A randomised controlled trial of relaxation to reduce hot flushes after breast cancer

Aims: Around 65% of women treated for breast cancer experience menopausal difficulties and 96% of these have hot flushes. For many women flushes can be severe and debilitating.Treatment options for the management of menopausal difficulties are limited by risks o fcancer recurrence and as yet there are few acceptable and effective strategies available to relieve hot flushes. This study was set up to test the effectiveness of relaxation training to reduce hot flushes.Procedures: A randomised, controlled trial was conducted on 150 women comparing a single relaxation training session (comprising stress management, muscle relaxation and deep breathing techniques) against usual care. Non parametric tests were conducted on the change in incidence and severity of flushes. Changes in distress due to flushes, problem factor and interference to daily life were measured (Hunter and Liao 1995) as well as STAI and FACT-ES quality of life. Significance levels were set at p<0.01 to allow for multiple testing.Major findings: Relaxation was found to be an effective intervention, which significantly reduced the incidence of hot flushes by 22% (p<0.001), the severity of flushes (p<0.01) and the distress caused by flushes (p=0.01).Significance and conclusions: Relaxation training may be a useful component of self-management measures for women who have had breast cancer in order to reduce the incidence and distress caused by hot flushes

The experiences of hot flushes after breast cancer

As survival from breast cancer increases, there is a corresponding rise in the number of women living with the long-term consequences of its treatment. Distressing menopausal hot flushes occur in many of these women. This article reports on interviews conducted with 8 women, exploring the experience of hot flushes after breast cancer. Women's accounts of hot flushes varied from being a mild sensation to an intensely unpleasant sensation affecting the whole body and accompanied by drenching perspiration. Flushes affected all aspects of the women's lives, including sleeping, clothing, social situations, intimate relationships, and ability to work. Emotionally, women talked about being out of control. Having cancer and menopause simultaneously made it more difficult for the women to cope, and cancer treatment could cause flushing. The women used many strategies to help relieve their difficulties. Some resorted to hormone replacement therapy, whereas others turned to herbal medications and other alternative interventions such as acupuncture. Most women adopted behavioral strategies to try to regain control. Ultimately, they found that control was gained by attitude of mind. Cognitive behavioral techniques may enhance the sense of control and contribute to coping during hot flushes

Is It Me Or Is It Hot In Here? A Plea For More Research Into Hot Flushes

Women who have been treated for breast cancer identify vasomotor symptoms, such as hot flushes and night sweats, as a serious problem. These symptoms can be unpleasant, with a significant impact on daily life and sleep quality: "It's as though somebody has built a furnace inside of you and it's your whole body. It starts almost at your feet and works up and you just feel as though you are literally on fire inside and it's trying to escape and you just want to escape but you can't escape, there's nowhere to go and nothing to do[1]. The social consequences of this embarrassing experience can affect employment, personal relationships and quality of life: Umm, when they were at their worst I would be yeah pretty much dripping in, in err, various places umm err from really from the nose downwards; the lips; the neck; umm chest and back; crooks of my arms. And I could, you know, often if I was sitting down I would get up and my trousers would be really wet and it would go right down to my toes[1]. Oestrogen replacement remains the most effective treatment for hot flushes. However, this is contraindicated in the majority of women with oestrogen-dependent breast cancer. An estimated 550 000 people live in the UK today with a diagnosis of breast cancer and up to 70% experience hot flushes [2–5], which are exacerbated by a lack of safe and effective management strategies [4]. Although hot flushes may occur for a number of reasons, including natural or chemotherapy-induced menopause, they may also be side-effects of adjuvant hormonal therapies, such as tamoxifen and the aromatase inhibitors. Two recent clinical trials (aTTom [6] and ATLAS [7]) showed that 10 years of tamoxifen significantly reduces the risk of recurrence and breast cancer mortality. However, an increasing number of studies report that over 50% of women do not adhere to 5 years of endocrine treatment with an associated increase in mortality [8]. The lack of effective management of vasomotor symptoms may be an important contributory factor to this lack of adherence [9]. The pathophysiology of hot flushes is poorly understood. Proposed mechanisms include altered peripheral vascular reactivity and a narrowed thermoneutral zone [10], although how this relates to oestrogen deprivation is not understood. Without a fuller understanding of the physiology, mechanisms and triggers it will be difficult to develop new targeted therapies. Adrienne Morgan says ‘I was diagnosed with breast cancer eight years ago and continue to take anti-oestrogen drugs because my cancer has returned. I have had a hot flush every 45 minutes for the last eight years. It is difficult to convey to anyone who has never had a hot flush how awful they are; exhausting, embarrassing, agitating…. I am fatigued, unable to work, sleep is only possible with medication and every morning my bed is soaked. I have tried everything. Only the SSRIs have some effect by reducing the severity of the hot flushes (venlafaxine made me feel horrible so I take Citalopram) but they make me anorgasmic. It surprises me that there is not more basic research being done into the causes of hot flushes. After all, most women will have them at some stage in their lives – not just breast cancer patients – and now men with prostate cancer are getting them too’.</p