Researchers from The Netherlands have found that the menopausal symptoms caused by giving chemotherapy or hormonal therapy to younger women with breast cancer can be ameliorated considerably through the use of cognitive behavioural therapy (CBT) and physical exercise (PE). These interventions can be effective in dealing with such distressing symptoms as hot flushes, night sweats, vaginal dryness, weight gain, urinary incontinence and sexual problems, a researcher will tell the 8th European Breast Cancer Conference (EBCC-8) today (Thursday).
The researchers studied 422 breast cancer patients with an average age of 48 years recruited from 14 hospitals from the Amsterdam and Rotterdam regions of the Netherlands. They were randomly assigned to four groups – CBT alone, PE alone, CBT and PE combined – and a control group. Compared with the control group, all those patients who received one or both interventions showed an overall decrease in the levels of menopausal symptoms, in addition to reporting an increase in sexuality and an improvement in physical functioning. These positive effects were still apparent after six months.
“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,” Dr. Marc van Beurden from The Netherlands Cancer Institute, Amsterdam, The Netherlands, will say. “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 programme consisted of six weekly group sessions of 90 minutes each, including relaxation exercises.
The primary focus of the CBT was on hot flushes and night sweats, but other symptoms were also addressed. The PE programme was a 12-week, individually tailored, home-based and self-directed exercise programme of two and a half to three hours per week. Initial training and follow-up was provided by physiotherapists. The goal was to exercise at an intensity level that achieved a target heart rate.
The researchers believe that the CBT reduces stress levels and helps women cope effectively with the symptoms they are experiencing. Physical exercise is intended 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,” says Dr. van Beurden’s colleague, Dr. Hester van Oldenburg. “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.”
Breast cancer treatments and the menopause
The sex hormones oestrogen and progesterone can encourage the growth of breast cancer cells. Treatment for breast cancer often involves hormonal therapy, which blocks oestrogen from getting to breast cancer cells, or reduces the level of oestrogen in the body. These treatments may cause an early menopause or menopausal symptoms.
Surgery, radiotherapy, chemotherapy and hormonal therapy may be used alone or in combination to treat breast cancer.
Some of these treatments can affect the function of the ovaries. They may cause your menopause to begin earlier than expected, or they may cause you to have menopausal symptoms.
Patients said that participation in the CBT programme made them more aware of their symptoms and how to deal with them. “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,” said one participant.
While the evidence that the interventions worked was convincing, compliance with them was poor, the researchers say. In the case of 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. The frequency and intensity of the PE programme was also a challenge for many women.
At the potent but risky end of the treatment spectrum is hormone replacement therapy (HRT). While HRT can ease menopausal symptoms, current and past users of HRT have a higher risk of being diagnosed with breast cancer. Before the link between HRT use and breast cancer risk was established, many post-menopausal women took HRT for many years to ease menopausal symptoms and to reduce bone loss. Since 2002, when research linked HRT and risk, the number of women taking HRT has dropped dramatically. Still, many women continue to use HRT to handle bothersome menopausal symptoms.
If you’ve been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn’t use HRT. The hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow. While only a few small studies have looked at HRT use in women with a personal history of breast cancer, the fact that HRT use increases breast cancer risk among women in general makes almost all doctors advise women with a personal history of breast cancer to avoid HRT. The prescribing sheet included with HRT clearly states that it is “contraindicated in women with a diagnosis of breast cancer.” Not being able to use HRT can present a challenge for many women. If you’re having severe hot flashes or other menopausal side effects and have a personal history of breast cancer, talk to your doctor about non-hormonal options, such as dietary changes, exercise, weight management, acupuncture, or meditation.