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Therapy, exercise aid in chemo-related menopause

By Genevra Pittman

NEW YORK (Reuters Health) - Younger women who are thrust into menopause because of breast cancer treatment may get some relief from talk therapy and regular exercise, a new study from the Netherlands suggests.

Symptoms including hot flashes and vaginal dryness often come on gradually for women who go through natural menopause, as the body's production of hormones slowly dwindles.

But that's not often the case for women who are diagnosed with breast cancer before menopause and treated with chemotherapy and other potent drugs.

"Oftentimes with women with breast cancer who experience treatment-induced menopause, the symptoms are much more severe than in natural menopause," said Neil Aaronson from The Netherlands Cancer Institute in Amsterdam, who worked on the study.

What's more, those women shouldn't take replacement hormones - an effective but controversial treatment for menopause-related symptoms - because they can put them at risk of a cancer recurrence.

For the new study, Aaronson and his colleagues randomly assigned 422 women with breast cancer and treatment-induced menopause to one of four groups.

One group went to six weekly therapy sessions, another consulted with physiotherapists and started tailored exercise programs, a third did both therapy and exercise and the final group was put on a waitlist.

The type of group treatment, known as cognitive behavioral therapy, included relaxation exercises and addressed symptoms as well as body image and sexuality issues.

Six months later, women in the talk therapy, exercise and combined groups reported an improvement in treatment-related symptoms, each gaining about five points on a 73-point scale compared to less than two points among waitlisters.

Women who'd had therapy also said they were bothered less by their hot flashes and night sweats - but had them just as often, according to findings published in the Journal of Clinical Oncology.

"With the cognitive behavioral therapy, we were primarily targeting the subjective experience of the symptoms, and helping women to cope with the symptoms," Aaronson told Reuters Health.

One in eight women in the U.S. will be diagnosed with breast cancer at some point, according to the National Cancer Institute. A woman's chance of being diagnosed in her 40s is one in 68.

For women who have been treated for breast cancer and have menopause-related symptoms, antidepressants and other medications may also offer some relief. But by that point, Aaronson said, many women aren't interested in taking any more drugs or dealing with any more potential side effects.

He and his colleagues are working on translating the therapy sessions into an online program that people can do on their own time. Most women in the current study weren't able to attend all of the sessions or get all of their recommended exercise, he said - likely because they were young and had children and jobs competing for their time.

"More research is needed on behavioral interventions such as relaxation therapy and cognitive behavioral therapy to understand more about how these things are helpful and for whom," Debra Barton from the Mayo Clinic in Rochester, Minnesota told Reuters Health in an email. "However, the data so far appear very promising."

Barton, who co-wrote an editorial accompanying the new study, said women in this position should talk with their doctors about exercise and therapy options to find a plan that's best for them.

"The thing that is important for women to keep in mind, is that behaviors, if not practiced or utilized, will not be beneficial in the same way that medications not taken will not help," Barton added. "It is important that women think through the ‘how' and ‘when' of using any behavioral strategy, make a definite plan and stick to the routine in order to maximize any benefit."

SOURCE: http://bit.ly/UTaeNa Journal of Clinical Oncology, online October 8, 2012.

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