The visible and invisible scars of childhood cancer: A qualitative study of body image and identity in survivorship.
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OBJECTIVES: This study explored the lived experiences of young adult childhood cancer survivors regarding the impact of visible physical differences on body image and identity. Although clinical survival rates have increased, the long-term psychological implications of treatment-related physical alterations remain under-researched. DESIGN: A qualitative study adopting a constructivist-interpretivist approach. METHODS: We conducted semi-structured interviews with 41 survivors (aged 19-28) recruited from a Spanish paediatric oncology unit. Data were analysed using reflexive thematic analysis. RESULTS: This analysis revealed a complex trajectory of embodiment across four central themes: Permanent Body Changes and Physical Consequences; Damage to Body Image, Self-Perception and Identity; Insecurity and Isolation in the Social/Sexual Sphere; and Coping Strategies-From Hiding to Acceptance. This trajectory spans from the initial trauma of permanent physical consequences and functional limitations to a sense of "spoiled identity" characterized by body shame and social avoidance. The findings highlight how visible scars and developmental delays often disrupt socio-sexual integration, creating a significant "disclosure burden" in romantic contexts. However, the analysis also identifies a dynamic shift towards resilience, where survivors increasingly re-signify physical marks as symbols of strength and survival. CONCLUSION: These results underscore the need for developmentally sensitive, lifelong psychosocial support that moves beyond biomedical metrics to address the nuanced, experiential reality of life after childhood cancer.