CBT improves hot flashes in breast cancer survivors
By Andrew Czyzewski
27 February 2012
Lancet Oncol 2012; Advance online publication

MedWire News: Breast cancer survivors who suffer hot flashes and night sweats (HFNS) may benefit from treatment with cognitive behavioral therapy (CBT), results of a randomized controlled trial show.

Indeed, CBT reduced the severity of HFNS relative to usual care with additional benefits to mood, sleep, and some aspects of quality of life.

Myra Hunter (King's College London, UK) and colleagues say CBT "has the potential to improve long-term health outcomes for patients with breast cancer, and could be incorporated into breast cancer survivorship programmes."

Around 65-85% of breast cancer patients experience HFNS after treatment causing distress, sleep problems, and decreased quality of life.

"Hormone replacement therapy is often either undesirable or contraindicated," say Hunter et al, adding that "safe, effective nonhormonal treatments are needed."

For the current study, they recruited 97 women with problematic HFNS (minimum 10 problematic episodes a week) who had completed medical treatment for breast cancer (surgery, radiotherapy, or chemotherapy), and had no evidence of other cancers or metastases.

Women were randomly allocated to receive usual care (n=49) or CBT (n=47). The latter comprised one 90-minute session a week for 6 weeks, and included psycho-education, paced breathing, and cognitive and behavioral strategies to manage HFNS.

Women taking adjuvant endocrine treatment were eligible if they had been using the treatment consistently for 2 months or more, and planned to continue at the same dose during the trial.

The primary outcome was the adjusted mean difference in HFNS problem rating (1-10) between CBT and usual care groups at 9 weeks after randomization.

Hunter et al found that women in the CBT group reported less problematic HFNS than those receiving usual care (mean difference -1·67), and these improvements were maintained at both the 9- and 26-week follow-ups.

Although the pre-specified endpoint of a between-group difference of 2 points was not met, a larger proportion of women who had received CBT achieved a reduction of 2 points compared with the usual care group at 26 weeks (78 vs 33%).

Hunter et al note that the results of the study were very similar to the preliminary findings of a parallel trial of CBT for HFNS in a sample of healthy women (MENOS2).

"This consistent pattern of results suggests that the CBT might work by affecting symptom perception and cognitive appraisal of HFNS and possibly mood, rather than physiological mechanisms of HFNS, such as temperature regulation or the thermoneutral zone in the hypothalamus," they comment in Lancet Oncology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

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