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AN EVALUATION OF GROUP COGNITIVE BEHAVIOUR THERAPY FOR MENOPAUSAL SYMPTOMS IN WOMEN FOLLOWING BREAST CANCER TREATMENT
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8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
125
Free Communications: Symptomatology
123 AN EVALUATION OF GROUP COGNITIVE BEHAVIOUR THERAPY FOR MENOPAUSAL SYMPTOMS IN WOMEN FOLLOWING BREAST CANCER TREATMENT M. Hunter 1 , S. Coventry 2 , E. Grunfeld 1 . 1 Institute of Psychiatry, Dept of Psychology, London, United Kingdom; 2 City & Hackney PCT, Psychology, London, United Kingdom Objectives: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre and post treatment assessment and a 3 month follow up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2 week daily diary assessment they were offered 6 (90min) weekly sessions of Group CBT. The CBT included information, discussion, paced breathing and CBT to reduce stress and manage hot flushes, night sweats and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women’s Health Questionnaire (WHQ) and health related quality of life (SF 36). Beliefs about hot flushes and mood were monitored. Results: Hot flushes and night sweats reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36). There was a significant reduction in negative beliefs about hot flushes, night sweats and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment; a randomized controlled trial is planned. Keywords: Cognitive behaviour therapy, hot flushes, breast cancer, menopause.
124 MID-AGED HEALTH IN WOMEN FROM THE INDIAN SUBCONTINENT (MAHWIS): A QUALITATIVE STUDY OF EXPERIENCE OF MENOPAUSE ACROSS CULTURES M.S. Hunter 1 , P. Gupta 2 , A. Papitsch-Clarke 3 , D. Sturdee 2 . 1 Institute of Psychiatry, KCL, London, United Kingdom; 2 Solihull Hospital, Solihull, United Kingdom; 3 Central & NW London NHS Trust, London, United Kingdom Objectives: We previously found differences in experience of menopausal symptoms between a migrated Asian sample of women from the Indian subcontinent living in the UK (UKA), and matched samples of UK Caucasian women (UKC) and Asian women living in Delhi, India (DEL) (Gupta et al 2006). This study aims to investigate these differences using qualitative methods. Methods: 153 peri and postmenopausal women aged 45-55 years were interviewed about their experience of menopause, lifestyle and health. The current study is a qualitative thematic content analysis of their accounts of menopause. Results: Differences between the UKA, UKC and DEL groups of women emerged in their experience of menopause and in the social meanings ascribed to it. but these also varied depending on country of residence as well as ethnicity. Differences in symptom attribution to menopause were apparent, such as visual problems, weight gain and blood pressure. The UKA women reported more distressing experience of menopause and a less coherent framework of social meanings. Conclusions: Subtle differences between experience of menopause and its meanings emerged from this qualitative study, which have implications for health care of migrated Asian communities. Keywords: Culture, menopause, symptoms, Asian women.
DEPRESSIVE SYMPTOMS AND MENOPAUSAL BURDEN IN THE MIDLIFE S. Reed 1 , E. Ludman 2 , K. Newton 2 , L. Grothaus 2 , L. Nekhlyudov 3 , L. Spangler 2 , A. LaCroix 2 . 1 University of Washington, Seattle, United States; 2 Group Health Center for Health Studies, Seattle, United States; 3 Harvard Medical School, Harvard Pilgrim Health Care, Boston, United States Objectives: The goal of this study was to assess whether menopausal symptoms were more common and/or more severe among women with depressive symptoms. Methods: A cross-sectional survey of 1,358 women, ages 45-70, at 2 large integrated health plans (Seattle; Boston) was performed. Information on demographics, medical and reproductive history, medication use, menopausal experience and depressive symptoms (PHQ-8) were collected. Women taking HT were excluded. Logistic regression models adjusted for age and body mass index tested the associations between menopausal symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) and presence of moderate/severe depressive symptoms. Results: 770 women were included; 98 (12.7%) had moderate/severe depressive symptoms and 672 (87.3%) had no/mild depressive symptoms. Women with moderate/severe depressive symptoms were almost twice as likely to report recent vasomotor symptoms (hot flashes and or night sweats) versus women with no/mild depressive symptoms (adjusted odds ratio (aOR) 1.67, 95% CI 1.04-2.68), and to report them as severe (aOR 1.63, 95%CI 0.95-2.83). A higher symptom burden was observed despite the fact that 20% of women with moderate/severe depressive symptoms (vs. 4.6% no/mild depressive symptoms) were using an SSRI or SNRI, medications known to improve vasomotor symptoms. The percentage of women with menopausal symptoms, and the percentage with severe vasomotor symptoms were linearly associated with the depressive symptom score. Conclusions: Depressive symptoms “amplified” the menopausal experience, or alternatively, severe vasomotor symptoms worsened depressive symptoms. Keywords: Hot flushes, night sweats, vaginal dryness, dyspareunia and depressive symptoms.
126 DULOXETINE AND ESCITALOPRAM FOR TREATMENT OF HOT FLUSHES IN BREAST CANCER SURVIVORS N. Biglia 1 , P. Sgandurra 1 , E. Peano 1 , G. Moggio 1 , M. Spatola 2 , D. Palmisano 2 , R. Torta 2 , P. Sismondi 1 . 1 Mauriziano “Umberto I” Hospital and Institute for Cancer Research and Treatment of Candiolo (IRCC), University of Turin, Department of Gynaecological Oncology, Turin, Italy; 2 S. Giovanni Battista Hospital, Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy Objective: To compare the efficacy and tolerability of duloxetine and escitalopram in reducing frequency and severity of vasomotor symptoms in postmenopausal breast cancer survivors and to assess the effect on mood and coping’s style. Material and methods: Symptomatic women with previous breast cancer received randomly duloxetine 60 mg daily or escitalopram 20 mg daily for 12 weeks. Patients were asked to record hot flushes (HF) frequency and severity at baseline and after 4 and 12 weeks of treatment and validated questionnaires (Beck Depression Inventory, Montgomery Asberg Depression Rating Scale and Mini Mental Adjustment to Cancer Scale) were administrated. Results: Preliminary data on the first 37 women are presented. 28% of the patients in duloxetine group and 39% in escitalopram group never began therapy; the treatment was interrupted by 20% and 14% respectively for side effects (nausea, somnolence). In duloxetine group, at the end of the study period, the reduction in HF frequency was 59% (p=0.03) and in HF score was 70% (p=0.1). With escitalopram, after 12 weeks, HF frequency and HF score decreased by 55% (p<0.001) and 64% (p<0.001) respectively.In both groups we observed an improvement of mood: MADRS score reduction 40% and B.D.I. score reduction 22%; about coping’s style data showed a slight reduction in several aspects (fatalism, fighting spirit, helpless-hopelessness, anxious preoccupation). Conclusion: Duloxetine and escitalopram seems to be effective for the treatment of HF; moreover it was obtained an improvement of mood and coping’s style. Keywords: Hot flushes, escitalopram, duloxetine, breast cancer survivors.
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
125
Free Communications: Symptomatology
123 AN EVALUATION OF GROUP COGNITIVE BEHAVIOUR THERAPY FOR MENOPAUSAL SYMPTOMS IN WOMEN FOLLOWING BREAST CANCER TREATMENT M. Hunter 1 , S. Coventry 2 , E. Grunfeld 1 . 1 Institute of Psychiatry, Dept of Psychology, London, United Kingdom; 2 City & Hackney PCT, Psychology, London, United Kingdom Objectives: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre and post treatment assessment and a 3 month follow up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2 week daily diary assessment they were offered 6 (90min) weekly sessions of Group CBT. The CBT included information, discussion, paced breathing and CBT to reduce stress and manage hot flushes, night sweats and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women’s Health Questionnaire (WHQ) and health related quality of life (SF 36). Beliefs about hot flushes and mood were monitored. Results: Hot flushes and night sweats reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36). There was a significant reduction in negative beliefs about hot flushes, night sweats and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment; a randomized controlled trial is planned. Keywords: Cognitive behaviour therapy, hot flushes, breast cancer, menopause.
124 MID-AGED HEALTH IN WOMEN FROM THE INDIAN SUBCONTINENT (MAHWIS): A QUALITATIVE STUDY OF EXPERIENCE OF MENOPAUSE ACROSS CULTURES M.S. Hunter 1 , P. Gupta 2 , A. Papitsch-Clarke 3 , D. Sturdee 2 . 1 Institute of Psychiatry, KCL, London, United Kingdom; 2 Solihull Hospital, Solihull, United Kingdom; 3 Central & NW London NHS Trust, London, United Kingdom Objectives: We previously found differences in experience of menopausal symptoms between a migrated Asian sample of women from the Indian subcontinent living in the UK (UKA), and matched samples of UK Caucasian women (UKC) and Asian women living in Delhi, India (DEL) (Gupta et al 2006). This study aims to investigate these differences using qualitative methods. Methods: 153 peri and postmenopausal women aged 45-55 years were interviewed about their experience of menopause, lifestyle and health. The current study is a qualitative thematic content analysis of their accounts of menopause. Results: Differences between the UKA, UKC and DEL groups of women emerged in their experience of menopause and in the social meanings ascribed to it. but these also varied depending on country of residence as well as ethnicity. Differences in symptom attribution to menopause were apparent, such as visual problems, weight gain and blood pressure. The UKA women reported more distressing experience of menopause and a less coherent framework of social meanings. Conclusions: Subtle differences between experience of menopause and its meanings emerged from this qualitative study, which have implications for health care of migrated Asian communities. Keywords: Culture, menopause, symptoms, Asian women.
DEPRESSIVE SYMPTOMS AND MENOPAUSAL BURDEN IN THE MIDLIFE S. Reed 1 , E. Ludman 2 , K. Newton 2 , L. Grothaus 2 , L. Nekhlyudov 3 , L. Spangler 2 , A. LaCroix 2 . 1 University of Washington, Seattle, United States; 2 Group Health Center for Health Studies, Seattle, United States; 3 Harvard Medical School, Harvard Pilgrim Health Care, Boston, United States Objectives: The goal of this study was to assess whether menopausal symptoms were more common and/or more severe among women with depressive symptoms. Methods: A cross-sectional survey of 1,358 women, ages 45-70, at 2 large integrated health plans (Seattle; Boston) was performed. Information on demographics, medical and reproductive history, medication use, menopausal experience and depressive symptoms (PHQ-8) were collected. Women taking HT were excluded. Logistic regression models adjusted for age and body mass index tested the associations between menopausal symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) and presence of moderate/severe depressive symptoms. Results: 770 women were included; 98 (12.7%) had moderate/severe depressive symptoms and 672 (87.3%) had no/mild depressive symptoms. Women with moderate/severe depressive symptoms were almost twice as likely to report recent vasomotor symptoms (hot flashes and or night sweats) versus women with no/mild depressive symptoms (adjusted odds ratio (aOR) 1.67, 95% CI 1.04-2.68), and to report them as severe (aOR 1.63, 95%CI 0.95-2.83). A higher symptom burden was observed despite the fact that 20% of women with moderate/severe depressive symptoms (vs. 4.6% no/mild depressive symptoms) were using an SSRI or SNRI, medications known to improve vasomotor symptoms. The percentage of women with menopausal symptoms, and the percentage with severe vasomotor symptoms were linearly associated with the depressive symptom score. Conclusions: Depressive symptoms “amplified” the menopausal experience, or alternatively, severe vasomotor symptoms worsened depressive symptoms. Keywords: Hot flushes, night sweats, vaginal dryness, dyspareunia and depressive symptoms.
126 DULOXETINE AND ESCITALOPRAM FOR TREATMENT OF HOT FLUSHES IN BREAST CANCER SURVIVORS N. Biglia 1 , P. Sgandurra 1 , E. Peano 1 , G. Moggio 1 , M. Spatola 2 , D. Palmisano 2 , R. Torta 2 , P. Sismondi 1 . 1 Mauriziano “Umberto I” Hospital and Institute for Cancer Research and Treatment of Candiolo (IRCC), University of Turin, Department of Gynaecological Oncology, Turin, Italy; 2 S. Giovanni Battista Hospital, Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy Objective: To compare the efficacy and tolerability of duloxetine and escitalopram in reducing frequency and severity of vasomotor symptoms in postmenopausal breast cancer survivors and to assess the effect on mood and coping’s style. Material and methods: Symptomatic women with previous breast cancer received randomly duloxetine 60 mg daily or escitalopram 20 mg daily for 12 weeks. Patients were asked to record hot flushes (HF) frequency and severity at baseline and after 4 and 12 weeks of treatment and validated questionnaires (Beck Depression Inventory, Montgomery Asberg Depression Rating Scale and Mini Mental Adjustment to Cancer Scale) were administrated. Results: Preliminary data on the first 37 women are presented. 28% of the patients in duloxetine group and 39% in escitalopram group never began therapy; the treatment was interrupted by 20% and 14% respectively for side effects (nausea, somnolence). In duloxetine group, at the end of the study period, the reduction in HF frequency was 59% (p=0.03) and in HF score was 70% (p=0.1). With escitalopram, after 12 weeks, HF frequency and HF score decreased by 55% (p<0.001) and 64% (p<0.001) respectively.In both groups we observed an improvement of mood: MADRS score reduction 40% and B.D.I. score reduction 22%; about coping’s style data showed a slight reduction in several aspects (fatalism, fighting spirit, helpless-hopelessness, anxious preoccupation). Conclusion: Duloxetine and escitalopram seems to be effective for the treatment of HF; moreover it was obtained an improvement of mood and coping’s style. Keywords: Hot flushes, escitalopram, duloxetine, breast cancer survivors.