**2. Breast cancer: a challenge to women's body, identity and quality of life**

Breast cancer treatment often involves several long-term interventions. Typically, it involves a surgery (mastectomy or lumpectomy), followed by additional therapies that may include chemotherapy alone or in combination, radiotherapy and hormone therapy. These treatments lead to several side effects such as changes or loss of one or both breasts, visible scars, hair, eyebrows and eyelashes loss, lymphedema, increased body weight and difficulty getting used to prostheses [9, 10]. Therefore, the various dimensions of the body are affected in its functionality and shape (or disshape). Besides, the imminence of a terminus of that body is a constant. Henceforth, survivors tend to be hypervigilant of their bodily sensations, which is even more intense before the routine exams due to the fear of cancer recurrence [11]. All the treatments and associated effects significantly impact women with breast cancer's body schema and body image [3, 12, 13]. In breast cancer, all cognitive survival schemes and bodily schemes interact in a complex way throughout the process of adjustment to the disease and the survival phase [14].

Body image is considered as the mental image of the body, the subjective perception of one's physical and appearance, health status, normal bodily functioning and sexuality [15]. Body image is also related to other dynamic elements, such as the subjective perspective of one's opening or distancing to others, the dimensions of tension/relaxation, activity/passivity and to the perception of femininity/masculinity [16]. Considering the context of a potentially deadly disease and associated decreased vital energy, loss or change of body and role in family, social and professional milieus, breast cancer is, therefore, a real test to one's body image, which is itself the foundation of identity. In fact, research shows that 77% of women with breast cancer have body image disturbances that persist beyond cancer treatments and reconstructive surgeries [10]. These disturbances are even more significant in women undergoing more radical surgeries. For example, six months after a mastectomy, only 63% of the women feel comfortable when fully clothed, and 21% feel comfortable when unclothed [14].

The body image disturbances and the organic factors (e.g., decreased sexual desire) associated to breast cancer have a significant impact on intimate relationships [3] and sexuality itself [17]. It is important to note that sexuality goes beyond sexual activity but mostly to intimacy. It is related to the experience of an interiority expressed to the other in a corporeal dimension, involving the real body and the imaginary body. The surgery often brings psychological distress accompanied

#### *Complementary Treatment for Women with Breast Cancer: A Psychomotor Therapy Approach DOI: http://dx.doi.org/10.5772/intechopen.100544*

by a feeling of emotional rupture that extends to the intimate relationship with the partner. Moreover, the various effects of chemotherapy (e.g., fatigue, weight changes, alopecia) also impact sexual health and intimate relationships. Also, hormone therapy, which often extends throughout time (5 or 10 years), is responsible for profound changes in sexual desire. In fact, high rates of sexual disturbances have been reported in women's breast cancer: around 70% of sexual dysfunctions and 30% of other sexual complaints throughout the treatment and the survival phases [18].

Moreover, the uncertainty, fear, pain, fatigue, discomfort, sleep disturbances and cognitive impairment associated with a breast cancer diagnosis and treatment result in anxiety and depressive symptoms [19, 20]. These mental health symptoms are common at diagnosis and often become more intense with treatment burden and in the survival phase [21–23] and may affect the treatment, especially regarding compliance with treatment protocols, follow-up exams, and social and family routines [24].

In this pathway, it is also important to consider stress. From the diagnosis to the survival phase, stress is prevalent [25, 26]. Despite the low prevalence of posttraumatic stress disorder [27, 28], clinically significant symptoms are relatively common, and the diagnosis and the treatment are often experienced as traumatic [28, 29]. Although stress is an adaptive response of the body to internal or/and external challenges, prolonged exposure to stress conditions, such as a breast cancer diagnosis and/or associated treatment, leads to neuroendocrine dysregulations and immune dysfunctions [30]. Moreover, chronic stress can also affect behavioral processes and pathways involved in cancer progression [31] and block health-protective behaviors, such as adherence to treatments [22].

Finally, the adverse effects described above regarding physical and emotional wellbeing, along with the difficulties on social functioning [32], compromise the quality of life both in the treatment phase and in the survival phase [10, 33].

Either in the diagnosis, the treatment or the survival phase, the experience of a body limited by fatigue, pain, or even of a new/different/foreign body (i.e., with a prosthesis) involves mourning the previous body and readjusting the body scheme and the body image. Besides, all the changes associated with women's breast cancer are deeply rooted in a painful corporeality that embraces an interiority threatened by its continuity, visibility, and wellbeing. Therefore, dealing with breast cancer implies an internal and external recognition and readaptation to the new body and an internal symbolic reorganization of the female, intimate, and social identity [34].
