Breast cancer

15 February 2012

Psychotherapy helps hot flashes

After breast cancer treatment, many women suffer from hot flashes and night sweats, but a type of "talk therapy" might relieve these symptoms for some women.


After breast cancer treatment, many women suffer from hot flashes and night sweats, but a type of "talk therapy" might relieve these symptoms for some women, British researchers suggest.

In a new study, women who received this form of psychotherapy, known as cognitive behavioural therapy, had reduced their symptoms by half within six months.

"Hot flashes and night sweats are distressing symptoms, which cause social embarrassment and sleep problems, and they are challenging to treat, especially for women who have had breast cancer" because hormone replacement therapy is generally not recommended for these women, explained lead researcher Myra Hunter.

According to background information in the study, which is published in the online edition of The Lancet Oncology, 65% to 85% of women have hot flashes after breast cancer treatment.

Group cognitive behavioural therapy is a safe and effective treatment for women who have hot flashes and night sweats following breast cancer treatment, Hunter said, with additional benefits to mood, sleep and quality of life.

"The women in this trial reported frequent and problematic symptoms and relatively low quality of life," said Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry.

Hunter's team randomly assigned 96 women who had been treated for breast cancer and suffered from night sweats and hot flashes to either "talk therapy" or usual care.

The 47 women who received the therapy attended weekly 90-minute sessions for six weeks. For the others, usual care consisted of access to nurses and oncologist, telephone support and cancer support services, the researchers noted.

The therapy sessions

The therapy sessions included psycho-education, paced breathing, and behavioural strategies to manage hot flashes and night sweats, as well as interactive PowerPoint presentations, group discussion, handouts and weekly homework, Hunter said.

In addition, participants learned how to handle the stress associated with hot flashes and night sweats, and found new ways to decrease anxiety, she explained.

The women were also taught to manage hot flashes in social situations and to understand night sweats and improve sleep habits using mental and behavioural strategies.

The investigators found that the women who had received the cognitive behavioural therapy significantly reduced the number of hot flashes and night sweats they experienced in the nine weeks after the start of the study.

This reduction in symptoms lasted for 26 weeks. At nine weeks there was a 46% reduction in symptoms and a 52% reduction at 26 weeks, Hunter's team found.

However, among women receiving usual care, hot flashes and night sweats decreased by 19% after nine weeks and 25% after 26 weeks.

"These reductions were sustained and associated with significant improvements in mood, sleep and quality of life," Hunter said. "This is a safe, acceptable and effective treatment option, which can be incorporated into breast cancer survivorship program and delivered by trained breast cancer nurses."

Hot flashes common in women

Holly Prigerson, director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, wrote an accompanying journal editorial.

"Hot flashes and night sweats are very common, distressing and persistent – women reported being troubled by them for an average of two years after breast cancer treatment," Prigerson said.

She noted that the new study provides sound evidence upon which to recommend cognitive behavioural therapy for breast cancer patients suffering from these symptoms.

"Adaptations to an online, self-management version of the intervention would allow for more flexible scheduling and greater access at potentially lower cost of delivery," Prigerson said. "Combining the intervention with medications that effectively treat hot flashes and night sweats might produce the most dramatic effects with reductions in symptoms as well as the distress caused by them."

Prigerson said this type of therapy might also be used to treat postmenopausal women suffering from these symptoms.

"Of course, scientifically, we can't generalise beyond the sample of women who experience menopausal symptoms as a result of treatment for breast cancer," she said. "But given that they found that [this type of therapy] worked on the distress associated with hot flashes and night sweats, then it would seem likely to generalise to menopausal symptoms experienced outside of this context."

(Steven Reinberg, HealthDay, February 2012) 

(Copyright © 2012 HealthDay. All rights reserved.) 

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Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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