Management of hot flushes in UK breast cancer patients: clinician and patient perspectives

Abstract

Introduction: Menopausal problems are among the most prevalent and distressing problems following breast cancer treatment, with 70% women experiencing hot flushes and night sweats (HFNS). A working party was set up to support the development of new research into the management of these problems.

Methods: We conducted surveys to explore the need as perceived by women with breast cancer and establish current UK management practices. A patient survey was conducted through a charity, Breast Cancer Care, and a health professional survey via the UK Breast Intergroup. The HFNS Problem Rating Scale was used, as well as specific questions addressing the aims of the study.

Results: Six hundred and sixty-five patients responded and 185 health professionals. Twenty-eight percent women had considered stopping adjuvant endocrine treatment because of HFNS, yet 34% had never been asked about HFNS by any health professional. The most commonly offered interventions were SSRIs, such as venlafaxine, yet only 25% patients had been offered these drugs. Cognitive behavioural therapy was rarely suggested (2%) despite good evidence.

Discussion: This study shows a lack of coherence in the management of HFNS in breast cancer survivors, which may lead to reduced adherence to adjuvant therapy. There is an urgent need to develop guidelines to support management of HFNS after breast cancer.

Keywords:

• Menopause
• breast cancer
• hot flushes
• survey
• management

Acknowledgements

The authors would like to acknowledge the members of the National Cancer Research Institute Clinical Studies Group Breast Cancer Symptoms subgroup for their help in designing the research and all the patients and clinicians who took part in the surveys.

Disclosure statement

None of the co-authors have any conflicts of interest to declare.

Current knowledge on the subject

• Many women with breast cancer suffer hot flushes and night sweats (HFNS)

• Adjuvant endocrine therapies may contribute to HFNS

• Hormonal interventions are not recommended for HFNS in women who have had breast cancer

• There is a lack of clarity regarding management of HFNS after breast cancer

What this study adds

• Twenty-eight percentage women with breast cancer experiencing HFNS consider stopping adherence to adjuvant endocrine therapy because of HFNS

• Thirty-four percentage women never asked by health professionals about HFNS

• Patients and clinicians alike recognise that HFNS are an unmet need

• Health professionals frequently recommend complementary therapies for which there is no evidence or which may be contraindicated

• Despite proven effectiveness cognitive behavioural therapy is rarely offered

• There is inequity of access to services and interventions for HFNS

• There is a need for agreed national guidelines for how to manage HFNS in the context of breast cancer.