Factors related to the experience of menopausal symptoms in women prescribed tamoxifen

Zoe Moon,Myra S Hunter,Rona Moss-Morris,Lyndsay Dawn Hughes

doi:10.1080/0167482x.2016.1216963

Zoe Moon, Myra S Hunter + Show 2 more

Open Access

https://doi.org/10.1080/0167482x.2016.1216963

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Abstract

Introduction: Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; however, treatment options are limited for these patients as hormonal replacement therapy is contraindicated. This study aimed to explore the experience and attribution of menopausal symptoms and identify factors related to the experience of menopausal symptoms in women taking tamoxifen.Methods: Women who had been prescribed tamoxifen for a diagnosis of primary breast cancer were recruited from oncology clinics across England and from online advertisements. Seven hundred and forty women completed questionnaires assessing illness perceptions, social support, mood and symptom duration/severity.Results: Eighty-four percent of women had experienced hot flushes and 80% experienced night sweats; of these, 60% experienced severe symptoms. Symptoms persisted throughout 5 years of treatment and were mainly attributed to tamoxifen. Logistic regressions showed that depressive symptoms, previous chemotherapy and being employed were associated with increased odds of hot flush or night sweat prevalence. Symptom severity was associated with depression, being employed and attributing symptoms to tamoxifen.Discussion: These findings have clinical implications in terms of targeting women who are more at risk and offering non-hormonal treatment options, such as cognitive behavioural therapy, to help women to develop self-management strategies for coping with menopausal symptoms.

Highlights

Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; treatment options are limited for these patients as hormonal replacement therapy is contraindicated
Logistic regressions showed that depressive symptoms, previous chemotherapy and being employed were associated with increased odds of hot flush or night sweat prevalence
Symptom severity was associated with depression, being employed and attributing symptoms to tamoxifen. These findings have clinical implications in terms of targeting women who are more at risk and offering non-hormonal treatment options, such as cognitive behavioural therapy, to help women to develop self-management strategies for coping with menopausal symptoms

Summary

Introduction

Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; treatment options are limited for these patients as hormonal replacement therapy is contraindicated. Hot flushes and night sweats (HFNS), the main symptom of the menopause, typically involve a sudden sensation of heat and warmth, accompanied by reddening of the skin and sweating. They are thought to result from disturbances of the temperature regulating mechanism in the hypothalamus, triggered by reduced oestrogen levels [1]. Recent evidence suggests that survival benefits are enhanced if tamoxifen is taken for an additional 5 years [7,8] This increase in treatment duration, accompanied by a rise in breast cancer survival rates, means that increasing numbers of women may be suffering from HFNS as a consequence of tamoxifen. HFNS in breast cancer survivors are associated with anxiety, sleep

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