Can Cognitive Behavioral Therapy Improve Treatment-Induced Menopausal Symptoms in Survivors of Breast Cancer?
In a Dutch study reported in the Journal of Clinical Oncology, Atema et al found that an Internet-based cognitive behavioral therapy (iCBT) intervention improved treatment-induced menopausal symptoms in breast cancer survivors compared with a waiting list control group.
In the study, 254 women were randomly assigned to therapist-guided (n = 85) or self-managed (n = 85) cognitive behavioral therapy, or a waiting list control group (n = 84). Primary outcomes were effects on hot flushes and night sweats and overall levels of menopausal symptoms. The 6-week cognitive behavioral therapy program included psycho-education, behavior monitoring, and cognitive restructuring.
Questionnaires were given at baseline and at 10 and 24 weeks after randomization. Mixed-effects models compared the intervention groups vs the control group over time. Significance was set at P < .01. An effect size (ES) of 0.50 was considered moderate, with ES ≥ 0.50 being clinically significant.
Outcomes With Cognitive Behavioral Therapy
At 10 weeks, compared with the control group, the therapist-guided (ES = 0.63, P < .001) and self-managed (ES = 0.56, P < .001) Internet-based cognitive behavioral therapy groups exhibited significant improvements in perceived impact of hot flushes and night sweats, as well as improvements in sleep quality (ES = 0.57 in the therapist-guided group, P < .001; ES = 0.41 in self-managed group, P < .001). The therapist-guided group also reported statistically significant improvement in overall levels of menopausal symptoms (ES = 0.33, P = .003) and a clinically significant improvement in frequency of night sweats (ES = 0.64, P <.001).
At longer-term follow-up (24 weeks), effects remained statistically significant, with a smaller effect size for the therapist-guided group on perceived impact of hot flushes and night sweats (ES = 0.48, P = .002) and sleep quality (ES = 0.47, P < .001). The self-managed group exhibited a statistically significant longer-term improvement in overall levels of menopausal symptoms (ES = 0.34, P = .006). Overall, longer-term clinically significant improvements in the perceived impact of hot flushes and night sweats were observed in 45.6% of the therapist-guided group, 39.0% of the self-managed group, and 26.3% of the control group.
The investigators concluded, “[Internet-based cognitive behavioral therapy], with or without therapist support, has clinically significant, salutary effects on the perceived impact and frequency of hot flushes and night sweats, overall levels of menopausal symptoms, and sleep quality.”
Neil K. Aaronson, PhD, of the Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Dutch Cancer Society and The Netherlands Cancer Institute. The study authors' full disclosures can be found at jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
