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By Travis Loh Kok Wah, Senior Medical Social Worker

Coping with cancer can be challenging for many cancer patients. There may be many struggles and concerns that a cancer patient faces in his/her cancer journey. One of these concerns can be the impact of the illness on self-image and self-esteem.

Self or body image refers to how one perceives his/her own appearance, even though it may not be the way other people see him/her. Looking good is important and how one looks can affect how one feels about him/herself. Therefore, the overall physical appearance can be said to influence self-esteem.


According to psychologist Dr Wendy Schain (n.d.), she describes self-esteem as being made up of four components:

  1. NET WORTH OF PHYSICAL SELF – the appearance and functional ability of your physical body.
  2. SOCIAL SELF – your relationships and the emotional support that you can receive from others.
  3. TOTAL SUM OF ACHIEVING SELF – the achievements that you have accomplished in different areas of your life.
  4. SPIRITUAL SELF – the strength that you draw from your spiritual and moral beliefs.

Cancer treatment takes time and can be costly. It may adversely impact your physical functioning, relationships with others, your work, studies and even your spiritual faith.

Physical changes caused by cancer and its treatment are unique to each patient/survivor. They can prevent you from studying, working or doing the things that you used to enjoy prior to cancer. Such changes include:

  • Temporary side effects of treatment such as hair loss, skin/nail changes, weight loss, numbness in limbs etc. Permanent physical changes include permanent stoma and amputation.
  • Scars and disfigurement caused by surgeries.
  • Other body losses such as incontinence, loss of femininity or masculinity, and loss of eyesight and hearing.

Physical changes due to cancer or treatment can be very distressing as they can reduce one’s self confidence. This may cause a significant impact on the self-esteem and eventually the strength and will to overcome the challenges of cancer and its treatment.

Even if the physical changes are hidden and not noticeable by others, it can also have an impact on the self. Body image is about how one feels about his/her body and not how it actually looks to others. Hence, even if there are no physical changes, one may still feel as though he/she is being seen differently and that he/she is unable to relate to others. The feelings of uncertainty and insecurity may then affect one’s body image.

With poor body image and low self-esteem, it can impact one’s intimacy with his/her partner. For example, women who have undergone a mastectomy may find it difficult to be intimate with her partner due to mental, physical and emotional barriers. She may feel ashamed, self-conscious and anxious about her body. Intimacy is not just about sex; it is also about the physical (touching, holding and hugging), mental (ability to care for the other person) and emotional (sharing of feelings such as fears and hopes) connection that one shares with his/her partner. The ability to connect and feel supported can have an impact on a patient’s quality of life.

The following are some possible signs of a poor body image and low self-esteem affecting a patient’s quality of life:

  • Not wanting to leave the house because of the fear of people seeing him/her
  • Avoiding intimacy or sex with his/her partner
  • Feeling ashamed for having cancer
  • Not being able to accept him/herself after the cancer diagnosis

Some coping strategies that patients can adopt to build a more positive body image and self-esteem:

  1. Regaining confidence in your appearance
    – Wear clothes that you like and which can make you feel good about yourself
    – Camouflage the body changes by using make-up, wigs, prostheses or clothing
    – Enroll in the “Look Good Feel Better” programme
  2. Broadening of perspective. If you focus only on your physical appearance and losses, you may overlook the other strengths, interests and talents in your life. For instance, a cancer patient may pick up a new hobby such as painting as a way of expressing what he/she is experiencing and feeling. Also, while it may be physically challenging for a patient to engage in strenuous exercises, he/she may still enjoy light exercises such as morning walks. The focus is now shifted to building up on what you enjoy and can do.
  3. Allowing yourself the space and time to get used to the physical changes and how you feel about yourself. Go slow and do things at a comfortable pace. Over time, your body image will improve as you adjust mentally and emotionally to life after cancer.
  4. Sharing of any sexual concerns that you may have with your partner. Taking the first step to talk about intimacy issues may be difficult. However, it is also likely that your partner is as concerned as you are over these issues. Open communication helps to build the couple’s relationship and in turn, enhance the emotional support between each other.
  5. Building up your support network by talking to other patients and survivors who share similar struggles with body image and self-esteem. Join a support group where you can share your experiences, learn new coping methods and talk about your feelings in a safe environment.
  6. Strengthening your spiritual life. Spirituality may or may not be tied to a particular religion. According to Sherfield (n.d.), spirituality is about the inward exploration of the self to gain inner peace and understanding. It involves the appreciation of self, the environment and the role one plays in the “big picture of life”. A strong sense of spirituality may bring about a greater sense of inner peace, purpose and belonging which will ultimately strengthen one’s self-esteem.
  7. Seeking professional counselling for yourself and your loved ones. You may wish to speak to a medical social worker in the hospital.

At the end of the day, when cancer patients are able to better manage and deal with body image and self-esteem concerns, they gain greater confidence and are empowered to be in control of their lives.

This article is republished from Salubris, quarterly publication of National Cancer Centre Singapore, October-December 2012 issue.

image from Health photo created by jcomp –