Menopausal symptoms in breast cancer patients could be reduced through CBT delivered by nurses

Menopausal symptoms - hot flushes and night sweats – experienced by women with breast cancer can be reduced through group cognitive behavioral therapy (CBT) delivered by breast care nurses, a new clinical trial reveals.

Up to 85% of women with breast cancer suffer from hot flushes and night sweats due to chemotherapy and hormone therapy treatments. These side effects are often more extreme and can last longer for women with breast cancer than for women who experience them due to natural menopause. Hormone replacement therapy (HRT) may be offered to relieve menopausal symptoms, but is not usually recommended for women with breast cancer because it may increase their risk of the disease returning, therefore safe and effective alternatives to reduce side effects and ensure quality of life are urgently needed.

Researchers funded by Breast Cancer Now have found that women with breast cancer, who received six weeks of group CBT from a breast care nurse, reported that their menopausal symptoms became significantly less distressing and less problematic. Their frequency also reduced by over a quarter (28%). This more than doubles the reduction of symptoms reported by women receiving standard care, and often ad hoc advice (11%). Furthermore, for the women who received CBT from a nurse, these life-changing benefits lasted several months.

For many women with breast cancer, menopausal side effects can have a devastating impact on both their quality of life and mental health; consequently, some women stop treatment that could help prevent their breast cancer returning. However, in the study women reported that after receiving CBT from a nurse their night sweats and hot flushes were almost twice as easy to cope with. They also experienced significantly improved quality of sleep and reduced levels of depression and anxiety.

Led by Professor Deborah Fenlon from Swansea University, in collaboration with Southampton Clinical Trials Unit at the University of Southampton and the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, the trial involved 127 women from six UK hospitals. All participants had primary breast cancer or DCIS (ductal carcinoma in situ), an early type of the disease, and were experiencing severe and frequent hot flushes or night sweats.

The participants attended six 90-minute sessions, delivered by 11 different breast care nurses who had been specially trained by a clinical psychologist to deliver CBT. The sessions covered topics including stress management, paced breathing, improved wellbeing and strategies for managing the specific side effects of hot flushes, night sweats and disrupted sleep.

Once the pressures on the NHS start to ease, and capacity and resource has been considered, Breast Cancer Now would like to see Trusts and Health Boards across the UK support breast care nurses to deliver group CBT to patients suffering with these menopausal side effects of treatment. Where this intervention is possible it will improve quality of life, and critically, help women to continue treatment that helps reduce the chances of their cancer coming back.

Professor Myra Hunter from King’s IoPPN, who developed the group CBT and trained the nurses in the trial, said:

“In previous trials we have found that group CBT delivered by clinical psychologist is an effective way to alleviate menopausal symptoms for women who have undergone breast cancer treatment. There are clear advantages for women to access this support from nurses who they may already know, so it is a considerable step forward to demonstrate that this therapy is just as effective when delivered by trained breast care nurses. We have a published treatment manual and a training course with the British Menopause Society, so that this therapy is available for health professionals to access and can reach more women who might benefit from it.”

Menopausal symptoms, such as hot flushes and night sweats, can profoundly impact quality of life for women with breast cancer. It’s hugely exciting to see that CBT delivered by a breast care nurse can help to spare women, who’ve already had the difficult experience of a breast cancer diagnosis, this further anguish. The COVID-19 pandemic has thrown us into unprecedented times. But one thing that remains the same is the critical need for us to strive, through research, to find ways to prevent breast cancer and save lives, and equally to make discoveries that mean the 600,000 people currently living with the disease live as well as possible.

We appreciate that the NHS is working tirelessly under immense strain right now, but hope that when pressures on breast care nurses begin to ease the findings of this innovative study lead to CBT being made available to help women affected by breast cancer to enjoy a better quality of life. Our world-class research is only possible thanks to public support. Due to the impact of COVID-19 our fundraising income is projected to drop by 43% in this financial year, meaning we are less able to fund new research that could transform the lives of people affected by breast cancer. We need your support now more than ever. For more information and to donate please visit www.breastcancernow.org/donate.”

Dr Simon Vincent, Director of Research, Support and Influencing at Breast Cancer Now

Natalie Richards, 39, mum-of-two, from London, who was diagnosed with triple negative breast cancer in April 2019 and experienced intense hot flushes and night sweats during chemotherapy. She said:

“I was shocked to be told I had breast cancer. Treatment began pretty quickly and as soon as I started chemotherapy my periods stopped. I hadn’t been aware of the side effects I’d experience.

“I had hot flushes all through the day and night. It felt like every half an hour. I was breaking out into full sweats no matter the time or weather, on top of all the other side effects of my chemotherapy, yet this side effect had never been mentioned or discussed with me. When I explained I was struggling with hot flushes I felt this was dismissed, without any advice around how I could try to ease this distressing side effect.

“I became very down and anxious with my hot flushes and night sweats being all-consuming and overwhelming. I was so embarrassed when it happened in public. I don’t know how I managed, but I just tried to take one day at a time and focusing on my daughters helped me push through. It was the best part of a year before these symptoms eased off.

“I knew less about these menopausal symptom side effects and they seemed overlooked; yet for me they were just as distressing as hair loss, perhaps more so because they were so unexpected. I had such a wonderful breast care nurse, and I think if she’d been able to provide me with some support specifically for my menopausal symptoms that could’ve made a huge difference.”

Other ways of managing hot flushes and night sweats can be found on Breast Cancer Now’s website here.

Anyone seeking information and support can speak to Breast Cancer Now’s expert nurses by calling the charity's free Helpline on 0808 800 6000.

Breast Cancer Now is grateful to Walk the Walk for their generous financial support of Professor Fenlon’s project.

Source:
Journal reference:

Fenlon, D., et al. (2021) Effectiveness of nurse‐led group CBT for hot flushes and night sweats in women with breast cancer: Results of the MENOS4 randomised controlled trial. Psycho Oncology. doi.org/10.1002/pon.5432.

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