Perceived control over menopausal hot flushes: Exploring the correlates of a standardised measure

Objectives: A substantial minority of women report considerable distress during hot flushes. Coping with various chronic health problems has been related to perceived control in previous studies. Hence this study developed a standardised measure to investigate whether perceived control is associated with less distress during menopausal hot flushes. Method: The study presented a suitably re-worded 15-item scale (the Arthritis Helplessness Index, originally developed by Nicassio et al (1985). Scoring was reversed so that high scores signified greater perceived control. A volunteer sample of 43 women (mean age 51 years) completed the scale together with several further measures. Thirty five women returned 12 month follow-up questionnaires. Results: the Perceived Control Index (PCI) scores correlated with standardised measures of self-esteem and simple self-ratings (0-100) of perceived control, and remained very stable over 12 months. Self-rated distress during flush episodes was more closely related to perceived control than to more objective factors such as flush frequency and chronicity. Conclusion: These findings support further investigation into whether subjective coping with flushes may be improved by psychological interventions that enhance perceived control and self-esteem

A randomised controlled trial of a cognitive behavioural intervention for men who have hot flushes following prostate cancer treatment (MANCAN):trial protocol

Background:- This randomised controlled trial (RCT) aims to evaluate the effectiveness of a guided self-help cognitive behavioural intervention to alleviate problematic hot flushes (HF) and night sweats (NS) in men who are undergoing prostate cancer treatment. The trial and the self-help materials have been adapted from a previous RCT, which showed that a cognitive behavioural intervention reduced the self-reported problem-rating of hot flushes in women with menopausal symptoms, and in women undergoing breast cancer treatment. We hypothesize that guided self-help will be more effective than usual care in reducing HF/NS problem-rating at post treatment assessment. Methods/Design:- Seventy men who are undergoing treatment for prostate cancer and who have been experiencing more than ten HF/NS weekly for over a month are recruited into the trial from urology clinics in London. They are randomly allocated to either a four-week self-help cognitive behavioural therapy (CBT) treatment or to their usual care (control group). The treatment includes information and discussion about hot flushes and night sweats in the context of prostate cancer, monitoring and modifying precipitants, relaxation and paced respiration, stress management, cognitive therapy for unhelpful thoughts and beliefs, managing sleep and night sweats, and advice on maintaining these changes.Prior to randomisation, men attend a clinical interview, undergo 24-48-hour sternal skin conductance monitoring, and complete pre-treatment questionnaires (e.g., problem-rating and frequency of hot flushes and night sweats; quality of life; mood; hot flush beliefs and behaviours). Post-treatment measures (sternal skin conductance and the above questionnaires) are collected four-six weeks later, and again at a six-month follow-up. Discussion:- MANCAN is the first randomised controlled trial of cognitive behavioural therapy for HF/NS for men that measures both self-reported and physiologically indexed symptoms. The results will inform future clinical practice by evaluating an evidence-based, non-medical treatment, which can be delivered by trained health professionals. Trial registration:- UK Clinical Research Network UKCRN10904

Distress and coping with hot flushes at work: Implications for counsellors in occupational settings

This study explored whether mid-life women regard hot flushes at work as a substantial stressor. A sample of 29 working women reporting hot flushes for at least 12 months rated the degree to which each of ten work situations influenced flush distress or discomfort. Ratings were compared with qualitative accounts of coping with flushes at work. Results showed that women differed markedly in the work situations that they regarded as most problematic, but flush distress was commonly magnified during formal meetings, in hot enclosed spaces and in the presence of male colleagues. A substantial minority viewed colleagues as conveying negative attitudes towards menopausal problems, which jeopardised general confidence at work as well as creating specific difficulties during flush episodes. Flush distress was higher among those reporting embarrassment and difficulties disclosing menopausal status to others. Respondents made suggestions for ways in which the working environment could be improved to assist women in managing hot flushes. Coping with flushes was largely seen as an individual rather than organisational responsibility. Other stigmatising health problems may present similar subjective problems at work and this needs further study. Some implications for counsellors working in organisational settings are explored

Some relationships between perceived control and women’s reported coping strategies for menopausal hot flushes

Objectives: This questionnaire study compared the patterns of reported coping strategies of women high and low in perceived control over hot flushes. Method: A volunteer sample of 38 women fully completed a postal questionnaire. Perceived control was measured by a standardised scale (Reynolds 1997a) and respondents provided qualitative accounts of coping. Results: Consonant with previous findings that higher perceived control is associated with lower distress, the data indicated that women high in self-rated perceived control tended to describe more numerous coping strategies to manage both the physical and socio-emotional discomfort of flush episodes. Preventive strategies were infrequently adopted in both groups. However, the links between distress, control and coping were complex and subject to several influences. Those feeling low in control tended to report rather more numerous flushes (although the differences did not quite reach significance). Also qualitative analysis of coping strategies suggested that it is not always coping behaviour per se that differentiates more and less distressed women, but attitudes towards these behaviours. A coping strategy (such as wearing cotton fabrics) that seems satisfactory to one woman may fundamentally challenge the body-image of another, increasing distress by making her feel drab and different from her pre-menopausal self. Also women often make reference to situational influences on their coping choices. Conclusion: The data support further enquiry into the role of psychological interventions to enhance strategies for coping with hot flushes

Long-term experience of vasomotor instability: A five-year follow-up study of perceived control, coping and distress

Objectives: Vasomotor instability can be a long-term feature of the post-menopause yet little is known about how women cope. This study followed up a group of women over five years, to examine whether current levels of flush-related distress/discomfort were associated with past and present control beliefs, catastrophic thoughts and coping strategies. A further aim was to validate two measures developed in previous research against conceptually relevant standardised scales

PCN77 – Cost-effectiveness of cognitive-behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients

Objectives Many breast cancer patients suffer from (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The standard treatment for these complaints is hormone replacement therapy, which, however, is contraindicated for this group, as it may have tumor-promoting effects. The aim of this study was to assess the cost-effectiveness of three interventions aimed at alleviating these symptoms: cognitive-behavioral therapy (CBT), physical exercise (PE), and the combination of both (CBT+PE). Methods A cost-effectiveness analysis was performed from a health care system perspective. The primary outcome was incremental health care costs (IHCC) per patient with a clinically relevant improvement after six months of treatments. The secondary outcome was incremental costs per quality-adjusted life years (QALYs) gained over a five-year time period. This was assessed using a Markov model, populated with data from a recent randomized controlled trial evaluating the effectiveness of CBT, PE, and CBT+PE in the clinical setting and additional cost data. The robustness of the results was analyzed through one-way and probabilistic sensitivity analyses. Results IHCCs for alleviating one patient of the perceived symptom burden by a clinically relevant difference after six months of treatment were EUR€605 for CBT, EUR€1,847 for CBT+PT, and EUR€1,250 for PE alone, compared to the waiting list control group. CBT generated 0.009 additional QALYs at an additional cost of EUR€162, compared to the control group, leading to an Incremental Cost Utility Ratio (ICUR) of EUR€18,655 per QALY gained and The ICUR of CBT+PE was EUR€42,375 per QALY in comparison to the control group. CBT had a high probability (circa 61%) of being cost-effective at prevailing ceiling ratios. Conclusions CBT is likely the most cost-effective of the three interventions investigated for alleviating treatment-induced menopausal symptoms in breast cancer patient