Posted by: bcconnections | October 19, 2012

Cognitive Behavioral Therapy and Exercise Eases Treatment-induced Menopausal Symptoms

Treatment for premenopausal women with early-stage breast cancer often involves chemotherapy and/or endocrine therapy.  These treatments can cause menopause-like symptoms including hot flashes, night sweats, vaginal dryness, weight gain and urinary incontinence.  Such side effects can cause significant discomfort and may negatively affect women’s sex life, emotional well-being, and overall quality of life.  Getting relief from these side effects is challenging given that hormone-replacement therapy is contraindicated in women with a history of breast cancer.

A study published in the Journal of Clinical Oncology suggests that cognitive behavioral therapy and physical exercise are effective in alleviating treatment-induced menopausal symptoms. The  study enrolled 422 women with early-stage breast cancer, all under the age of 50 and premenopausal, yet experiencing menopausal symptoms attributed to treatment with chemotherapy and/or hormonal therapy.  The women were assigned to one of four groups:  cognitive behavior therapy (CBT), physical exercise (PE), CBT and PE (CBT/PE), or wait-list control.

The cognitive behavior therapy intervention involved six weekly group sessions, 90 minutes each, which focused on relaxation exercises to reduce menopausal symptoms.  The physical exercise program was a 12-week (2.5-3 hours/week), home-based, individualized program that aimed to achieve a target heart-rate during each exercise session.  The type of exercise performed varied (running, cycling, swimming).  A trained physiotherapist helped the women initiate the exercise program, and then checked in via telephone interview in weeks 4 and 8 to assess the need for adjustments.  Women in the CBT/PE group attended the weekly therapy sessions and performed the exercise program, while women in the wait-list group received no intervention.  Women in each of the four groups completed questionnaires at study entry, 12 weeks, and 6 months.

Compared to the wait-list control group, women in the intervention groups showed an improvement in physical functioning and a decrease in the frequency of endocrine and urinary symptoms.  Groups that included cognitive behavioral therapy also showed an increase in sexual activity and a decrease in the perceived burden of hot flashes and night sweats.  These positive effects were achieved despite incomplete adherence to the different programs.

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