PUBLISHED ON: 27 July 2018

Living with breast cancer can be incredibly challenging and it’s important to acknowledge the massive impact it has on psychological wellbeing and everyday life. Our goal is to ensure that by 2050 everyone diagnosed with breast cancer not only lives, but lives well. And this is why we’re funding psychosocial research. 

Our researchers working in this field are finding ways in which they can improve the quality of life for women with breast cancer while they are living with the disease, and beyond it. 

One of our researchers, Professor Deborah Fenlon from the University of Swansea, is on the search for the best way to support women with breast cancer experiencing debilitating menopausal symptoms. Symptoms like night sweats and hot flushes may not sound like a big deal to those who haven’t experienced them, but they can be a big problem for women with breast cancer.

It’s normal to feel hot and start sweating if it’s hot outside, or you’re all wrapped up in your blanket. But when you suddenly feel uncomfortably hot and start sweating even though nothing is making you hot, it’s a different story. Especially when it happens several times during the day and night.

Why does it affect so many women with breast cancer? 

Breast cancer is most commonly diagnosed in women between the age of 50-65, overlapping with the age when women undergo menopause. Additionally, some breast cancer treatments such as tamoxifen and aromatase inhibitors can bring about menopause symptoms, as they reduce oestrogen levels in the body. This is the predominant reason as to why there’s such a high number of women with breast cancer suffering from night sweats and hot flushes. 

Are hot flushes and night sweats really a big problem?

The short answer is yes. And women with breast cancer usually aren’t allowed to take hormone replacement therapy, which is normally given to ease menopause symptoms, as it has oestrogen and can make their breast cancer worse. Around 70% of women with breast cancer experience severe night sweats and hot flushes, not only causing a major physical discomfort, but also causing anxiety and affecting someone’s confidence. Imagine you’re giving an important presentation at work, and on top of being nervous, which is completely normal, you suddenly start sweating excessively because of a hot flush. This adds even more stress to the situation. 

Hot flushes and night sweats can also cause sleep disturbances, and not having a proper night’s sleep over time may build up to a serious sleep deprivation. 

These problems aren’t short lived either, and they can persist for many years. Tamoxifen and aromatase inhibitors are often given to women with oestrogen receptor positive breast cancer for five years or more to reduce the risk of their cancer returning, and the menopause symptoms may persist for the duration of this treatment. Oestrogen helps tumours grow in four out of five breast cancers; tamoxifen prevents oestrogen from stimulating cancer growth, while aromatase inhibitors block the production of oestrogen within the body. This reduced level of oestrogen resembles that naturally occurring during menopause, and it is why the menopause symptoms can arise. 

In an earlier patient survey done by the National Cancer Research Institute, around 30% of women said they were considering ceasing their treatment because of how severely their menopause symptoms were affecting their life. The longer women are taking the anti-hormone treatment, the more likely that they’ll stop it before it’s entirely safe to do so, which can then increase the chance of their breast cancer coming back. These severe and persistent symptoms of menopause experienced by these women are one of the main factors contributing to this increase in women discontinuing their treatment as time passes. In fact, one of our researchers, Dr Lyndsay Hughes is leading another research project aimed at developing new ways to help women keep taking their anti-hormone treatment, for however long it’s prescribed, by helping them manage the side effects

What can we currently do to make the symptoms more manageable?

Despite menopause symptoms being a serious and common problem, many women feel that their clinicians don’t take these symptoms seriously enough. Hormone replacement therapy (HRT) is the primary treatment for symptoms of menopause. Unfortunately, as there is strong evidence to suggest that HRT can increase the risk of breast cancer coming back, women diagnosed with breast cancer can’t use it. 

But what are other options? Clinicians are recommended to send women with menopause symptoms to a menopause clinic, which are scarcely available within the UK. Antidepressants can sometimes be prescribed, but they don’t seem to always help. 

Psychological approach to the problem

On the other hand, psychological approaches, such as relaxation and cognitive behavioural therapy (CBT) have shown effectiveness in helping women with severe menopause symptoms. During CBT sessions, you explore how your thoughts might affect the way you behave or feel in certain situations, e.g. during a hot flush, and find coping methods for when you’re in them. In a trial where women learned and used relaxation techniques, the frequency of hot flushes they experienced went down by 20%. Professor Fenlon believes that CBT helps to give women tools to cope with the overwhelming sensations and anxiety towards hot flushes, and can help to ease physical symptoms. 

Our body temperature will increase or decrease within a normal range before we start to sweat or shiver, but stress can reduce that range and make our bodies feel uncomfortable more quickly. So, stressing about your menopause symptoms can very easily exacerbate these symptoms. This is why psychological coping methods, which can reduce the stress levels felt by women, also work to reduce physical symptoms.

Testing the success of CBT in breast cancer

Professor Fenlon is leading the MENOS4 clinical trial, which aims to assess how feasible it would be to train breast cancer nurses to deliver CBT, to help women with breast cancer to deal with their menopause symptoms. The trial is currently ongoing, with half of the participants receiving six CBT sessions from specialist breast cancer nurses who had been trained to deliver CBT, and the other half of the women receiving the support that they would normally be given by their healthcare team. 

Professor Fenlon will evaluate how problematic the symptoms were, the level of anxiety women experienced, and their quality of life. In this trial, CBT is delivered in small groups, and Prof Fenlon believes the support given by other group members could have additional benefits helping women cope with menopause symptoms. 

The cost of training, availability of ongoing supervision, and workload changes for breast cancer nurses will be analysed in this project. This way, we can assess how practical it is to deliver this type of support in terms of NHS budgets, and how manageable the additional workload would be for the nurses.

If CBT delivered by breast cancer nurses is deemed effective in the MENOS 4 clinical trial, we hope it would be possible to make this programme available in hospitals nationwide.

This means the treatment would reach many more women with breast cancer who need support with the exhausting menopause symptoms.

Bringing the support closer to home

There’s nearly 700,000 women living with or beyond breast cancer in the UK and the menopause symptoms are extremely common. Professor Fenlon suggests the delivery of CBT or self-help strategies in the local community through already existing support groups may be a powerful way to tackle menopause symptoms in women with breast cancer. This would be more accessible, allow women to talk about their experiences and support one another. 

But could technology such as mobile apps help?

Although Professor Fenlon recognises the benefit of easily accessible nature of using technology, she points out the need for personalised treatment and advice. She believes that apps may help as an add-on treatment, for those who have already been given CBT or other personalised treatment or advice. 

Now we are eagerly waiting for the results of Professor Fenlon’s trial, and hoping that CBT delivered by breast cancer nurses can help more women with breast cancer with their symptoms of menopause, helping them to live well. 

This blog was written by Akiha Kuniyoshi, Research Communications intern.