Cognitive Behavioral Therapy, Exercise Alleviate Breast Cancer Symptoms

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(ChemotherapyAdvisor) – Cognitive behavioral therapy and physical exercise have beneficial effects on women with breast cancer who experience treatment-induced menopause, according to results of a multicenter study presented at the 8th European Breast Cancer Conference in Vienna, Austria, March 22.

Marc van Beurden, MD, PhD, from The Netherlands Cancer Institute, Amsterdam, The Netherlands, and colleagues randomly assigned 422 patients to cognitive behavioral therapy (CBT; n=109), physical exercise (PE; n=104), CBT/PE combined (n=106), or a “waiting list” control group (n=103) to evaluate effects on menopausal symptoms in women with breast cancer (median age, 48 years). Also assessed were the effects of these interventions on body image, sexual functioning, psychological well-being, and health-related quality of life.

The CBT program consisted of six weekly group sessions of 90 minutes each, including relaxation exercises. The primary focus was on hot flushes and night sweats; other symptoms were also addressed. The PE program was a 12-week, individually tailored, home-based, and self-directed exercise program of 2, 2.5, or 3 hours per week. Initial training and follow-up was provided by physiotherapists. The goal was to exercise at an intensity level that achieved a target heart rate. Patients completed self-report questionnaires at baseline and at 12 weeks and 6 months after entering the study.

The investigators found that compared with the control group, women in the CBT, PE, and CBT/PE groups showed an overall decrease in levels of menopausal symptoms (FACT-ES; P<0.001), hot flushes (Hfrs; P<0.001), urinary symptoms (Bfluts; P=0.002), and an increase in sexuality (habit; P=0.027) and physical functioning (SF36 PF; P=0.002). Positive effects of the interventions were found at both short- and long-term follow-up.

“To our knowledge, this is the first study to investigate the efficacy of these two interventions specifically in women who have experienced acute, treatment-induced menopause,” said Dr. van Beurden. “This is a very important issue for the quality of life of younger breast cancer patients. Unlike healthy women starting the menopause, they are unable to take hormone replacement therapy to alleviate their symptoms. There are other drugs available, but they are only moderately effective and have troublesome side-effects.”

Patients said that participation in the CBT programme made them more aware of their symptoms and how to deal with them. “Before, I more or less accepted them unconsciously. Now I'm more alert about my symptoms, their effect, and possible ways to cope with them. By sharing my experiences with others, I've learned to put my symptoms in perspective and to cope with them,” said one participant.

While the evidence that the interventions worked was convincing, compliance with them was poor, the researchers say. In the case of CBT, it was difficult to schedule the group sessions at a time that was convenient for women who often had both work and parenting responsibilities. The frequency and intensity of the PE program was also a challenge for many women.

“We think that we have made an important step forward in improving the quality of life of these patients,” Dr. van Beurden said. “Based on input from patients, we are now developing an internet-based version of the CBT program. We hope that this will further increase the accessibility and convenience of the interventions and lead to more women benefiting from their results.”

Abstract (Enter Beurden” in the author box to search for Abstract No.199)

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