Body image issues among adolescents and young adult cancer patients and survivors – A literature review from the STRONG AYA Project

Background: Adolescents and young adults (AYAs, aged 15–39 years) face cancer during a life phase marked by physical, psychological, and social development, in which body image plays a significant role. We aimed to: (1) describe body image issues among AYA cancer patients and survivors by synthesising quantitative and qualitative evidence across intrapersonal, interpersonal and societal levels, and (2) identify the negative, positive, and mixed or no/unclear impact of body image outcomes of AYA cancer patients and survivors. Methods: This review is part of STRONG-AYA and builds on prior research to develop a core outcome set for young cancer patients. Titles and abstracts were screened, methodological quality was assessed, and data were extracted by three independent researchers. The results were summarised narratively and thematically analysed. Results: In total, 716 articles were screened, of which 62 were included. Findings highlight the complexity of body image issues in AYAs with cancer. Quantitative studies showed mixed results. Some reported poorer body image compared to healthy peers, while others found no difference. Qualitative studies revealed both negative comparisons (e.g., to pre-cancer self or societal ideals) and positive adjustments (e.g., pride, acceptance). As studies often reported multiple types of psychosocial outcomes, the total frequency exceeds the number of included papers (N = 62). Negative impacts on body image were most common (n = 57), followed by positive (n = 39), mixed (n = 23), and unclear or no impacts (n = 15). Conclusion: Our study highlights that body image issues in AYAs with cancer are deeply shaped by comparisons to their pre-cancer selves, peers, and societal ideals. These comparisons and the impact of body image can be both distressing and supportive.