Introduction

A cancer diagnosis during childhood and its intensive treatment requiring frequent hospitalizations and invasive procedures raises a broad range of medical and psycho-social challenges for the affected children.1 Despite steadily increasing survival rates, reaching 85% in Switzerland,2 childhood cancer survivors have a lifelong increased risk of chronic health conditions.3,4The treatment’s immediate impact on the body, visible and invisible late consequences such as scars, amputations or endocrine problems such as growth hormone deficiency may interfere with survivors’ psycho-sexual development and body image.5-7 Growth hormone deficiency is a common consequence of childhood cancer treatment and has been previously shown to impair linear growth, reduce cardiac muscle mass, and increase fat mass.8 The cancer experience may further disrupt social interactions with peers and survivors may perceive their bodies as something that has failed them or as a source of pain.9 A healthy body image is of particular importance during adolescence which is a critical developmental period characterized by many challenges such as puberty, establishing autonomy, first partner relationships, and realization of own sexuality.10-12
Understanding the impact of childhood cancer on the body image of adolescent survivors is critical to guide adequate support strategies and to mitigate adverse consequences on survivors’ future quality of life and psycho-social well-being.13,14Qualitative studies suggest negative effects of childhood cancer on survivors’ body image.15-18 However, a systematic review from 2009 concluded that there is no consistent evidence regarding differences in body image between children and adolescents with cancer and healthy controls.19 A recent study from Sweden indicated higher body image disturbance in adult women who survived childhood cancer compared to the cancer-free women20 while another study from the Netherlands found no differences.9 However, evidence from studies including adolescent childhood cancer survivors is sparse and it remains unclear how chronic health conditions affect the body image of long-term survivors. In this study, we therefore aimed to compare the body image between adolescent cancer survivors and their siblings and to determine whether survivors’ body image is associated with socio-demographic characteristics, clinical characteristics, and chronic health conditions.