Body Image and its Relation with Coping Strategies in Breast Cancer Patients: A Descriptive Study in Sulaimaniyah, Iraq


  • Bakhan Farah Hama Sharif Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Author
  • Mahabat Hassan Saeed Department of Maternal Neonate Nursing, College of Nursing, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Bijan Nouri Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. Author
  • Sina Valiee Clinical Care Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. Author



Breast cancer, body image, coping strategies, Iraq


Background: Breast cancer is several of the worst severe illnesses for women, which influences their physical and mental quality of life and acceptance of their bodies. It affects patients' views of their bodies; thus, finding effective coping mechanisms is essential.


Objective: This study aimed to discover body image and its relation with coping mechanisms in breast cancer patients admitted to Hiwa Hematology/Oncology Hospital in Sulaimaniyah, Iraq.


Materials & Methods: This Cross-sectional study was conducted on women diagnosed with breast cancer admitted to the Hiwa Hematology/Oncology Hospital Sulaimaniyah, Iraq. A three-part questionnaire was utilized to gather information to determine body image and coping mechanisms that were demographic and clinical form, body image scale and Coping Orientation to coping or regulating cognitions in response to stressors (Brief-COPE).


Results: The mean score for the body image was reported as 7.86±7.73, the mean score for coping strategies, including problem-focused /active coping strategies items was reported as 2.74±0.67, and functional items as 2.82±0.43. Considering the calculated mean scores, the distress or concerns of the participants about their body image were lower. The most frequent coping strategies were religious coping (3.88±0.32), while the least active coping approach was humor (1.96±1.08). Self-distraction (3.13±1.03) was the least avoidant coping strategy. A significant positive relationship between the coping strategies with body image was reported as (p=0.032, r=0.200).


Conclusions: Good body image in women was associated with increased usage of practical acceptance. Therefore, it is advised to promote a positive view of physical appearance and having skilled nurses assess all breast cancer patients' capacity for coping following surgery. Nurses and patients can effectively communicate about body image and coping techniques through these assessments.


Invernizzi M, De Sire A, Venetis K, Cigna E, Carda S, Borg M, Cisari C, Fusco N. (2022). Quality of life

interventions in breast cancer survivors: State of the art in targeted rehabilitation strategies. Anti-Cancer

Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry-Anti-Cancer Agents). ;22(4):801-10.

Siegel RL, Miller KD, Fuchs HE, Jemal A. (2022). Cancer statistics, 2022. CA: A Cancer Journal for DOI:


Alwan NA, Tawfeeq FN, Mallah N. (2019). Demographic and clinical profiles of female patients diagnosed DOI:

with breast cancer in Iraq. Journal of Contemporary Medical Sciences. 5(1):14-9.

M-Amen K, Abdullah O, Amin A, Hasan B, Mohamed Z, Sulaiman L, Shekha M, Najmuldeen H, Barzingi

B, Salih A, Mahmood D. Cancer Statistics in Kurdistan Region of Iraq: A Tale of Two Cities.

Winters S, Martin C, Murphy D, Shokar NK. (2017). Breast cancer epidemiology, prevention, and screening. DOI:

Progress in Molecular Biology and Translational Science. 151:1-32.

Chen C, Cao J, Wang L, Zhang R, Li H, Peng J. (2020). Body image and its associated factors among

Chinese head and neck cancer patients undergoing surgical treatment: a cross-sectional survey. Supportive

Care in Cancer. 28:1233-9.

van Oers H. (2020). Body image and the psychological and behavioural indices of distress in female breast

cancer patients. World Scientific News. (140):172-84.

Sukartini T, Permatasari YI. (2020). Women with breast cancer living with one breast after a mastectomy.

Central European Journal of Nursing and Midwifery.12(2):366-75.

Thornton M, Lewis-Smith H. (2021). “I listen to my body now”: a qualitative exploration of positive body

image in breast cancer survivors. Psychology & Health.1-20.

Mohammadi SZ, Khan SM, Vanaki KZ. (2018). Reconstruction of feminine identity: the strategies of

women with breast cancer to cope with body image altered. International Journal of Women's Health.689-97.

Herman KC, Reinke WM, Eddy CL. (2020). Advances in understanding and intervening in teacher stress

and coping: The Coping-Competence-Context Theory. Journal of School Psychology. 78:69-74.

Torralba-Martínez E, Quintana MJ, Carbonell MC, de Las Sias E, Carrillo CP, Codern-Bové N. (2022).

Coping experiences of women in the different phases of breast cancer. Supportive Care in Cancer. 30:197-206. DOI:

Zamli MS, Palutturi S, Suriah AY. (2019). Relaxation Intervention and Counselling Models In Controlling DOI:

Stress In Cancer Patients. Indian Journal of Public Health.10(8):833.

Nasrudin, A. M and Budu. (2019) “Relationship between Premenstrual Coping and Premenstrual

Syndrome (PMS) among Female Midwifery Students in Kendari Health Polytechnic.” Indian Journal of Public

Health Research & Development 10 (4):1002-1007.

Seib C, Porter‐Steele J, Ng SK, Turner J, McGuire A, McDonald N, Balaam S, Yates P, McCarthy A,

Anderson D. (2018). Life stress and symptoms of anxiety and depression in women after cancer: the mediating

effect of stress appraisal and coping. Psycho‐Oncology. 27(7):1787-94.

Tang M, Liu X, Wu Q, Shi Y. (2020). The effects of cognitive-behavioral stress management for breast DOI:

cancer patients: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing.


Vergara RG, Vera Contreras GM, Sobarzo González SG, Cisternas Farias FI. (2021). La religión como

afrontamiento en pacientes oncológicos: síntomas depresivos y ansiosos. Psychologia. Avances de la

Disciplina. 15(1):69-81.

Ernst J, Friedrich M, Vehling S, Koch U, Mehnert-Theuerkauf A. (2021). Cancer-related distress: How

often does it co-occur with a mental disorder? –Results of a Secondary Analysis. Frontiers in Psychology.


Terol Cantero MC, Bernabé M, Martín-Aragón M, Vázquez C, Buunk AP. (2021). Social comparison and

stress appraisal in women with chronic illness. International Journal of Environmental Research and Public

Health. 18(10):5483.

Nihayati HE, Fadila FL, Fauziningtyas R. (2020). The relationship between psychosocial stress and coping

strategies for breast cancer patients. Systematic Reviews in Pharmacy.11(3):817-22.

Sajadian A, RajiLahiji M, Motaharinasab A, Kazemnejad A, Haghighat S. (2017). Breast cancer coping

strategies after diagnosis: A six-month follow-up. Multidisciplinary Cancer Investigation. 1(4):12-6.

Gómez-Campelo P, Bragado-Álvarez C, Hernández-Lloreda MJ, Sánchez-Bernardos ML. (2015). The

Spanish version of the Body Image Scale (S-BIS): psychometric properties in a sample of breast and

gynaecological cancer patients. Supportive Care in Cancer. 23:473-81.

Rand KL, Cohee AA, Monahan PO, Wagner LI, Shanahan ML, Champion VL. (2019). Coping among

breast cancer survivors: a confirmatory factor analysis of the brief COPE. Journal of Nursing Measurement.


Daryaafzoon M, Ahadi H, Jomehri F, Eftekhar-Ardebili M, Babaei G. (2021). Methods of Maintaining

Mental Health in Iranian Patients with Cancer: The Factor Structure of Brief Coping Orientation to Problems

Experienced Scale. Qom University of Medical Sciences Journal. 14(12):41-51.

Roudi O, Tirgari B, Cheraghi MA, Nayeri ND, Rayyani M. (2019). “Tender Care”: Iranian women’s needs

to cope with hysterectomy and oophorectomy-a qualitative content analysis study. International Journal of

Community Based Nursing and Midwifery. 7(1):63.

Zhou K, Wang W, Li M, An J, Huo L, He X, Li J, Li X. (2020). Body image mediates the relationship

between post-surgery needs and health-related quality of life among women with breast cancer: a crosssectional study. Health and Quality of Life Outcomes. 18(1):1-1.

Yamani Ardakani B, Tirgari B, Roudi Rashtabadi O. (2020). Body image and its relationship with coping

strategies: The views of Iranian breast cancer women following surgery. European Journal of Cancer Care.

(1): e13191.

Hajian S, Mehrabi E, Simbar M, Houshyari M, Zayeri F, Hajian P. (2016). Designing and psychometric

evaluation of adjustment to illness measurement inventory for Iranian women with breast cancer. Iranian

Journal of Cancer Prevention. 9(4).

Boatemaa Benson R, Cobbold B, Opoku Boamah E, Akuoko CP, Boateng D. (2020). Challenges, coping

strategies, and social support among breast cancer patients in Ghana. Advances in Public Health. 2020:1-1. DOI:

Tariq A, Hasan SS. (2015). Body image and quality of life of young and middle aged married Pakistani

mastectomy breast cancer patients. FWU Journal of Social Sciences.;9(2):32-9.

Pakseresht S, Monfared A, Ghanbari A, ATRKAR RZ, Rahimi A. (2011). Investigating body image and

the related factors among women with breast cancer at educational and therapeutic hospitals in Rasht in 2011-12.

Moreira H, Silva S, Marques A, Canavarro MC. (2010). The Portuguese version of the Body Image Scale

(BIS)–psychometric properties in a sample of breast cancer patients. European Journal of Oncology Nursing.


Lake B, Fuller HR, Rastall S, Usman T. (2019). Breast reconstruction affects coping mechanisms in breast

cancer survivors. Indian Journal of Surgery. 81:43-50.

Xu N, Liu Y. (2020). Coping strategy mediates the relationship between body image evaluation and mental DOI:

health: A study with Chinese college students with disabilities. Disability and Health Journal. 13(1):100830.



How to Cite

Body Image and its Relation with Coping Strategies in Breast Cancer Patients: A Descriptive Study in Sulaimaniyah, Iraq. (2023). Journal of Zankoy Sulaimani - Part A, 25(2), 11.