Depression and Anxiety in Patients With Cancer

Breast cancer is one of the most prevailing diseases in the world. Wu et al. (2021) investigate the problem associated with self-image in patients with breast cancer. The scientists hypothesized that changes in body image represent threatening events for women, especially those with breast cancer (Wu et al., 2021). Thus, these patients are unable to adequately cope with the situation due to changes in the body image they are exposed to, resulting in disagreement psychological reactions such as despair.

In cancer patients, mental well-being has been shown to provide some protective effect against end-of-life despair. Patients with high overall meaning, peace, faith, and FACIT scores had better emotional and cognitive performance, according to Abou Chaar et al. (2018). Patients with good general health and quality of life had higher importance, peace, and overall FACIT scores. All characteristics of mental well-being have been found to be basically associated with fear and sadness. Spirituality has been shown to improve the quality of life of cancer patients and reduce anxiety and sadness. The results of the study handled by Abou Chaar et al. (2018) underscore the need to incorporate mental guidance into the healthcare system. Mental illnesses such as depression and anxiety are common, but cancer outcomes that affect the quality of life, patient compliance, cancer survival, and cost of treatment are often overlooked (Pitman et al., 2018). Several studies support the idea that psychiatric disruptions in patients influence the state of the disease.

However, there are limited studies on the association between body image and despair of mastectomy breast cancer survivors and the association between these two categories throughout the patient’s length of stay. Instead, most studies have focused on long-term body image, with mixed results when it comes to body image issues. Therefore, the purpose of this study was to examine the body image and despair of early-stage breast cancer survivors who tried to change clothes once after surgery and were discharged from a Chinese hospital.

This study seeks to answer important issues for the care sector, as it is important to consider the patient’s mental state when providing care. If the patient feels hopeless, the healing process can be hindered. The purpose of the study is to examine the body image and despair of early-stage breast cancer survivors who had to change clothes after surgery and were about to be discharged from a Chinese hospital.

Review of the Literature

The main themes of research are despair and body image. Despair is a cognitive experience in which people believe their current situation is unchanging. As a result, they have negative self-expectations, a pessimistic attitude towards the future, and a sense of control, self-confidence, courage, and loss of energy to achieve their present and future goals. Body image has received many different definitions over the years because it is a complex phenomenon that involves physiological, psychological, and social elements.

Most references are recent and have been published within the last five years. However, some resources are old and were released over five years ago. The reason is that the focus is on data from Chinese hospitals, so it can be difficult to find enough work based on tests done in China. Second, some psychological principles remain constant over time and can therefore be quoted from previous publications.

Theoretical Framework

Theoretical terms are defined and linked to the course. Body image and despair were the main concepts to be defined. This study does not rely solely on nursing theory. It also includes other disciplines, especially psychological theories. The terms self-image and depression were borrowed from psychological research. The theoretical framework was formulated as the hypothesis that changes in body image represent threatening events for women, especially those with breast cancer. The situation cannot be adequately addressed due to changes in body image, which can lead to a psychological reaction of inconsistency or despair.

Variables / Hypotheses / Questions / Assumptions (Quantitative)

Independent variables are participants’ sociodemographic variables, and the dependent variables are the rates of hopelessness. The operational definition of the variables was given, and they were concrete and measurable. The sociodemographic variables included age, educational level, occupation, marital status, illness duration, and type of surgery. The research question is: “What is the relationship between body image and hopelessness among breast cancer survivors in the immediate post-op period after undergoing mastectomy?”


The research piece used a questionnaire-based cross-sectional study design. From October to December 2019, samples were registered at Tianjin Hospital for this study. The selection criteria were (a) Eighteen years and older, (b) early-stage breast cancer (stage IIII, no metastases determined by histological image analysis), and (c) recovery from discharge after mastectomy. The final selection criteria for this study was the period immediately after surgery. This was defined as the period of surgical recovery for the female, who had the opportunity to perform a single dressing change and examine the surgical scars on the chest wall. Females who received breast reconstruction or breast-conserving therapy were excluded, women with serious psychological problems, unable to read, interpret, or speak Chinese, and suffering from other serious complications.

Deductive reasoning was used in the study; the sampling method was based on the age of the participants. The study was conducted in the settings of the Chinese hospitals. The investigator chose a probability sample, and the type of reliability and the validity of the measurement tools is test-retest. The sampling size is 211 survivors, with the participation rate at almost 92 percent. A total of 230 surveys were distributed, were nine survivors refused to participate, and more than 50% of the data was missing in 10 questionnaires. After that, 211 survivors completed all interviews and analyzed the data.


Initially, researchers received ethical approval from the Medical Center’s Institutional Review Board to carry out this study. Second, they discussed the purpose and method of the study with qualified people. Patients who consented to participate in this study verbally or in writing were asked to fill out a self-reported questionnaire immediately upon consent. Researchers have reaffirmed their freedom to opt-out at any time and have announced that they will take all necessary steps to protect their identities.

Data Analysis

The linear relationship between participants’ body image and despair was investigated using Spearman’s correlation analysis. The effect of body image on despair was tested using structural equation modeling (SEM) adapted to sociodemographic variables. The model’s fit indices were evaluated by several criteria: root-mean-square error of approximation (RMSEA) < 0.08, χ2 /df < 3, Tucker–Lewis index (TLI), adjusted goodness-of-fit index (AGFI), the goodness-of-fit index (GFI), and comparative fit index (CFI) > 0.90.

The results were presented via descriptive statistics using tables and a diagram. Table 1 shows the sociodemographic characteristics of the participants. The average age of the 211 participants was 50.85 years (SD = 9.43), ranging from 29 to 77 years. The highest percentage of age groups was 44-55 years (35.5 percent, n = 75). Most completed elementary school (34.1%) and junior high school (37.9%). About one-third (29.9%) were employed, and the majority were married (87.7%). Table 2 shows the participants’ BHS scale scores for the three subscales and their sociodemographic variables. The results of the Spearman correlation analysis are shown in Table 3. The results of the SEM to assess the effect of body image on despair were presented using a diagram. These were added to the model due to covariance parameter issues. Body image was found to be strongly and positively associated with hopelessness (r = 0.423, p.01) and its subscales (r = 0.202 0.413, all p.01) in the research finding.

Summary / Conclusions, Implications, and Recommendations

In conclusion, the themes adequately captured the meaning of the data—the analysis yielded an insightful, provocative and meaningful picture of the phenomenon under investigation. The methods were used to enhance the trustworthiness of the data, and the description of those methods was adequate. There is a clear explanation of the limitations of the research, a thick description, and an audit trail. One of the limitations is that the study did not include more detailed sociodemographic variables to compare the body image of breast cancer survivors with hopelessness (such as caregiver attitudes and behaviors). Therefore, further research is needed to compare these variables of interest with more sociodemographic characteristics.

Second, the current study only looks at the participants’ body image and despair in a short period of time and uses a cross-sectional design, so generalization needs to be treated with caution, and our results are It means that it is not relevant. Future longitudinal studies are needed to better understand how the body image and despair score of the examined samples changed over time.

Third, because the sample size is limited and the detective power calculation was not performed first, it is necessary to investigate future larger samples and estimate the detective power before adopting the sample. Fourth, the current study excluded patients who were clinically diagnosed with mental health problems but did not use measurements of depressive symptoms or anxiety, and these were not used as possible covariates. Therefore, future studies will need to analyze these covariates and look at these psychological issues when recruiting participants.

The strength of the work is that it has a clear clinical implication of the results. The main finding is that despite the lack of basic data on body images of preoperative samples, physical changes in breast cancer survivors associated with the surgical process are associated with increased body image scores. It was possible that they were taller and suggesting image difficulties. Moreover, such an increase was associated with an increase in disappointment. These results suggest that care should be taken as it helps identify the most pressing concerns faced by healthcare professionals when assessing the level of distress in patients after mastectomy.

In terms of the findings, the researcher could generalize to other populations because the concepts used in the study are from common psychological theories. People might experience hopelessness, depression, and problems with body image regardless of belonging. However, more investigation is needed for the other populations. The findings are significant for nursing because nurses are responsible for effective patient care. However, problems with the body image may disrupt the desired outcomes of the curing process. Because depression and hopelessness might be experienced by patients with different diseases, including breast cancer, nurses should think about the elimination of such psychological issues when working with the patients.


Abou Chaar, E., Hallit, S., Hajj, A., Aaraj, R., Kattan, J., Jabbour, H., & Khabbaz, L. R. (2018). Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study. Supportive Care in Cancer, 26(8), 2581-2590. Web.

Pitman, A., Suleman, S., Hyde, N., & Hodgkiss, A. (2018). Depression and anxiety in patients with cancer. Bmj, 361. Web.

Wu, Q., Yin, Y., Wang, Q., Wang, S., & Jia, X. (2021). Body image and hopelessness among early‐stage breast cancer survivors after surgery in China: A cross‐sectional study. Nursing Open, 8(6), 3384-3393. Web.

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