Modeling hot flushes and quality of life in breast cancer survivors.
OBJECTIVE
To evaluate the relationships among measures of hot flushes, perceived hot flush interference, sleep disturbance, and measures of quality of life while controlling for potential covariates (patient and treatment variables).


METHODS
Breast cancer survivors (n = 395) due to receive aromatase inhibitor therapy provided demographic information, physiological hot flush data via sternal skin conductance monitoring, hot flush frequency via written diary and electronic event marker, hot flush severity and bother via written diary, and questionnaire data via the Hot Flash Related Daily Interference Scale, Pittsburgh Sleep Quality Index, the EuroQOL, Hospital Anxiety and Depression Scale and the Center for Epidemiologic Studies Depression Scale.


RESULTS
Confirmatory factor analysis supported a two-factor model for hot flush symptoms (frequency and severity). Although there was strong convergence among self-reported hot flush measures, there was a high degree of unexplained variance associated with physiological measures. This suggests that self-report and physiological measures do not overlap substantially. The structural model showed that greater hot flush frequency and severity were directly related to greater perceived interference with daily life activities. Greater perceived interference, in turn, directly predicted greater sleep disruption, which predicted lower perceived health state and more symptoms of anxiety and depression.


CONCLUSIONS
Findings suggest hot flush interference may be the most appropriate single measure to include in clinical trials of vasomotor symptom therapies. Measuring and ameliorating patients' perceptions of hot flush interference with life activities and subjective sleep quality may be the most direct routes to improving quality of life.
Rand
K L
KL
Department of Psychology, Indiana University-Purdue University, Indianapolis.
Otte
J L
JL
Flockhart
D
D
Hayes
D
D
Storniolo
A M
AM
Stearns
V
V
Henry
N L
NL
Nguyen
A
A
Lemler
S
S
Hayden
J
J
Jeter
S
S
Carpenter
J S
JS
D001007:Anxiety / Q000523:psychology; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D005712:Galvanic Skin Response; D006304:Health Status; D019584:Hot Flashes / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D018670:Monitoring, Ambulatory; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors
D047072:Aromatase Inhibitors
J Gerontol B Psychol Sci Soc Sci. 1995 May;50(3):S182-9
7767702
Psychiatry Res. 1989 May;28(2):193-213
2748771
Cancer. 2005 Apr 1;103(7):1494-502
15726544
N Engl J Med. 2003 Aug 7;349(6):523-34
12904517
Issues Ment Health Nurs. 1998 Sep-Oct;19(5):481-94
9782864
Int J Behav Med. 2006;13(2):163-72
16712434
Breast Cancer Res Treat. 2006 Sep;99(2):215-20
16541307
Climacteric. 1999 Mar;2(1):21-8
11910676
J Clin Oncol. 2001 Jan 15;19(2):322-8
11208822
Menopause. 2005 Sep-Oct;12(5):512-9
16145304
J Pain Symptom Manage. 2001 Dec;22(6):979-89
11738160
Oncol Nurs Forum. 2005 Sep 01;32(5):969-78
16136195
J Clin Oncol. 2001 Dec 1;19(23):4280-90
11731510
Menopause. 2008 May-Jun;15(3):469-75
18467951
Ann N Y Acad Sci. 1990;592:52-86; discussion 123-33
2197954
Obstet Gynecol. 1999 Aug;94(2):219-24
10432131
Semin Oncol. 2006 Dec;33(6):696-707
17145350
N Engl J Med. 2004 Mar 4;350(10):991-1004
14999111
Eur J Obstet Gynecol Reprod Biol. 2004 Apr 5;113 Suppl 1:S33-40
15041128
JAMA. 2002 Jul 17;288(3):321-33
12117397
Am J Med. 2005 Dec 19;118 Suppl 12B:98-108
16414334
Multivariate Behav Res. 1990 Apr 1;25(2):173-80
26794479
JAMA. 2003 Oct 1;290(13):1729-38
14519707
Oncol Nurs Forum. 2005 May 10;32(3):542
15897927
Drugs. 2005;65(7):927-47
15892588
Arch Intern Med. 2006 Jul 24;166(14):1453-65
16864755
Acta Psychiatr Scand. 1983 Jun;67(6):361-70
6880820
JAMA. 2003 May 28;289(20):2651-62
12771112
J Pain Symptom Manage. 2004 Jun;27(6):513-22
15165649
JAMA. 2004 Oct 6;292(13):1573-80
15467059
J Support Oncol. 2003 May-Jun;1(1):11-21; discussion 14-5, 19-21
15352639
JAMA. 2003 Jun 25;289(24):3243-53
12824205
JAMA. 2006 May 3;295(17):2057-71
16670414
J Pain Symptom Manage. 2002 Jun;23(6):501-9
12067774
Fertil Steril. 1998 Aug;70(2):332-7
9696230
Obstet Gynecol. 2004 Dec;104(6):1322-6
15572497
Menopause. 2004 Jul-Aug;11(4):375-81
15243274
Oncol Nurs Forum. 2002 Apr;29(3):E16-25
11979290
Mayo Clin Proc. 2004 Jun;79(6):777-81
15182093
Menopause. 2002 Sep-Oct;9(5):367-76
12218726
J Psychosom Res. 1998 Jul;45(1):5-13
9720850
Med Care. 2007 May;45(5):431-9
17446829
Am Fam Physician. 2006 Feb 1;73(3):457-64
16477892
Health Qual Life Outcomes. 2003 Aug 01;1:29
12914662
Sleep. 2003 Sep;26(6):667-72
14572118
J Consult Clin Psychol. 2001 Aug;69(4):587-96
11550725
Menopause. 1999 Fall;6(3):209-15
10486790
Acta Oncol. 2002;41(3):269-75
12195746