In a traditional medical context the focus is dealing with the disease, cancer treatment and the side effects. All these aspects can compromise the psycho-physical wellbeing of people affected by cancer. A client who manages to maintain good body function will certainly be able to count on a greater number of resources to cope with the difficulties brought about by the illness.
It is wise in today’s world of health challenges, that a spa has experienced staff trained to work with people living with cancer. A person who frequents spas regularly can be assured that the esthetician who can personalise their spa service according to the person’s medical history is likely to provide a mindful, safe service which ultimately enhances the client’s quality of life. A well trained, experienced esthetician should be knowledgeable about cancer as well as the many side effects resulting from cancer treatment whether physical, psychological and the person’s individual coping skills.
It is for this reason many medical professionals today are paying more attention to the quality of life of their patients, through the management of symptoms and the adverse effects of cancer treatment.
Oncology estheticians/beauty therapists can complete the circle of care by providing their esthetic/beauty therapy services to enhance a positive outcome.
An equally important factor is that of a psychological nature. In particular this comprises the personal history of an individual, his/her organization of personality, his/her temperament and his/her defence mechanisms. The latter are “mechanisms of psychical functioning” aimed at preserving one’s psychical balance and adaptation to reality with regards to the anguish caused by an illness. Defence processes can be adaptive, when they enable a person to better face their condition, or maladaptive, when used in a rigid and dysfunctional way. The main defensive processes can vary and change in the course of time and stages of the disease, and according to the awareness of the patient with regards to his/her situation (Lingiardi and Madeddu, 2002).
Among the main defence mechanisms for a person living with cancer, we may find:
- denial: an attempt to dull one or more aspects of one’s experience that generate anguish.
- projection: projecting one’s own thoughts and negative feelings to others.
- regression: taking the person back to a stage in their life of dependence and almost childish requests for reassurance.
- intellectualization: the person distances themselves from his/her emotional discomfort, and they focus on a logical and rational level, for example, by continuing to search the internet for information concerning the disease and talking about it as if the situation does not apply to them;
- fatalistic attitude: the person accepts their illness without any resistance and they accept this as their destiny.
Many studies in the psycho-oncologic field have shown that around 40% of patients during their illness have at least one clinically serious psychiatric disorder (Grassi, et al. 2003). The most vulnerable people from a psychological point of view are those who in the past have already had episodes of psychological issues, in particular disorders with anxiety-depression which appear to be frequent with oncology patients. With regards to coping factors, patients with a smaller number of personal and interpersonal resources are usually more vulnerable to psychological stress.
The following are the most frequent disorders to be seen in the oncology setting.
Anxiety in oncology patients is one of the symptoms, or can even be the main symptom, of a series of disorders which have different clinical, prognostic and therapeutic features. (SIPO, 1998).
Depression is very common among oncology patients. Just like anxiety, a dismal mood may assume variable intensity, duration and quality, and can be associated with other symptoms, which can produce different types of disorders.
Trauma and stress induced disorders with a cancer diagnosis and cancer treatment related to it are considered extremely stressful life events, and sometimes even traumatic for a person.
Sleep disorders are common with anxiety and depression. Waking up during the night, besides psychological reasons, may be due to the physical discomfort of the disease. Examples are pain, which may be derived from surgical wounds, the site of disease, or from metastases, the presence of any catheters or surgical drains, the need to urinate frequently, or breathing difficulties. In any event, insomnia compromises the person’s quality of life in a significant way, setting off a vicious circle of tiredness, fatigue, irritability and depression.
“Salute allo Specchio” (“Health in the mirror”) is a psychosocial program for cancer patients, based on group sessions during which a team of estheticians/beauty therapists demonstrate their cosmetic and skincare skills to show the patient how to manage some of the physical side effects of the disease and its treatments. After “esthetic/beauty therapy services” the patients participate in groups led by psychologists, as the program is considered part of a wider psychological supportive care whose aim is to improve well-being and quality of life.
The Psychology of Cancer, Body Image and Oncology Esthetics
Body image disorders resulting from anti-cancer treatment may lead a person to experience intense emotional discomfort, which compromises their self-esteem as well as their everyday social life. They psychological aspects are covered in the following paragraph.
As already stated in the previous article, the onset of a cancerous tumor for a person who experiences it firsthand (and for the people close to them) is capable of affecting all the important dimensions of his/her life. However, among the many aspects involved in the experience of illness, the body plays the leading role. Starting from the diagnosis, and during cancer treatment, the body is in the forefront with all its fragility. It is the body which gets ill and feeble and it is the body which experiences the effects of the treatments: alopecia, changes in weight, mutilations, edema, paleness, nausea, vomiting, taste changes, loss of energy. Physical changes highlight the image of a changed and suffering body, and what happens often is that the person feels that their body is no longer their own, or one that they know. (Rosemberg, et al. 2013).
Quite commonly, a patient will experience a reaction to their illness, and some disorders may appear such as body dysmorphic disorder. This specifically affects the way they perceive their personal appearance, (a concern for any defects or impairments), and this causes a significant discomfort which can also negatively affect other areas of their life such as their interpersonal relationships.
This topic of body image, which in the past has been studied in other sectors, has now achieved importance in the oncology world with even more attention paid to the patient’s quality of life and his/her adaptation to the disease and to cancer treatment.
Currently researchers agree on defining body image as the mental representation related to what one thinks and feels about one’s own body (White, 2000; Cash, 2004; Erol, et al. 2012).
What is important is the way in which everyone experiences and perceives themselves, and the feelings that accompany such experiences. If this is true, it is easy to understand how, in the course of a disease like cancer, body image is affected, especially resulting from changes that a body ill with cancer is forced to undergo.
For many types of cancer, surgery still represents the treatment of choice. Despite the numerous improvements aimed at limiting the invasiveness of a surgical procedure and the damage related to it, scarring or mutilations do remain visible, and often for the patient this represents the most substantial evidence of his/her disease, as well as an element of stigma on a social level.
With breast cancer, for example, a series of studies have shown that women treated with radical mastectomies present with a more negative experience of their body image, especially in the short term, compared to women treated with conservative surgery (Anagnostopoulos et Myrgianni, 2009; Rosenberg, et al. 2013).
These women describe themselves as unhappy with regards to their body and appearance (Hartl, et al. 2003) and obtain lower scores on the scales measuring physical and functional well-being (Arora, et al. 2001). Similar results have been gathered also for oral cancers (Rogers, 2004). The more invasive or mutilating the surgery is, where visible changes are noticeable, the worse it is for the patient to adapt to the new condition, and this ultimately leads to an impairment in their quality of life, poor self esteem with higher levels of depression and irritability.
Alopecia, i.e. the total or partial loss of hair (often associated with the loss of eyelashes and eyebrows), is one of the most frequent negative effects of chemotherapy, but can also occur if radiation therapy has been administered to the head area. There are many drugs which can cause hair thinning or loss
However, this also depends on the dose and protocols. Alopecia is often considered among the top three most traumatic side effects to cancer treatment (Carelle, et al. 2002), sometimes even more so than the removal of a breast (Freedman, 1994). As a result the individual has impoverished social activities and relationships, the loss of hair becomes visible evidence of one’s state of disease, as well as a constant reminder, for oneself and for others, to one’s stigmatized and easily recognizable condition of a “person with cancer” (Erol, et al. 2012).
One of the most feared elements at the beginning of cancer treatment, more specifically chemotherapy is “Will I lose my hair?” This is particularly true for younger patients and the female population. For women, in fact, the loss of hair often means the loss of one’s identity, femininity, beauty and self-identity. A series of studies has shown that alopecia associates with a significant impairment of the perceived quality of life and of one’s wellbeing, a reduction in levels of self-esteem and self confidence, an increase in psychological distress, and higher levels of anxiety and depression (Rosman, 2004). In addition, many patients, when describing their experience, report that they felt “unprotected, naked, exposed to the outer world, and deprived of their intimacy”, that they experienced social situations with discomfort and embarrassment (in which they felt they were being observed and judged due to their appearance). The patient ends up avoiding social situations, and they incurred a decline in their affection and sexuality, despite the reassurances received from their partners (Hansen H.P., 2007).
Alopecia, even though a temporary condition, does not seem to diminish the impact since this visible “difference”, is described as a “social disability”. These women’s experiences are parallel to those of other people with a permanent visible defect, who feel “stigmatized” as being different and they consequently experience sensations of lack of self-confidence, discomfort when interacting within a social environment, which leads to avoiding the situation. (Rumsey & Harcourt, 2004).
Other adverse events
Changes to the skin, paleness, increase or loss of weight are some negative side effects that affect the perception that the ill person has of him/herself. Some drugs from the new biological (targeted) therapy group produce more intense side effects on the skin such as the acneiform or papular/pustular rash, especially found on the head and upper body. For the human being, skin is not only the largest organ among others, but it also possesses a psychical meaning that the skin enables a person to feel good about themselves; it acts as a barrier against external aggressions and represents a means for communicating with the outer world, for establishing relationships, and for creating contacts. Therefore, our skin ensures our “self” as individuals, and at the same time is an instrument for exchanges with the external world. In light of all this, it becomes easier to understand how damage (even temporary) of the “skin container” may manifest itself with feelings of deep discomfort, affecting deep emotional dimensions of the individual. All this may determine deterioration in the quality of life, with risks involving treatment compliance (Unger, 2013).
In recent years all this information has resulted in a need for a variety of treatments to complement traditional medical treatment in oncology. The aim is to give patients the resources to cope with all these problems – whether they be medical, psychological, social or practical – on a daily basis.
This primary role is played by estheticians/beauty therapists certified in Oncology Esthetics and those participating in the Salute allo Specchio project underway at the prestigious San Raffaele Hospital in Milan, Italy.
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She pioneered the Oncology Esthetics® advanced training for spa professionals and has set the standard in Canada, US, Australia and New Zealand. She is also the author of Oncology Esthetics: A Practitioner’s Guide (Allured Books 2009) and Health Challenged Skin: The Estheticians’ Desk Reference (Allured Books 2012).
Her students learn to incorporate adjustments to spa treatments specifically for people undergoing cancer therapies, and other health issues.
She continues to travel the globe with her training and expertise, helping to raise the bar in the spa industry and to open the door to all people regardless of skin type or health issues.
A contributor to many consumer and business magazines, her work has appeared in numerous national and international publications. Currin currently serves on the advisory committee of the Skin Inc Magazine Board, and the International Society of Oncology Estheticians.
Going beyond the world of esthetics, Mórag continues to reach out to those suffering from a variety of health challenges through Equine Facilitated Wellness (EFW).