Non-drug treatment reported to improve quality of life in younger breast cancer patients
VIENNA, AUSTRIA - Chemotherapy produces a number of unpleasant side effects including nausea, vomiting, and hair loss. However, for younger breast cancer patients, it also produces distressing menopausal symptoms such as hot flushes, night sweats, vaginal dryness, weight gain, urinary incontinence and sexual problems. Researchers from The Netherlands have developed a non-medicinal treatment to relieve those symptoms. They reported their findings at the 8th European Breast Cancer Conference (EBCC-8), held last week in Vienna, Austria.
The researchers reported that menopausal symptoms caused by giving chemotherapy or hormonal therapy to these women can be significantly relieved with cognitive behavioral therapy (CBT) and physical exercise (PE). The study group was comprised of 422 breast cancer patients with an average age of 48 years; they were recruited from 14 hospitals from the Amsterdam and Rotterdam regions of The Netherlands. The women were randomly assigned to four groups: CBT alone, PE alone, CBT and PE combined, and a control group. Compared with the control group, all patients who received one or both interventions were found to experience an overall decrease in the levels of menopausal symptoms; furthermore, they reported an increase in their sexuality and an improvement in physical functioning. Six months after the interventions, the benefits were still present.
“To our knowledge, this is the first study to investigate the efficacy of these two interventions specifically in women who have experienced acute, treatment-induced menopause,” noted Dr. Marc van Beurden from The Netherlands Cancer Institute, Amsterdam, The Netherlands. He added, “This is a very important issue for the quality of life of younger breast cancer patients. Unlike healthy women starting the menopause, they are unable to take hormone replacement therapy to alleviate their symptoms. There are other drugs available, but they are only moderately effective and have troublesome side-effects.”
The CBT program entailed six weekly group sessions of 90 minutes each, which included relaxation exercises. The primary focus of the CBT was on hot flushes and night sweats; however, other symptoms were also addressed. The goal of the PE program was to exercise at an intensity level that achieved a target heart rate. It included 12 weeks of individually tailored, home-based, and self-directed exercise regimen of two-and-a-half to three hours per week. The initial training and follow-up was overseen by physiotherapists.
The investigators were under the impression that CBT reduces stress levels and helps women cope effectively with the symptoms they are experiencing. The intent of the PE program was to reduce hot flushes through an effect on the thermoregulatory system. “There was already evidence that both interventions were effective in women undergoing the natural menopause,” noted co-author Dr. Hester van Oldenburg. She explained, “We are pleased to have established that they also work in women with induced menopause, which is significantly more difficult for patients to deal with both because it is caused by cancer treatment, which is distressing in itself, and because the symptoms often come on so quickly that there is little or no time to get used to them.”
The women involved in the study noted that participation in the CBT program made them more aware of their symptoms and how to deal with them. One participant explained, “Before, I more or less accepted them unconsciously. Now I’m more alert about my symptoms, their effect, and possible ways to cope with them. By sharing my experiences with others, I’ve learned to put my symptoms in perspective and to cope with them.”
The researchers found a major shortcoming of the interventions: poor compliance. In regard to the CBT, it was difficult to schedule the group sessions at a time that was convenient for women who often had both work and parenting responsibilities. Furthermore, the frequency and intensity of the PE program was a challenge for many women.
Take Home Message:
This study reported that unpleasant menopausal symptoms can be reduced by both cognitive behavioral therapy and physical exercise. This finding is not only beneficial to breast cancer patients but also to women entering the menopause who do not undergo hormone replacement therapy (HRT).