Analysis of the Causal Relationship of Body Image Factors in Patients with Cancer

Vita Ari Fatmawati, Christantie Effendy, Ridho Rahmadi



Patients with cancer can potentially experience the negative impacts of treatment. Physical conditions due to illness and therapy can affect the patient's body image. This study aims to find a causal model among body image factors of patients with cancer using the S3C-Latent Method. The measurement of body image of patients with cancer used the BIS questionnaire. One hundred and ninety-nine patients with cancer participated in this study. The results showed the existence of causal relationships between behavior to cognitive factors and duration of illness with reliability scores of 0.8 and 0.6, respectively; from gender to affective factors, illness duration, behavior, and cognitive factors with reliability scores of 0.6, 0.8, 0.65, and 1, respectively. There are also causal relationships from age to affective factors, duration of illness, and cognitive factors with reliability scores of 0.8, 0.7, and 0.9, respectively. The results also showed that affective factors are associated with behavior, cognitive factors, and duration of illness, with reliability scores of 1, 1, and 0.9, respectively. The results showed further the association of cognitive factors and illness duration with a reliability score of 1. We expect that the estimated causal model will serve as a scientific reference for medical experts in developing a better intervention such as treatment.


cancer; body image; s3c-latent; causal relationship

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C. A. Wijaya and M. Muchtaridi, “Pengobatan Kanker Melalui Metode Gen Terapi,” Farmaka, vol. 15, no. 1, pp. 53–68, 2017.

P. Nova and E. N. Sumintarddja, “Peran BRIEF CBT Terhadap Tingkat Depresi dan Masalah Body Image Pasien Kanker Payudara Dewasa Muda,” J. Ilm. Psikol. MANASA, vol. 5, no. 2, pp. 103–113, 2016.

H. C. Melissant et al., “A systematic review of the measurement properties of the Body Image Scale (BIS) in cancer patients,” Support. Care Cancer, vol. 26, no. 6, pp. 1715–1726, 2018, doi: 10.1007/s00520-018-4145-x.

Sriwahyuningsih, Dahrianis, and M. Askar, “Faktor yang berhubungan dengan gangguan citra tubuh (body image ) pada pasien post pperasi mastektomi di RSUP dr . Wahidin,” STIKES Nani Hasanuddin Makassar, vol. 1, no. 3, pp. 1–6, 2012.

L. A. Rozika and N. Ramdhani, “Hubungan antara harga diri dan body image dengan online self-presentation pada pengguna instagram,” Gadjah Mada J. Psychol., vol. 2, no. 3, p. 172, 2018, doi: 10.22146/gamajop.36941.

G. K. Tiwari and S. Kumar, “Psychology and body image : a review,” Shodh Prerak, no. January, 2015.

P. Hopwood, I. Fletcher, A. Lee, and S. Al Ghazal, “A body image scale for use with cancer patients,” Eur. J. Cancer, vol. 37, no. 2, pp. 189–197, 2001, doi: 10.1016/S0959-8049(00)00353-1.

W. Luo, W. Wu, and Y. Zhu, “Learning Heterogeneity in Causal Inference Using Sufficient Dimension Reduction,” J. Causal Inference, vol. 7, no. 1, 2019, doi: 10.1515/jci-2018-0015.

E. Wolfe, R. W. Spekkens, and T. Fritz, “The Inflation Technique for Causal Inference with Latent Variables,” J. Causal Inference, pp. 70–91, 2019, doi: 10.1515/jci-2017-0020.

T. A. Glass, S. N. Goodman, M. A. Hernán, and J. M. Samet, “Causal inference in public health,” Annu. Rev. Public Health, vol. 34, pp. 61–75, 2013, doi: 10.1146/annurev-publhealth-031811-124606.

M. L. Petersen and M. J. Van Der Laan, “Causal models and learning from data: Integrating causal modeling and statistical estimation,” Epidemiology, vol. 25, no. 3, pp. 418–426, 2014, doi: 10.1097/EDE.0000000000000078.

R. Rahmadi, “Finding stable causal structures from clinical data,” Radboud Universiteit Nijmegen, 2019.

Z.-P. Ai, X.-L. Gao, J.-F. Li, J.-R. Zhou, and Y.-F. Wu, “Changing trends and influencing factors of the quality of life of chemotherapy patients with breast cancer,” Chinese Nurs. Res., vol. 4, no. 1, pp. 18–23, 2017, doi: 10.1016/j.cnre.2017.03.006.

D. E. Fingeret, M. C., Teo, I., & Epner, “Managing body image difficulties of adult cancer patients: lessons from available research,” Cancer, vol. 120, no. 5, pp. 633–641, 2014, doi: 10.1002/cncr.28469.Managing.

S. S. Yatmi Tri, Effendy Christantie, “Gambaran diri dan kualitas hidup pasien kanker payudara,” Gadjah Mada, 2018.

S. A. Bahrami, M., Mohamadirizi, M., Mohamadirizi, S., & Hosseini, “Evaluation of body image in cancer patients and its association with clinical variables,” J. Educ. Health Promot., vol. 6, no. 81, 2017, doi: 10.4103/jehp.jehp_4_15.

J. M. Youngblut, “A consumer’s guide to causal modeling: Part I,” J. Pediatr. Nurs., vol. 9, no. 4, pp. 268–271, 1994.

J. M. Youngblut, “A consumer’s guide to causal modeling: Part II,” J. Pediatr. Nurs., vol. 9, no. 6, pp. 409–413, 1994, [Online]. Available:

P. Judea, Causality: models, reasoning and inference. Cambridge: Cambridge University Press, 2000.

D. M. Chickering, “Learning Equivalence Classes of Bayesian-Network Structures,” J. Mach. Learn. Res., vol. 2, no. 3, pp. 445–498, 2002, doi: 10.1162/153244302760200696.

N. Meinshausen and P. Bühlmann, “Stability selection,” J. R. Stat. Soc. Ser. B Stat. Methodol., vol. 72, no. 4, pp. 417–473, 2010, doi: 10.1111/j.1467-9868.2010.00740.x.

S. D. Stovitz, E. Verhagen, and I. Shrier, “Distinguishing between causal and non-causal associations: implications for sports medicine clinicians,” Br. J. Sports Med., vol. 53, no. 7, pp. 398 LP – 399, Apr. 2019, doi: 10.1136/bjsports-2017-098520.

S. P. S. Sulisno Madya, “Artikel asli,” Media Med. Muda, vol. 1, no. Januari-April, pp. 7–12, 2016, [Online]. Available:

P. J. et al Gouin, “NIH Public Access,” NIH Public Access, vol. 31, no. 1, pp. 81–93, 2011, doi: 10.1016/j.iac.2010.09.010.The.

M. Ubando, “Gender differences in intimacy, emotional expressivity, and relationship satisfaction,” Pepperdine J. Commun. Res., vol. 4, no. 13, pp. 19–29, 2016, [Online]. Available:

D. Susilawati, “Hubungan Antara Dukungan Keluarga dengan Tingkat Kecemasan Penderita Kanker Serviks Paliatif,” J. Keperawatan Indones., vol. 4, no. 2, pp. 87–99, 2013, [Online]. Available:

K. Fletcher et al., “Gender differences in the evolution of illness understanding among patients with advanced cancer,” J. Support. Oncol., vol. 11, no. 3, pp. 126–132, 2013, doi: 10.12788/j.suponc.0007.

A. Melliana, Menjelajah tubuh perempuan dan mitos kecantikan. Yogyakarta: LKiS Yogyakarta, 2006.

N. Wardana and R. Ernawati, “Hubungan Usia dan Aktivitas Fisik dengan Jenis Kanker di Ruang Kemoterapi RSUD Abdul Wahab Sjahranie Samarinda,” Borneo Student Res., no. 2018, pp. 159–165, 2019, [Online]. Available:

D. L. Murman, “The Impact of Age on Cognition,” Semin. Hear., vol. 36, no. 3, pp. 111–121, 2015, doi: 10.1055/s-0035-1555115.

M. L. Healey and M. Grossman, “Cognitive and affective perspective-taking: Evidence for shared and dissociable anatomical substrates,” Front. Neurol., vol. 9, no. JUN, pp. 1–8, 2018, doi: 10.3389/fneur.2018.00491.

S. Nyumirah, “Pengaruh Terapi Perilaku Kognitif Terhadap Kemampuan Interaksi Sosial Klien Isolasi Sosial di RSJ Dr. Amino Gondhohutomo Semarang,” 2012.

R. Saniatuzzulfa and S. Retnowati, “Program " Pasien PANDAI " untuk Meningkatkan Optimisme Pasien Kanker,” Gadjah Mada J. Prof. Psychol., vol. 1, no. 3, pp. 163–172, 2015.

P. P. Pandharipande et al., “Long-term cognitive impairment after critical illness.,” N. Engl. J. Med., vol. 369, no. 14, pp. 1306–1316, Oct. 2013, doi: 10.1056/NEJMoa1301372.

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