Abstract
BACKGROUND: Body image distress (BID) is a significant psychological issue for patients with head and neck cancer (HNC) and arises from the visible disfigurements and functional impairments often associated with the disease and its treatment. Understanding the factors contributing to BID in this population is crucial for developing effective interventions and support mechanisms. OBJECTIVE: This systematic review outlines methods for identifying, evaluating, and synthesizing the available evidence on factors associated with BID among patients with HNC. This review intends to explore both clinical and psychosocial variables that may influence body image perceptions and the resulting psychological impact. METHODS: This review will follow the Joanna Briggs Institute (JBI) Reviewer's Manual for Systematic Reviews Concerning Etiology and Risk Factors. PsycINFO, MEDLINE, EBSCOhost CINAHL, Web of Science, Cochrane Library, and Embase were searched for relevant studies from inception to December 2024. All in-depth quantitative analyses, descriptive observational studies, experimental studies, and quasi-experiments published in English or Chinese were analyzed and described. Studies examining factors associated with BID in patients with HNC were included. The population, exposure, comparison, and outcome (PECO) format was used to develop the search strategy. For different databases, search terms will be combined using Boolean operators. The JBI Risk of Bias Tool was used to evaluate bias risk in the included studies. The extracted data will include basic study information, research design, sample characteristics, BID measurement tools, primary outcomes, statistical analysis methods, and quality assessment results. Subgroup and meta-regression analyses will be performed on different therapies, treatment stages, genders, ages, cultural backgrounds, etc. I2 statistics will be used to evaluate heterogeneity, and funnel plots will address publication bias. If we detect significant heterogeneity, the findings will be reported as a systematic review without a meta-analysis. RESULTS: The database search will be conducted in October 2025. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of March 2026. CONCLUSIONS: This study will summarize the factors that can help identify and evaluate the factors associated with BID in patients with HNC, providing up-to-date evidence to inform the management of body image in this patient population.