor analysis. Using causal mediation analysis, we estimated the proportion of psychological distress associated with treatment-related scarring/disfigurement that could be eliminated by resolving BID through a hypothetical intervention.
RESULTS
Among survivors with scarring/disfigurement of the head, a sizable proportion of the relative excess of psychological distress could be eliminated if BID was successfully treated (males: [cancer-related BID: depression: 63%; anxiety: 100%; PTSS: 52%]; [general BID: depression: 70%; anxiety: 100%; PTSS: 42%]; females: [cancer-related BID: depression: 20%; anxiety; 36%; PTSS: 23%]; [general BID: depression: 32%; anxiety: 87%; PTSS: 38%]). The mediating effect of BID was less pronounced for the association between scarring/disfigurement of the body and psychological distress for both males and females.
CONCLUSIONS
Body image dissatisfaction mediates the association treatment-related scarring/disfigurement and psychological distress among adult survivors of childhood cancer, particularly among survivors with scarring/disfigurement of the head and male survivors. Successful treatment of body image dissatisfaction has the potential to eliminate a substantial proportion of psychological distress related to scarring/disfigurement among adult survivors of childhood cancer.
Topics: Adolescent; Adult; Adult Survivors of Child Adverse Events; Anxiety; Body Image; Cancer Survivors; Child; Cicatrix; Cohort Studies; Depression; Factor Analysis, Statistical; Female; Humans; Male; Middle Aged; Neoplasms; Quality of Life; Stress, Psychological; Young Adult
PubMed: 28419648
DOI: 10.1002/pon.4439 -
Otolaryngologic Clinics of North America Oct 1990Ear injuries occur in people of all ages but predominate in active people such as wrestlers, boxers, and bike riders. The types and extent of injury are a function of... (Review)
Review
Ear injuries occur in people of all ages but predominate in active people such as wrestlers, boxers, and bike riders. The types and extent of injury are a function of the force causing the injury. Shearing forces of moderate intensity cause hematoma formation, whereas greater force causes lacerations or even amputation. Sharp objects cause lacerations determined by the force, direction, and point of impact. The high ratio of surface area to mass makes the auricle vulnerable to extremes of temperature. People participating in high-risk activities should wear protective headgear. The goal of treatment is to restore the normal contours while preventing infection. Hematoma results in disfigurement by organization or chondritis. Evacuation and pressure dressings using sterile technique correct the condition. Second-degree burns are treated by regular cleansing and application of topical antimicrobials. Deeper burns require debridement, biologic dressings, or burying the cartilage subcutaneously for later reconstruction. Simple lacerations are closed under aseptic technique using either skin-to-skin sutures only or sutures of the skin combined with intercartilage sutures. Extensive and complex lacerations require meticulous care to match all fragments and prevent infection or loss of tissue. Bare cartilage must be covered with vascularized tissue. The treatment of total amputation is controversial. Some advocate reattachment as a composite graft using intravenous low molecular weight dextrans and heparin as adjuvants. Mladick dermabrades the amputated pinna, reattaches it with sutures, and then slips it into a pocket of elevated postauricular skin for 2 weeks. Others urge microvascular reanastomosis of the small nutrient vessels. Brent and Byrd separate the cartilage from its overlying skin and envelope it first with vascularized temporoparietal fascia and then a split-thickness skin graft. Chondritis is the most feared complication of injury or surgery of the pinna. It is an aggressive process, and prompt removal of pus and necrotic cartilage is required. Exteriorization and removal of all cartilage is effective but disfiguring. Removal of only affected cartilage and constant irrigation with antibiotic solutions is effective but requires prolonged hospitalization. Iontophoresis of antibiotics into the auricle may be effective and conserve tissue. Traumatic deformities are corrected with composite grafts from the opposite ear, costal cartilage, and local pedicled flaps.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Amputation, Traumatic; Burns; Cartilage Diseases; Ear, External; Humans; Inflammation; Skin Transplantation; Surgery, Plastic; Sutures; Wounds, Nonpenetrating
PubMed: 2259501
DOI: No ID Found -
Plastic and Reconstructive Surgery Sep 1998Portwine stain disfigurement is caused by several factors. To what extent and in which proportion these factors influence the overall perceived disfigurement is...
Portwine stain disfigurement is caused by several factors. To what extent and in which proportion these factors influence the overall perceived disfigurement is incompletely understood. In this study, the contribution of seven portwine stain characteristics to overall portwine stain disfigurement was assessed. Color slides were taken from 90 patients with untreated portwine stains in the head/neck area. From these slides, overall portwine stain disfigurement was judged by a panel of 16 lay persons. The reliability of the average ratings of this panel was established with weighted kappa analysis (kappa = 0.51) and by calculating the Cronbach alpha coefficient (0.99). Using a previously tested multi-item questionnaire, the following portwine stain characteristics were rated quantitatively by a panel of five professionals: color, patchiness, boundary, size, shape, surface structure, and hypertrophy of the underlying tissue. By means of multiple linear regression analysis, the ratings for overall portwine stain disfigurement (panel of lay persons) were compared with the ratings for the individual portwine stain characteristics (panel of professionals). From the results of this analysis, the percentual contribution of each of the characteristics to overall portwine stain disfigurement was calculated. Size turned out to be the most important portwine stain characteristic, being responsible for almost half of the overall disfigurement. Color and boundary are the next two most important characteristics, contributing 18.7 and 12.4 percent, respectively. The other four characteristics together account for 10 percent. In our model, 13 percent of overall portwine stain disfigurement remains unexplained. We expect patient features to account for this. We feel that these results may have consequences for laser treatment of portwine stains. Reducing the size and fading out the boundary of the stain probably reduce overall portwine stain disfigurement more effectively than primarily trying to lighten the often persistent center of the stain.
Topics: Adolescent; Adult; Attitude of Health Personnel; Attitude to Health; Child; Child, Preschool; Esthetics; Female; Humans; Infant; Laser Therapy; Male; Middle Aged; Port-Wine Stain
PubMed: 9734447
DOI: No ID Found -
Nursing TimesThis is a two-part unit on helping patients to cope with the anxiety and challenges of disfigurement or looking different. Part 1 examines the causes of disfigurement,...
This is a two-part unit on helping patients to cope with the anxiety and challenges of disfigurement or looking different. Part 1 examines the causes of disfigurement, dispels myths surrounding the issue and offers guidance on understanding the feelings and behaviours of those affected and their families.
Topics: Adaptation, Psychological; Congenital Abnormalities; Disease; Humans; Self Concept; United Kingdom
PubMed: 18481759
DOI: No ID Found -
Clinical Trials (London, England) Apr 2024We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement...
BACKGROUND/AIMS
We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement and evaluated its feasibility, reliability, and validity.
METHODS
Twenty-eight raters, divided into four cohorts based on neurofibromatosis type 1 familiarity and clinical experience, were shown photographs of children in a clinical trial (NCT01362803) at baseline and 1 year on selumetinib treatment for plexiform neurofibromas ( = 20) and of untreated participants with plexiform neurofibromas ( = 4). Raters, blinded to treatment and timepoint, completed the 0-10 disfigurement severity score for plexiform neurofibroma on each image (0 = not at all disfigured, 10 = very disfigured). Raters evaluated the ease of completing the scale, and a subset repeated the procedure to assess intra-rater reliability.
RESULTS
Mean baseline disfigurement severity score for plexiform neurofibroma ratings were similar for the selumetinib group (6.23) and controls (6.38). Mean paired differences between pre- and on-treatment ratings was -1.01 (less disfigurement) in the selumetinib group and 0.09 in the control ( = 0.005). For the disfigurement severity score for plexiform neurofibroma ratings, there was moderate-to-substantial agreement within rater cohorts (weighted kappa range = 0.46-0.66) and agreement between scores of the same raters at repeat sessions ( > 0.05). In the selumetinib group, change in disfigurement severity score for plexiform neurofibroma ratings was moderately correlated with change in plexiform neurofibroma volume with treatment ( = 0.60).
CONCLUSION
This study demonstrates that our observer-rated disfigurement severity score for plexiform neurofibroma was feasible, reliable, and documented improvement in disfigurement in participants with plexiform neurofibroma shrinkage. Prospective studies in larger samples are needed to validate this scale further.
Topics: Child; Humans; Neurofibroma, Plexiform; Neurofibromatosis 1; Prospective Studies; Reproducibility of Results
PubMed: 37877369
DOI: 10.1177/17407745231206402 -
Clinics in Plastic Surgery Jul 2005Reconstruction of patients with severe facial disfigurements due to burns, trauma, or cancer is a challenging task for plastic surgeons. Currently, available... (Review)
Review
Reconstruction of patients with severe facial disfigurements due to burns, trauma, or cancer is a challenging task for plastic surgeons. Currently, available reconstructive options rarely result in satisfactory functional and aesthetic outcomes. In this article the authors present the rationale and experimental basis for the introduction of composite facial allograft transplantation in humans. They outline the ethical, social, and media-related issues in facial allograft transplantation.
Topics: Animals; Face; Forecasting; Humans; Immunosuppression Therapy; Models, Animal; Scalp; Tissue Transplantation; Transplantation, Homologous
PubMed: 15979478
DOI: 10.1016/j.cps.2005.02.003 -
Pediatric Clinics of North America Oct 1986Scleroderma is a rare disease in children. Heterogeneous in its many forms, it ranges from circumscribed and self-limited pigmentary disorders to disabling and... (Review)
Review
Scleroderma is a rare disease in children. Heterogeneous in its many forms, it ranges from circumscribed and self-limited pigmentary disorders to disabling and disfiguring involvement of an extremity. It also may include diffuse skin disease, multiple internal organ derangements, and a rapidly fatal outcome. Outcome varies widely and is related to the location and extent of cutaneous involvement, evaluation of disfigurement or impairment, and which treatment resources are available.
Topics: Child; Eosinophilia; Fasciitis; Humans; Raynaud Disease; Scleroderma, Localized; Scleroderma, Systemic; Syndrome
PubMed: 3532005
DOI: 10.1016/s0031-3955(16)36111-9 -
Journal of Investigative Surgery : the... 1994Treatment of patients with maxillofacial defects includes not only the technical procedures involved in producing a prosthesis, but also the psychosocial aspects. In all...
Treatment of patients with maxillofacial defects includes not only the technical procedures involved in producing a prosthesis, but also the psychosocial aspects. In all cases, these patients must learn to live with a severe facial disfigurement. People born with congenital defects grow up with disfigurement. For cancer patients, in addition to the mutilation, fear of the tumor plays a significant role. This paper reports on research into this specific treatment aspect. Such patients first must learn to cope with the possibility of premature death. They then must learn to accept facial disfigurement and the fact that society will respond differently to them.
Topics: Adaptation, Psychological; Adult; Aged; Face; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Quality of Life
PubMed: 7803342
DOI: 10.3109/08941939409051149