Body Image Following Ostomy Surgery for Cancer: A Systematic Review

Ostomy surgery, often required in the treatment of colorectal, bladder, prostate and gynaecological cancers, has profound effects on body image and psychosocial well-being. While previous reviews have examined body image in colorectal cancer patients, no synthesis to date, to our knowledge, has focused on body image across cancer-related ostomy populations.

A systematic review methodology was employed, following PRISMA guidelines. Four databases (PsycINFO, MEDLINE, CINAHL, and Web of Science) were systematically searched for peer-reviewed, quantitative studies assessing body image in cancer survivors with ostomies. Inclusion criteria required validated body image measures and separable ostomy data. Ten studies met eligibility criteria, comprising 1454 participants.

Across studies, the presence of a stoma was consistently associated with poorer body image compared to non-stoma groups. Permanent stomas were linked with the greatest body image disturbance, while reversal of temporary stomas was associated with improvements. Body image was associated with psychosocial outcomes including quality of life, anxiety, depression, self-efficacy, and social support, and many of these psychosocial variables mediated the relationship between stoma status and psychological wellbeing. However, evidence regarding differences across cancer types was limited, and definitions and measures of body image varied considerably, with some studies relying on instruments not specifically designed for cancer populations.

Body image distress is a significant yet under-recognised concern for cancer survivors with ostomies. Greater conceptual clarity, standardised and ostomy-sensitive measurement, and longitudinal research across cancer diagnoses are needed.

More refined ostomy-sensitive measurement, routine assessment of body image concerns and access to tailored psychosocial interventions may improve body image and related outcomes for cancer survivors with ostomies.