Early Diagnosis of Skin and Breast Cancer in Women: Inuence of Body Image Perception

Background. The diagnosis of melanoma and breast cancer may impact many aspects of life with signicant reductions in emotional functioning and quality of life. Aims. Aim of the study was to analyze the emotional traits of female patients with oncological diagnosis (early stage melanoma/breast cancer) investigating prevalence and predictors for psychological stress. Methods. A sample of 84 female patients (age range 30-50 years) with diagnosis of melanoma/breast cancer stage T0-T2 participated in the study. The examined emotional variables were: psychological distress, depression, stress, anxiety, metacognitions and body self-perception. Results. Findings showed higher psychological distress in breast cancer than melanoma patients and, that was related to lower positive self-perception of body image. No signicant difference between cancer staging. Conclusions. Prevention and intervention protocols must be adapted taking into account tumor type in the adoption of preventive behaviors and compliance with medical recommendations during survivorship.


Background
Acceleration in psychosocial research effort over the past 5 years is clear; however, this is not enough to de ne psychological aspects and emotional trends of early melanoma stage patients during clinical trajectory. Currently new medical treatments are being offered promising long survivorship as chronic lifethreatening disease, however most of randomized clinical trials are focused on medical treatment outcomes of melanoma rather than psychosocial ones. Psychosocial research and practice have failed to keep pace with advances in medical management of the disease [1,2,3,4,5].
Negative emotional reactions to stressful life events are normal short-term emotional-behavioral response to threat; anger, fear, and are not sign of psychopathological disorder [2,4]. Melanoma may have a considerable impact on patients' lives including their health-related quality of life. Moreover, psychological responses to diagnosis and treatments may vary substantially over time and according to clinical aspects of the healthcare pathway. Throughout the diagnostic process and survivorship, patients with melanoma report signi cant reductions in psychological well-being and quality of life, including greater pain and fatigue, insomnia, and greater interference of stressors (physical and emotional) on social activities [1,2,3,4,5].
The antecedents and contributing factors to distress and other psychosocial outcomes are largely unexplored. Furthermore, a clear framework for adaptation and effective coping in the context of melanoma is not de ned to identify patients at risk of negative psychosocial outcomes in order to structure personalized interventions.
Kasparian's contribution [6] have highlighted oncological patients' signi cant psychosocial challenges and consequences of having melanoma. A diagnosis of melanoma may impact all aspects of life. The primary negative impact of melanoma is on individual personal level (life expectation, body image, selfesteem, well-being); the secondary effect is on social relationships (sociality, work performance, sexuality, family roles). The psychological distress evoked by cancer diagnosis, long lasting threatening survivorship, and outcome uncertainty may impact negatively on patient compliance to medical treatment and win back to everyday life.

Aims
Study aimed to investigate the emotional traits of female patients with early stage melanoma and breast cancer diagnosis analyzing body image perception. Breast cancer and melanoma were selected for this study because they have impact the physical perception of women. We wanted to analyze the psychological dimensions of young patients dealing with early stage cancer diagnosis evaluating the metacognition thinking, emotional traits and body self-perception.

Material And Methods
Ethic Statement Hospital in L'Aquila (IT). We contacted 114 eligible patients, of whom 84 provided informed consent; 28 patients did not consent to participate in the experimental protocol; whereas two patients signed the informed consent form, but at the rst session, they declined further involvement (dropped out).
Demographic characteristics of the participants are reported in Table 1. Depression Anxiety Stress Scales-21 (DASS-21) [10]. DASS-21 is a 21-item self-report questionnaire assessing three dimensions (7 items per subscale): depression, anxiety and stress. Patients are asked to score every item on a scale from 0 (did not apply to me at all) to 3 (applied to me very much).

Study design
We conducted an observational study to evaluate the emotional traits, body self-perception, and metacognitions in melanoma and breast cancer patients. Descriptive statistics were calculated for baseline characteristics and outcome measures. One-way analysis of variance (ANOVA) and analysis of covariance were conducted to detect the statistical signi cance of the overall differences across the examined psychological variables, while a MANOVA was performed to calculate the signi cant differences according to cancer type. Statistical analyses were performed using the jamovi 1.6.10.0 with a xed α-value ≤0.05.

Results
Analyzing the sociodemographic data, breast cancer and melanoma patients did not differ signi cantly  Table I). Participants resulted homogeneous in demographic data.
In Table 2 we reported clinical treatments. As expected, treatments differed between the types of cancer. Almost, breast cancer patients were treated with surgery (66,6% lumpectomy and 30,9% mastectomy) and radiotherapy. 38% of them received hormonal therapy, and half of them received chemotherapy. Differently, melanoma patients received surgical excision and no pharmacological therapy.
Then, MANOVA statistical analyses (3x2) was conducted comparing emotional traits (MCQ, PDI, BPS) and groups (Bg and Mg). Table 3 reported the raw scores. Mg evidenced signi cant positive emotional traits than Bg: Bg showed higher psychological distress (p = 0.00, whereas Mg showed better Body Image Perception (p = 0.03), in particular in Impact of Treatment Consequences on Body Image index (p = 0.01) and on social wellness index (p = 0.04) (see Figure 1).

Discussion
Aim of the study was to analyze the emotional traits of female patients with early stage breast cancer and melanoma diagnosis, verifying the diagnosis impact on body image perception; in particular, focus of the study was to de ne the predictive factor of psychological stress by metacognition thinking, emotional traits and body self-perception on the younger sample (range age 30-50 years).
According to the emerging literature on the wellness in survivorship of younger cancer patients [11,12,13,14,15,16], our ndings showed the young women with melanoma/breast cancer resilient as our sample showed no signs of mood disorders or psychopathological conditions.
According to Bourdon's suggestions [17], melanoma patients showed fewer negative physical and social consequences than breast cancer patients, which decreased their body image self-perception as physical and role functioning experiencing more extensive and painful treatment.
Our study shows that early stage melanoma patients represent an oncological target with the best adaptability and management of their own body in the post-diagnosis. Early screening as an effective tool for the early diagnosis of melanoma favors not only less invasive clinical treatments but also a greater awareness of one's body with a better management of it in the post-diagnosis, thus laying down for a better quality of life and well-being during survivorship.
Taking into account breast cancer patients' performance, the diagnosis represents a stressor not only for illness management, but even for physical perception impacting signi cantly the psychological dimensions for body image.
Our nding con rmed the investigated largely negative impact of cancer diagnosis [2,5,8,13,14,15,16], and contributed in emerging research topic regard to the clinical implication of early diagnosis in younger age (in this case in women population), detecting the high relevance of clinical psychological interventions among medical and pharmacological solutions in primary treatments.
This study has some limitations. First, this study is an observational study, which is di cult to determine the causal relationships, further follow-up studies are needed. The psychological battery is composed of self-report measures of depression, anxiety, and distress symptoms and are not measures of their clinical indicators. Further, the relatively small sample size limits the generalizability of our ndings regarding regaining a normal life after clinical pathway.

Conclusions
Our study suggested that psychological support in primary treatments should be speci c and related to the cancer type in order to recover mental well-being. Last, our nding highlighted the need for regular screening of psychological distress even in patients with early cancer diagnosis, and also in the case of long-term follow-up.  Psychological distress and self-body perception representation of both Bg and Mg groups.