Factors related to the experience of menopausal symptoms in women prescribed tamoxifen

Abstract

Introduction: Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; however, treatment options are limited for these patients as hormonal replacement therapy is contraindicated. This study aimed to explore the experience and attribution of menopausal symptoms and identify factors related to the experience of menopausal symptoms in women taking tamoxifen.

Methods: Women who had been prescribed tamoxifen for a diagnosis of primary breast cancer were recruited from oncology clinics across England and from online advertisements. Seven hundred and forty women completed questionnaires assessing illness perceptions, social support, mood and symptom duration/severity.

Results: Eighty-four percent of women had experienced hot flushes and 80% experienced night sweats; of these, 60% experienced severe symptoms. Symptoms persisted throughout 5 years of treatment and were mainly attributed to tamoxifen. Logistic regressions showed that depressive symptoms, previous chemotherapy and being employed were associated with increased odds of hot flush or night sweat prevalence. Symptom severity was associated with depression, being employed and attributing symptoms to tamoxifen.

Discussion: These findings have clinical implications in terms of targeting women who are more at risk and offering non-hormonal treatment options, such as cognitive behavioural therapy, to help women to develop self-management strategies for coping with menopausal symptoms.

Keywords:

• Health psychology
• menopause
• psycho-oncology

Acknowledgements

We are grateful to all the women who took part in the study. We would also like to thank all the sites who recruited to the study (Airedale General Hospital, Calderdale and Huddersfield NHS Foundation Trust, Charing Cross Hospital, Dorset County Hospital, Ealing Hospital, East Lancashire Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Frimley Park Hospital, Great Western Hospital, Guy’s Hospital, Kingston Hospital, Macclesfield Hospital, Norfolk and Norwich University Hospital, Northwick Park Hospital, Oxford University Hospitals NHS Foundation Trust, Queen Alexandra Hospital, Royal Albert Edward Infirmary, Royal Blackburn Hospital, Royal Shrewsbury Hospital, Russells Hall Hospital, Tameside Hospital, The Mid Yorkshire Hospitals NHS Trust, The Pennine Acute Hospitals NHS Trust, The Princess Alexandra Hospital, The Whittington Hospital, University Hospital Coventry and Warwickshire, York Teaching Hospital NHS Foundation Trust) and Breast Cancer Care and Macmillan Cancer Support for assisting us with online advertisements.

Disclosure statement

The authors report no conflicts of interest.

Current knowledge on this subject

• Hot flushes and night sweats (HFNS) are common and severe in breast cancer survivors taking tamoxifen, yet HFNS treatment options for these patients are limited.

• Sociodemographic and psychological factors have been shown to be related to HFNS in the general population.

• Little is known about the experience of HFNS in breast cancer survivors taking tamoxifen, and few predictors of HFNS have been found.

What this study adds

• Over 80% of women taking tamoxifen report experiencing HFNS, and around 60% of these women report severe symptoms.

• Symptoms are mainly attributed to tamoxifen and the prevalence remains high even in the fourth and fifth years of treatment, challenging previous research suggesting that HFNS would lessen after the first year of treatment.

• Previous chemotherapy, higher levels of depression, being employed and attributing symptoms to tamoxifen are related to HFNS prevalence/severity in breast cancer survivors taking tamoxifen.