“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 Feb. 15 online edition of The Lancet Oncology, 65 percent to 85 percent of women have hot flashes after breast cancer treatment.
Group cognitive behavioral 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 oncologists, telephone support and cancer support services, the researchers noted.
The therapy sessions included psycho-education, paced breathing, and behavioral 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 behavioral strategies.
The investigators found that the women who had received the cognitive behavioral 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 percent reduction in symptoms and a 52 percent reduction at 26 weeks, Hunter’s team found.
However, among women receiving usual care, hot flashes and night sweats decreased by 19 percent after nine weeks and 25 percent 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 programs and delivered by trained breast cancer nurses.”
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 behavioral 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 generalize 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 “talk therapy” worked on the distress associated with hot flashes and night sweats, then it would seem likely to generalize to menopausal symptoms experienced outside of this context.”