Qualitative study on body image disturbance in young and middle-aged women with breast cancer in China.

Introduction
Breast cancer is one of the most prevalent, and most dangerous, forms of cancer among adult female patients. Its public health impact cannot be overstated.1 In the last 20 years, breast cancer has been more frequently diagnosed in younger female patients,2 which has led to a new wave of epidemiological studies evaluating the impact of the disease at a younger age, from the psychosocial and disease burden points of view.3 Breast cancer represents a very large share of the global disease burden (2.3 million patients diagnosed every year).4 In China, younger women, especially in the age range of 20–40 years, have increasingly been diagnosed with breast cancer.5 Breast cancer is one of the leading causes of cancer deaths in women, especially in younger patients, thus breast cancer in younger women clearly needs more attention.6
Altered body image leads to the aggravation of the issues surrounding the evaluation of one’s body image as well as the feelings of uneasiness associated with one’s body image.7 A major consequence of the altered body image phenomenon is the decreased self-worth of the individuals experiencing altered body image as well as the chronic and worsened depression. These issues have a negative and long-lasting impact on the ability of individuals to adapt to new situations.8 In patients with breast cancer, the negative issues described above are directed toward the altered body image phenomenon. This aspect is the most prevalent in the active intervention stage. It contributes to the breast cancer patients experiencing depression and anxiety and worsens the negative issues described previously.9 As a result of these feelings, patients are less likely to adhere to the treatment course and cooperation decreases. Additionally, these feelings negatively impact the individuals with altered body image as well as their family relationships and their relationships within the community, especially in social isolation.10 Furthermore, these factors negatively impact the patients and their treatment plans, especially in the implementation of the treatment plans.11
Recent studies have shown that body image disturbances might be affected by a number of psychological factors, such as emotional regulation, self-concept, femininity and relationship identity. These factors shape women’s understanding of the changes occurring to their bodies as their roles in society and their meaning in society change with a cancer diagnosis. Sebri et al (2023) stated that women with breast cancer often have a gap between their real body and the body image that they wish to have, and that gap can cause cognitive and emotional maladaptive distress.12 Their body image findings illustrate the interaction between cultural and body image norms and the distress and psychological response patients experience due to those norms in relation to their gender.
With regard to interventions, growing evidence demonstrates that structured psychological approaches such as cognitive behavioural therapy (CBT), mindfulness-based interventions, acceptance and commitment therapy and body image focused therapeutic programmes can effectively reduce distress, improve body appreciation and support identity reconstruction. These interventions help patients develop adaptive cognitive strategies, enhance emotional regulation and foster positive embodiment, ultimately promoting better psychological outcomes. However, despite the documented benefits of such interventions, their applicability within the sociocultural context of Chinese women with breast cancer remains insufficiently explored.
Breast cancer patients’ experiences of their disease can be significantly shaped by their Chinese cultural background.13 In China, traditional values place great emphasis on women’s appearance and family roles, which may exacerbate patients’ feelings of shame and isolation. Cancer-related stigma can lead to social withdrawal and reduced social support, further worsening body image disturbance.14 While some researchers have studied body image issues in breast cancer patients, mainly using quantitative methods and focusing on the current status of body image disturbance and analysis of influencing factors,15 this study employs a qualitative research approach to explore the experiences of body image disturbance in young and middle-aged Chinese women with breast cancer in the context of social interactions, providing an informational basis for improving body image disturbance in this patient group.
Therefore, this study aims to explore the perceptions and emotional reactions of young and middle-aged Chinese women with breast cancer toward changes in their physical appearance and bodily function during treatment and social interactions, as well as to understand the coping strategies they adopt in response to these challenges. Based on existing literature, we hypothesise that body image disturbance in this population is jointly influenced by individual psychological factors (such as emotional regulation and self-concept), sociocultural expectations (including femininity norms and family roles), and interpersonal pressures (such as stigma and social evaluation).
Hence, this study aims to (1) investigate how females understand and make sense of bodily and functional alterations resulting from mastectomy, (2) explore their emotional and cognitive reactions and responses to a social context and (3) analyse the strategies they use to cope with disordered body image and the meaningful integration of their everyday lives.
This particular age group is considered an indivisible cohort instead of looking at the age subgroups since individuals in the cohort (women 18–59) are likely to face dual family and occupational involvements, which makes them particularly susceptible to body image disturbance and to the consequent psychological distress. It is postulated in the study that body image disturbance in the cohort is the result of a constellation of psychological factors emanating from the expected socio-cultural norms and interpersonal relationships and how they conjointly influence a woman’s ability to cope and regulate the emotional distress.

Methods

Research design
Reflecting on Husserl’s phenomenological approach, this research adopted a phenomenological qualitative design to understand people’s life experiences and the meaning they attached to a certain occurrence. This approach was in line with the objectives of the research in exploring the perception and the coping mechanisms of young and middle-aged women with breast cancer towards the changes in their body image and the changes they undergo during the course of treatment. The objectives of the study were achieved through in-depth, semi-structured interviews and the participants’ experiences were analysed using Colaizzi’s 7 step method.

Patient and public involvement statement
Neither the patients nor the public were involved at any stage of the research process, nor will they be involved in the dissemination of the results.

Participants
This study was carried out from January to October 2024, including young and middle-aged women (18–59 years old) with breast cancer who were receiving inpatient treatment at two tertiary hospitals in North and Central China. The research involving human participants was reviewed and approved by the Medical Ethics Committee of Shanxi Bethune Hospital (Approval Number: YXLL-2024-062). This age range was selected because women in this group typically face dual pressures of family caregiving and professional responsibilities, making them particularly vulnerable to body image disturbance and psychological distress following mastectomy. Purposive maximum variation sampling was used, and a total of 18 young and middle-aged women with breast cancer were selected as study participants.
Inclusion criteria:
Women aged 18–59 years.

Pathologically diagnosed with breast cancer.

Had undergone mastectomy.

Body Image Scale (BIS) score ≥10.

Good cognitive and language expression ability.

Provided informed consent.

Exclusion criteria:
Presence of other malignant tumours or severe complications.

Inability to cooperate.

Withdrawal for personal reasons.

Recruitment process
Potentially qualifying individuals were initially recognised using the inpatient database from both participating centre’s departments of breast surgery. The study’s attending doctors and nursing staff filtered patients based on the study’s inclusion and exclusion criteria and presented the study to patients deemed eligible. In order to ensure positive sampling, the clinicians first made a list of potential participants with differences in age, education level, stage of the disease and number of chemotherapy treatments so that the researchers would be able to gain a wide array of views. After participants were first identified, the investigators met the patients while in their wards; described the objectives, the steps, the nature of the study and the confidentiality involved; and requested study participation. Each of these interactions took place in a location that granted them confidentiality and protection from interference by third parties, either in the patients’ rooms or in a nearby private office. The researchers explained that participation was completely voluntary and would not in any way alter the patients’ clinical treatments. There were no monetary rewards for participants. Each patient was given sufficient time to consider participation and provided written informed consent before the interview. The research team held daily communication with the clinical staff to identify newly admitted eligible patients and periodically reviewed records to ensure no eligible patient was overlooked. Recruitment continued until data saturation was achieved, meaning that no new themes emerged from interviews. Data saturation was evaluated jointly by two researchers after each round of coding, and recruitment was terminated when three consecutive interviews produced no new information. Study participants were guaranteed ample time to reflect on the prospect of involvement, and only after this contemplation period and the opportunity to ask any questions about the study, were participants invited to complete and provide their written informed consent prior to commencing the study interview. The study team established and maintained contact with the clinical team on a daily basis to be advised of any newly admitted candidates, regularly reviewing admission files to ensure that no eligible candidates from the admission lists were missed. The process of participant recruitment was carried out and continued to be conducted until the study reached the point of data saturation; that is, until and only after no further. Additionally, disparate templates and no unique data were identified and noted within the coded study participant interviews. Assessment of the level and extent of data saturation was jointly conducted and performed by two independent clinical researchers with the study participants, on a per participant interview basis, after each cycle of qualitative thematic coding, and the final participant interviews were accepted by the study team only following the completion of three consecutive participant study interviews, where no further unique participant study data or new coded data were identified from the participants. In the beginning, 21 individuals gave their consent for the study, but 3 of them backed out for personal reasons, so the conclusive total of study participants was 18. Of the study sample, one participant withdrew due to emotional stress, and the other two participants withdrew due to scheduling conflicts with treatment procedures. None of those that withdrew experienced problems with the study protocol.

Sampling method and sample size
Purposeful maximum variation sampling was used, taking into account participants in differing clinical stages and cycles of chemotherapy to enhance the richness of the interviews. No new information was emerging during the analysis, which indicated data saturation. The detailed steps of sampling are as follows: To begin, patients were invited to fill out the scale. Prior to each interview, 30 patients who had been diagnosed with breast cancer were chosen to complete the body image disturbance scale. 24 of these patients had a BIS score of 10 or above. Next, researchers provided patients with a BIS score above 10 an explanation regarding the aims, procedures and importance of the study, and those patients who provided consent to participate were selected to be interviewed face to face after the informed consent form was signed. During the research, three patients declined to participate in the interview. Finally, to verify data saturation, the researchers interviewed two more patients after collecting data from 18 participants. Since no new information emerged, the sample size was determined to be 18.

Study setting
The study was conducted among patients with breast cancer admitted to the breast surgery departments of two tertiary hospitals in North China and Central China. These hospitals receive over 800 breast cancer patients each year. Both departments manage all patient diagnoses and treatment information through a database, which facilitated the smooth progress of this study.

Interview aids/data collection instruments
Two instruments were used in this study to assist the interview process and participant selection:

General information survey form
Based on a literature review, the researchers designed a survey form to collect sociodemographic and disease-related information. Sociodemographic information included age, educational level and occupation, while disease-related information included clinical stage and number of chemotherapy cycles, among others.

Body Image Scale
The European Organisation for Research and Treatment of Cancer licensed and created the first BIS and the version for this study and translated BIS practice version is Zhang Yan.16 The scale is divided into three: affective, cognitive and behavioural and the measurement is a 4-point Likert scale with total scores rising from 0 to 30.
Indicators of severe disturbance of self-body image disturbance are from 10 to more, while scores from one and more indicate presence of disturbance of self-body. The Cronbach’s α coefficient for this scale in the present study was 0.93, indicating excellent reliability.

Interview procedure

Data were collected through semi-structured interviews
Interview times were demarcated post-therapy sessions as well as during break hours (16:00–17:00 or 19:00–20:00). Out of the fourteen participants, four had one interview due to effects from side effects before the next chemotherapy cycle that was planned. The duration of interviews ranged at an average of 45 min at 30–50 min.

Interview location
In order to keep participants at ease and to provide enough confidentiality, interviews were done in the patients’ peace, private rooms that had already been used before, with the placement of a ‘Do Not Disturb’ sign on the outside of the room.

Interview process
The explanation of procedures and self-introductions of the researcher were followed with a use of everyday terms, jargon and language similar to those of the participants, which was done to help the participants follow along more easily. The participants were assumed to respond how they chose, while the interviewers remained quiet to capture the participants’ responses as well as their actions and gestures.
A simplified interview guide was used which emphasised:
Understanding how others may view the patient post-diagnosis.

Feelings in response to others’ actions or attitudes.

Self-assessment on the changes in your appearance and in the functions of your body.

Mechanisms of coping and adjustment to the changes.

The comprehensive interview tool is available in online supplemental table S1.

Data management and analysis
The interviews were recorded verbatim, and transcripts were made as quickly as possible and within 24 hours of conducting each interview. To examine the transcripts, one of the seven methods of Colaizzi’s method of phenomenological analysis was selected, and this was the structuring of the method as follows:
Familiarisation: Gaining understanding via multiple readings of the transcripts.

Identification of meaningful statements: Selection of statements of significance.

Coding construction: Identification of particular recurring perspectives.

Theme Clustering: Arrangement of the codes of the group into the first level of a theme.

Detailed description: To each theme constructed, with supporting quotations, a description is provided.

Generation of basic structure: Significant and repeated themes were consolidated to a primary group.

Validation of basic structure: Checking themes against one another for alignment.

Colaizzi’s method was chosen as it provides a systematic method to disentangle the lived experiences of the participants and ensures the results are tied to the participants’ stories.
To ensure the analysis was trustworthy and rigorous, the four criteria of trustworthiness which are credibility, dependability, confirmability and transferability were applied. To ensure credibility, participants were asked to review the summary of the results to validate them. For dependability, peer debriefing was done with two experts on qualitative research. For confirmability, an audit trail was created detailing each step of the analysis process. Rich and thick descriptions of the participants and the setting of the study were provided to enhance transferability.
Conforming to the Standards for Reporting Qualitative Research (SRQR) criteria, the researcher(s) characteristics and reflexivity were also responded to (online supplemental table S2). Four members of the research team (initials: HL, JGa, XZ and YG), who were trained in qualitative research and had postgraduate degrees in nursing and/or psychology, conducted the interviews. The interviewers had no prior clinical or personal ties to the participants. To minimise bias, the researchers engaged in continuous reflexivity during the study. Analysis team meetings enabled self-reflexivity through discussion of the potential influence of the researchers’ subjective values on the analysis (online supplemental table S2 for individual reflexivity statements).

Results
A total of 18 young and middle-aged women with breast cancer participated in this study. Their demographic and clinical characteristics are summarised in table 1. The participants’ ages ranged from 18 to 59 years (mean: 44.1 ± 8.3), the majority were married (83.3%) and most had a middle or lower educational level. Clinical stages were distributed across 0–IV, with stage II and III cases being most common.
Through in-depth, semi-structured interviews with 18 young and middle-aged (18–59 years old) women with breast cancer, this study used phenomenological research methods to thoroughly and meticulously analyse their shared experiences of body image disturbance during treatment. The study identified the primary psychosocial themes for the entire population group and therefore, no age subgroup comparisons were carried out. The study employed Colaizzi’s phenomenological analysis to look at the participants’ lived experiences of body image disturbance during the treatment process. Instead of trying to classify the responses by how often they were repeated, the analysis aimed at the core of the participants’ meanings, emotions and the processes of identity formation and re-construction. The participants’ experiences of social pressure from the outside, and their coping and self-redefinition from the inside, culminated in four major themes and nine combined sub-themes. The thematic structure and meaning units from the participants’ narratives as an example can be seen in table 2.

Theme 1: perceived social group pressure
Patients said they felt extreme social pressure when it came to family expectations, peer comparisons and public scrutiny. The role of the sick person in the social family structure and the social role that they play such as wife, mother and caregiver got disrupted. Participants worried about becoming burdens to their family and about their loss of femininity.
A participant said, “With only one breast left, I feel incomplete and uncomfortable” (M), where one can see the extent to which the social and cultural values that intersected around femininity, and the idea of beauty as wholeness, affected her feelings. Other mothers also spoke about the sadness that came to them when they got sick and could not take care of their small children, which speaks to the double burden of being sick and having family responsibilities.
Interactions with other people also impacted their emotions. Hearing other people discuss their treatment stories was sometimes a source of solace but also generated even greater anxiety, as one woman stated, “She told me she was vomiting and pale after chemotherapy, which made me very scared” (G). Such exchanges made them more conscious of their own fragility and fears of death.
Experiencing public views, particularly for noticeable treatment signs like PICC line or missing hair, was embarrassing and led people to avoid social contexts. “I want to remove this PICC line because people stare when I wear short sleeves,” a participant illustrated (H). These social experiences highlight how social attitudes intensified their sense of difference and stigma and therefore increased their bodily distress.

Theme 2: emotional reactions to social pressure
The participants exhibited paradoxical behaviour regarding social pressure. A strong desire to achieve their goals countered deep feelings of hopelessness. Their motivation to achieve their goals was linked to an obligation to their families. As one maternal respondent stated, “I just want to live long enough to see my child grow up” (C). Here, survival was linked to maternal identity, which required self-sacrifice to achieve the family goals.
The participants’ responses to social pressure also revealed emotional conflict. Family visits were a source of comforting and uncomfortable feelings. “It warms my heart when they visit, but I don’t want them to see me like this” (D). This conflict illuminates her internal struggle concerning the balance between social interaction and the desire to avoid being seen as weak.
Numerous participants experienced a particular kind of confusion with regards to existence post the surgical operation. “Lying in the ICU, I wondered, am I still a woman? What will become of me?” (F). This kind of thought construction depicts a loss of both the outer shell and identity, which are frequently experienced in the first position. This disruption of the body represents not only the loss of body in a literal sense, but also the loss of self, both continuity and social connection.

Theme 3: perception of physical changes
The patients’ awareness of their suffering and physical injuries was bottomless and complex. Visible and invisible changes such as deep transformations, physical frailty, changes in body volume, loss of hair, numbness and changes in body weight loss restructured patients’ self-esteem and interactions to a will their self was deeply challenged by.
Physical weakness was only a small component of this suffering. ''I have the will but not the strength’’ was the deep frustration (H) expressed by one of the patients. Loss of energy was the most profound manifestation of loss of control and loss of the ability to act in everyday life.
The pain of losing hair and the associated stigmatisation of hair loss are summarised by one participant’s description of their loss: “My hair, eyebrows, and eyelashes are gone” (E). Another participant described the feeling as, “I feel less feminine and afraid to take off my clothes” (J). The comments synthesised above highlight how their dignity, femininity and other aspects of their self-image and self-worth were impacted by the changes associated with the treatments received.
Another participant commented on how changes in the weight of an individual influences one’s self-image as well: “I’ve gained weight and look unattractive” (G). The feeling of disconnectedness from one’s self could be compounded if one’s body is perceived to be gaining weight and, in their body’s non-cooperative state, is not putting on weight as an indicator of recovery.

Theme 4: coping and meaning reconstruction
Regardless of the excruciating nature of the experience, some women were able to discover means of coping mechanisms. They transformed the self-worth evaluation processes towards not being contingent on the physical, indicative of an introspective mental renovation of the identity structure towards the construction of purpose.
Initially, most decided to socially isolate themselves. “I stay home to avoid explaining my illness to others,” participant (J) stated. This implication did assist in the circumvention of unwanted inquiries or criticisms. However, the social reintegration efforts were still being hindered.
Over the years, several women recounted accounts of personal development, advanced psychological resilience and the ability to bounce back after hardship. A patient once stated, “I try to think positively; otherwise, negativity will drag me down. Murphy’s Law says what you fear most will happen.” (B). Some of these accounts indicate a shift from mere endurance to a more purposeful reflection as gained control over the circumstances and emotional strength.
Examining the growth from a phenomenological perspective, one can appreciate the evolution beyond the mere corporeal, as one seeks to derive meaning from the constraints of the illness. This evolution was not characteristic of a simple erasure of their suffering, but the ability to intricately integrate their suffering into a renewed and more profound sense of self.

Integrative interpretation
The experiences of body image disturbance due to social pressure and emotional distress to bodily dissociation to self-reconstruction among breast cancer patients. Their stories capture the intertwining of social and cultural expectations of illness and caregiving. Social and cultural expectations of illness and caregiving intertwine with the physical and emotional sequelae of illness to capture the impact of their stories.
From the perspective of phenomenology, their experiences embody a movement from loss of self to reconstruction of self. In facing their own mortality, these women were resilient and carved a path to self-actualisation and self-transformation which went beyond the corporeal self.

Discussion
The research study used the qualitative method to examine the extent of the body image disturbance during the treatment of breast cancer in young to middle-aged Chinese women patients, disclosing its impact on patients’ psychosocial concerns on social psychological coping. Providing a multidimensional perspective and informing body image disturbance psychological interventions in breast cancer patients.
Using Husserl’s phenomenological perspective, the study describes how the research participants made meaning of their bodily experiences and the self-renewal of their self-illness identity during the trajectory of the illness.

Social pressure and psychological reactions
It has been shown that social factors, psychological aspects and response to perceived change described by young and middle-aged patients with breast cancer during treatment align with other studies in the field. For instance, Lim et al17 noted that there is an absence of interspousal communication which plays a major role in amplifying psychological tension in breast cancer patients, which aligns with the reported communication barriers with spouses in the present study. Patients felt that their physical alterations would have a negative impact on the marital relationships and women would become less alluring, which demonstrates the far-reaching impact of traditional culture regarding body image acceptance.18 Furthermore, Gröschel et al19 noted that the absence of communication creates gaps of emotional disengagement and diminished satisfaction in marriage, which also presents an imperative need for training communication abilities among couples in breast cancer patients.
In relation to social support, the study found that a social avoidance behaviour pattern was noted due to the public scrutiny and preferential attention given to patients because of their condition. Zhu et al20 also noted the correlation between stigma and cancer-related social isolation, thus emphasising the importance of public awareness in the reduction of discrimination against breast cancer patients. Patients’ social avoidance behaviour and social integration can be improved through the dissemination of factual information pertaining to breast cancer through various platforms, such as WeChat and Weibo.

Psychological impact of body image disturbance
The research also showed the concerning consequences of body image disturbance in the patient’s self-worth and mental well-being. Patients exhibited anxiety due to the alteration of their physical body and even more, the fear of not having complete control over their bodies. This mental state may overshadow the patients’ treatment compliance and overall wellness. This aligns with Pereira et al,21 who discussed the impact of body image disturbance as being one of the prominent psychological strains for patients with breast cancer. Thus, the relevance of psychological strategies in the management of body image disturbance is evident.
Given that individuals were chosen as a result of their BIS scores being greater than or equal to a score of 10, which indicates a high level of body image disturbance, these results indicate the need to implement some form of support for this form of psychological distress as soon as possible.
Graboyes et al22 indicate that cancer patients can experience body image-related distress and that this form of distress can be reduced and even alleviated with the assistance of CBT. On the other hand, it shows that mindfulness-based stress reduction (MBSR) improves the adjunctive psychological well-being of patients.23 More recent literature indicates that self-perception and self-compassion components are interrelated with body image disturbance in survivors of breast cancer. Sebri et al proposed a body-compassion model that seeks to treat the altered body with the kindness that is due to any suffering, recognition of that suffering in a mindful state and the identification of that suffering with the suffering of others in a compassionate manner. This model indicates that body shame can be reduced and emotional recuperation after a mastectomy is supported.24 This is the same rationale that has been hypothesised by Millard et al that acceptance-based therapy that is focused on compassion can contribute to psychosocial improvement and the attainment of positive body image.25 Among other things, the results of this study highlight the need for generationally compassionate psychological support to be part of rehabilitation for breast cancer survivors to address the body image challenges.

Impact of cultural background
In Chinese society, the integration of body image disturbance issues within the context of culture, within breast cancer patients, is unique. In the traditional customs of the Chinese culture, body image of women is more around the family composition and the associated societal value.26 The breast, as an anatomical secondary sexual characteristic, is also an important marker of feminine social contribution and a physiologically definable feature.27 Hence, the loss of breast tissue is a huge psychological loss to the patients. In this study, a number of the patients have voiced worries about body mutilation, as well as the concerns of persons within marital partnerships, and here one may speculate the impact of culture on the disturbance of body image. In addition to the disturbance of the body image and the mental health of the patients, this issue may also react on the societal structures and the social roles of the patients. Furthermore, the psychological issues which arise in the patients also stem from the way in which society views cancer, as well as the common attitudes towards people afflicted with the illness. Within the past years, the cancer illness is seen as very problematic and serious, and because of this, people maintain a negative viewpoint and have a misunderstanding towards patients with cancer.28 This sociocultural environment is one of the factors patients deal with which increases the psychological difficulty of isolation throughout treatment. Therefore, reducing the stigmatisation of cancer patients and improving public understanding and support for cancer are important for improving patients’ psychological state.29

Clinical implications
The results of this study have important implications for the clinical care of breast cancer patients. First, healthcare providers should pay attention to patients’ psychological needs and provide targeted psychological support and interventions. CBT and MBSR have been proven to be effective in improving body image and psychological state in cancer patients.30 Second, healthcare providers should strengthen communication with patients and their families to help them better understand the disease and treatment process, reducing anxiety and fear caused by information asymmetry. Additionally, healthcare providers should pay attention to patients’ social support networks and encourage them to participate in support groups to share experiences and receive emotional support.31
Domare et al32 proposed that caregiver support programmes can alleviate caregiver burden. This study also found that patients’ inability to care for their elderly parents due to their own illness leads to a strong sense of guilt. This dual pressure (illness and parental health) may trigger a ‘stress-fatigue’ cycle. Therefore, integrating family-centred care models into oncology treatment may more comprehensively meet the needs of patients and caregivers.33

Innovative approaches and potential role of artificial intelligence
Considering the rapid development of artificial intelligence (AI) in healthcare, AI-based interventions could offer novel approaches to address body image disturbance in young and middle-aged breast cancer patients. Advanced AI algorithms developed within emotion recognition technologies, as well as within automated virtual psychotherapy programmes and digital personalised coaching systems, offer persistent monitoring of patients’ psychological state and well-being and are likely to increase patients’ engagement and ease of access to interventions.34
AI, for instance, offers an opportunity to synthesise and process real-time data on patients’ negative emotions and body image issues, which could be used to provide algorithmically determined personalised coping strategies and feedback, thereby complementing the effectiveness of primary interventions such as CBT or mindfulness programmes.35 Additionally, AI offers an opportunity to provide psychotherapy digitally, overcoming geographical barriers and optimising situations of limited healthcare access.
Nonetheless, certain features of AI should be taken into consideration. The human ability to empathise, form a bond with a patient and understand the complexities of a therapy relationship cannot be substituted. The use of AI also raises important ethical questions relating to privacy, data collection and informed consent, which cannot be ignored.
As a result of research collaboration, this evidence will be useful in the development of AI auxiliary applications that, along with traditional support approaches, would help address the disruption of body image in breast cancer patients and primarily support younger and middle-aged women. The patients need support that is tailored, sensitive to culture and easily accessible. This will help enhance the patients’ social and emotional integration and will support the findings expressed in this research.

Limitations
There is cause for concern related to the generalisability of the findings from this research, as this study is limited to just 18 young and middle-aged female breast cancer patients from just two tertiary hospitals in Northern and Central China, and the lack of control groups, participants of the male gender and follow-up assessments after extended periods of time affects the ability of evaluating the patients’ psychological continuance and social adjustments on a long-term basis.

Conclusion
This work elucidates why considering patients’ psychological and social dimensions is vital in the breast cancer care spectrum. The body image disturbances experienced by women diagnosed with breast cancer in their middle and young years while undergoing treatment are a contribution to this study that will benefit countless future endeavours in research and practice. Future research should focus on developing and evaluating interventions for these multidimensional challenges to improve the quality of life of breast cancer patients.

Supplementary material
10.1136/bmjopen-2025-100781online supplemental table 1