Abstract
ObjectiveTroublesome hot flushes and night sweats (HFNS) are experienced by many women after treatment for breast cancer, impacting significantly on sleep and quality of life. Cognitive behavioural therapy (CBT) is known to be effective for the alleviation of HFNS. However, it is not known if it can effectively be delivered by specialist nurses. We investigated whether group CBT, delivered by breast care nurses (BCNs), can reduce the impact of HFNS.MethodsWe recruited women with primary breast cancer following primary treatment with seven or more HFNS/week (including 4/10 or above on the HFNS problem rating scale), from six UK hospitals to an open, randomised, phase 3 effectiveness trial. Participants were randomised to Group CBT or usual care (UC). The primary endpoint was HFNS problem rating at 26 weeks after randomisation. Secondary outcomes included sleep, depression, anxiety and quality of life.ResultsBetween 2017 and 2018, 130 participants were recruited (CBT:63, control:67). We found a 46% (6.9‐3.7) reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% (6.5‐5.5) reduction in the UC arm (adjusted mean difference −1.96, CI −3.68 to −0.23, P = .039). Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly.ConclusionOur results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting.
Highlights
Hot flushes and night sweats (HFNS) tend to be worse in women who have been treated for breast cancer, largely because many breast cancer treatments are aimed at suppressing or opposing oestrogen, with HFNS being the natural consequence
The primary aim was to evaluate the effectiveness of breast care nurses (BCNs)-led group Cognitive behavioural therapy (CBT) on reducing the impact of HFNS in women with breast cancer 26 weeks after randomisation
9 weeks and 26 weeks after randomisation, we recorded the number of HFNS and bother related to HFNS using a 3-day diary card, hot flushes (HFNS Rating scale & HFNS Belief and Behaviour Scale), depression (patient health questionnaire [PHQ], general anxiety disorder (GAD-7), sleep (Pittsburgh Sleep Quality Index [PSQI]), impact of hot flushes on daily activities and overall QoL (Hot Flash Related Daily Interference Scale [hot flash related daily interference scale (HFRDIS)])[23] and quality of life (EQ-5D-5 L - collected on weeks 3 and 6 while on intervention)
Summary
Hot flushes and night sweats (HFNS) may be experienced by up to 85% of women after breast cancer,[1] having a significant impact on sleep, quality of life and with social consequences on employment and personal relationships.[2,3,4] HFNS tend to be worse in women who have been treated for breast cancer, largely because many breast cancer treatments are aimed at suppressing or opposing oestrogen, with HFNS being the natural consequence. CBT for menopausal symptoms was developed by Hunter and colleagues[9] and has been evaluated in several randomised controlled trials.[10,11,12,13] The intervention draws on Hunter and Mann's14 theoretical model of HFNS, based on symptom perception, self-regulation and cognitive behavioural theories to explain women's cognitive appraisal and behavioural reactions to symptoms. This model has been tested in a variety of settings and shows that women's beliefs drive the way that women experience HFNS and that their perception of HFNS as problematic can be altered by changes in beliefs and behaviours[15,16,17] (Figure 1). Each site aimed to run two sequential groups of the intervention with 6 to 8 women per group
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