Many cancer survivors and those with a chronic illness have had their body unintentionally altered. They must now attempt to recognize a body changed in some way. Like a wheat field after the harvest, they find themselves staring at a new landscape. Many don't like what they see.

Let's first recognize that body image after cancer is a real concern and not to be minimized. I don't feel it's talked about enough, and there are certainly not enough programs addressing this concern—for all genders. Many times, the issue of body image is tucked into a general program for cancer survivors, when it should be a full program all on its own.

Many survivors don't have the tools, understandably, to grapple with these sudden and dramatic physical changes. Physical changes range from the bloated side effects of steroids and skin changes, to a mastectomy or gastrointestinal and prostate surgeries. I am reminded of a beautiful park I stumbled upon that had wavy guide rails and posts to hold on to for the visually impaired. We also need those exact guideposts to help us safely navigate this new physical landscape.

A park for the visually impaired with guideposts.

As a dietitian, I'm concerned about body image because it can directly relate to how we take care of ourselves. Body image is the way we view our body, and can affect mental and sexual health, along with our relationships. A person with a negative self image may be less likely to take good care of their body, feed it, and move in a joyful way. But it's also very common after cancer treatments. Know that if you're experiencing these kinds of negative body image emotions, you are certainly not alone.

Moreover, whether it's hair loss, skin changes, or surgeries, the type of loss is less important than the impact on the individual. No matter what kind of physical change, the impact is very individual. We can't judge which is more important to someone. Who's to say hair loss is any less important than a disfiguring breast surgery to a woman, for example?

Among breast cancer survivors alone, body image was found to affect over half of survivors. From 31% to 67% of breast cancer survivors face negative body image, both short and long term. Body image more strongly affected young breast cancer survivors. The Breast Cancer Survivorship Care Guideline from the American Cancer Society and the American Society of Clinical Oncology (ASCO), directs primary care clinicians to help restore patients' self-esteem. They advise clinicians to assess for "body image and appearance concerns," and refer patients whose concerns are not corrected for psychosocial care. 

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As Jessica Queller, author and writer/executive producer on the show, Supergirl, says, cancer would force her to face "her most closely held beliefs about body image..." Queller wrote her memoir about how breast cancer upended her life. She aptly titled it, Pretty is What Changes, a line from a Stephen Sondheim musical, "Sunday in the Park with George," who describes beautiful as "what the eye arranges."

Jessica Queller, author of the memoir, Pretty is What Changes

Where can you turn if you have body image concerns after cancer or other illnesses? How can you befriend your body and begin to find its wisdom once again? Here are some general tips to start: 

• Find people you trust to talk about your body image concerns. Ask for referrals from your medical team.

• Find support in your area. For example, Sharsheret offers cancer support for women before, during and after a

diagnosis of breast or ovarian cancer.

• Find a local chapter of a cancer support program. For example, the national Cancer Support Community offers a myriad of support programs led by licensed psychotherapists, and some chapters offer specific ways to use your body to relieve stress, and improve body image and self-esteem after physical changes.

• Try guided imagery. In Los Angeles, WeSpark offers guided imagery, which has been proven to help body image, quality of life after cancer, and decrease body stigma.

• Some people find comfort talking to a religious leader who may have gone through cancer themselves and are uniquely qualified to offer spiritual support.

• Find role models in the body positivity movement. Body positivity can promote ways to turn to your body for comfort, instead of anger at its appearance. No, it doesn't necessarily mean loving your body; rather, it begins with body neutrality or acceptance of what is, regardless of appearance. 

• Speak kindly to your body and try to remain positive. Negative expectations can increase treatment-specific side effects. Women with negative expectations undergoing hormonal therapies, experience twice the side effects, compared to women who told themselves the side effects would not be as bad, a study in the Annals of Oncology reported. 

Other strategies are to find body movements that help heal, such as gentle and therapeutic yoga, T'ai Chi, integrative healing touch, meditation, intuitive eating, mindfulness, and many more. Try writing a gratitude journal; rest and recover when necessary; and remember to eat to take care of your body and become stronger, not to change your body size. Most important, be patient with yourself. 

Working on body trust techniques may also be helpful. The founder of the Jewish Breslov movement, said, "Know that a person has to cross a very narrow bridge in this world. And the main thing is that he shouldn't fear." This philosophy is taken to mean that we are the cause of our own fear. Cancer is one of the scariest bridges to cross, and losing your balance in a state of fear may be the true danger. 

You're still you—and maybe even better for what you can now teach others about resilience. And like the empty fields after harvesting, perhaps we will soon be ready to plant new seedlings and watch ourselves grow.

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