By: Susan Moench, PhD, PA-C
Patients with a history of breast cancer experiencing hot flushes and night sweats (HFNS) reported significant improvement in related quality-of-life measures following a nurse-led cognitive behavioral therapy (CBT) intervention compared with usual care, according to results of a randomized clinical trial published in Psycho-Oncology.
Hot flushes and night sweats (HFNS) are commonly experienced by women who have been treated for breast cancer, and have been shown to negatively impact quality of life for many of these women.
Previous studies have shown CBT to be an effective approach for helping women treated for breast cancer manage HFNS, although the CBT sessions in these studies were led by clinical psychologists. Driven in part by concerns related to the potential for limited access to these therapists, this randomized trial was designed to evaluate the effectiveness of CBT delivered by trained breast cancer nurse specialists to women with a history of breast cancer experiencing HFNS.
Prior to the study, 11 breast cancer nurse specialists in England and Wales were trained in the CBT intervention over 2 days by a clinical psychologist, and also maintained ongoing supervision as required.
In this multicenter phase III study (MENOS 4; International Standard Randomized Controlled Trials [ISRCTN.com] Identifier: 12824632), women who had completed primary therapy for nonmetastatic breast cancer reported 7 or more HFNS per week with an overall score of 4 out of 10 or higher on the Hot Flush Problem Rating scale, and were willing and able to attend weekly group sessions, were randomly assigned in a 1:1 ratio to receive weekly group CBT intervention delivered over 90 minutes for 6 weeks or usual care consisting of ad hoc advice for those reporting HFNS. The primary study endpoint was the Hot Flush Problem Rating score at 26 weeks following randomization.
Of the 130 patients recruited to the study, 3 patients withdrew; hence, 61 women undergoing the CBT intervention and 66 patients receiving usual care were included in this analysis.
Some of the key study findings included a significant improvement in the primary study endpoint, with those receiving the CBT intervention reporting a 46% reduction in their Hot Flush Problem Rating score at 26 weeks compared with a 15% reduction for those receiving usual care (P =.039). Other measures, such as the rate of reduction in the frequency of HFNS was also significantly higher in patients receiving CBT (28%) vs usual care (11%; P =.010) at 26 weeks, with similar findings at 9 weeks. Furthermore, significant improvements in sleep quality, depression, and anxiety were also observed for the intervention compared with the control arm at both 9 and 26 weeks.
“Our findings suggest that CBT is an important alternative to medication for women with troublesome hot flushes and night sweats following breast cancer treatment, and that this intervention can be delivered in practice by trained breast care nurses in the [National Health Service], with significant benefit to patients to improve their health,” the study authors noted in their concluding comments.
Fenlon D, Maishman T, Day L, et al. Effectiveness of nurse-led group CBT for hot flushes and night sweats in women with breast cancer: Results of the MENOS4 randomised controlled trial [published online May 27, 2020]. Psychooncology. doi: 10.1002/pon.5432
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