Results of a pilot study suggest a video-based telemedicine intervention providing cognitive behavioral therapy (CBT) may provide a clinically meaningful improvement in body image distress related to head and neck cancer (HNC). Results of the study were recently published in JAMA Otolaryngology-Head & Neck Surgery.

The BRIGHT trial ( Identifier: NCT03831100) evaluated the use of a CBT program (the BRIGHT intervention) for adult survivors of HNC experiencing body image distress. The intervention is administered via video telemedicine platform in 5 weekly 1-on-1 visits with a psychologist. 

Patients were randomly assigned to either the BRIGHT intervention arm or an attention control arm. Attention control involved sessions similar in frequency and delivery to the BRIGHT intervention, including discussions of survivorship, but without the behavioral change component that was incorporated into the BRIGHT intervention. 

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Some outcomes of interest were the change in HNC-related body image distress, which was evaluated through a patient-reported outcome tool called the Inventory to Measure and Assess imaGe – Head and Neck (IMAGE-HN), and clinical response with regard to HNC-related body image distress. Clinical response was calculated as the proportion of participants who had a clinically meaningful change in IMAGE-HN score. Statistical significance in this study involved P-values below .10. The trial included 44 survivors of HNC, with 20 participants in the BRIGHT arm and 24 in the attention control arm. 

Based on IMAGE-HN scores, compared with participants in the attention control arm, those in the BRIGHT arm experienced less HNC-related body image distress from baseline to 1 month after the intervention. This decrease was reported as a mean model-based difference in change in the IMAGE-HN score of −7.9 points (90% CI, −15.9 to 0.0; P =.10). At 3 months following the intervention, the mean model-based difference in change in these scores was −17.1 points (90% CI, −25.6 to −8.6; P =.002), favoring the BRIGHT intervention. 

The clinical response at 3 months following the intervention showed a pattern of being 6.6-fold greater for the BRIGHT arm than for the attention control arm (model-based odds ratio, 6.6; 90% CI, 2.0-21.8; P =.09). 

The acceptability of the BRIGHT intervention was considered to be high; 95% of participants in the BRIGHT arm reported that they were likely or highly likely to recommend the program to other survivors of HNC who experience body image distress.

The researchers concluded that for survivors of HNC, the study’s preliminary data indicated that the BRIGHT intervention may lead to a clinically meaningful improvement in body image distress. They noted that it seemed to be highly effective for most of the survivors of HNC experiencing body image distress in this study.

‘’Collectively, these promising preliminary data support conducting a large multisite efficacy trial to establish BRIGHT as the first evidence-based treatment for HNC survivors with [body image distress],” the study investigators wrote.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Graboyes EM, Maurer S, Balliet W, et al. Efficacy of a brief tele-cognitive behavioral treatment vs attention control for head and neck cancer survivors with body image distress: a pilot randomized clinical trial. JAMA Otolaryngol Head Neck Surg. Published online December 1, 2022. doi:10.1001/jamaoto.2022.3700