title: Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial.
abstract: BACKGROUND
  Hot flushes and night sweats (HFNS) affect 65-85% of women after breast cancer treatment; they are distressing, causing sleep problems and decreased quality of life. Hormone replacement therapy is often either undesirable or contraindicated. Safe, effective non-hormonal treatments are needed. We investigated whether cognitive behavioural therapy (CBT) can help breast cancer survivors to effectively manage HFNS.
  
  
  METHODS
  In this randomised controlled trial, we recruited women from breast clinics in London, UK, who had problematic HFNS (minimum ten problematic episodes a week) after breast-cancer treatment. Participants were randomly allocated to receive either usual care or usual care plus group CBT (1:1). Randomisation was done in blocks of 12-20 participants, stratifying by age (younger than 50 years, 50 years or older), and was done with a computer-generated sequence. The trial statistician and researchers collecting outcome measures were masked to group allocation. Group CBT comprised one 90 min session a week for 6 weeks, and included psycho-education, paced breathing, and cognitive and behavioural strategies to manage HFNS. Assessments were done at baseline, 9 weeks, and 26 weeks after randomisation. The primary outcome was the adjusted mean difference in HFNS problem rating (1-10) between CBT and usual care groups at 9 weeks after randomisation. Analysis of the primary endpoint was done by modified intention to treat. The trial is registered, ISRCTN13771934, and was closed March 15, 2011.
  
  
  RESULTS
  Between May 5, 2009, and Aug 27, 2010, 96 women were randomly allocated to group CBT (n=47) or usual care (n=49). Group CBT significantly reduced HFNS problem rating at 9 weeks after randomisation compared with usual care (mean difference -1·67, 95% CI -2·43 to -0·91; p<0·0001) and improvements were maintained at 26 weeks (mean difference -1·76, -2·54 to -0·99; p<0·0001). We recorded no CBT-related adverse events.
  
  
  CONCLUSIONS
  Group CBT seems to be a safe and effective treatment for women who have problematic HFNS after breast cancer treatment with additional benefits to mood, sleep, and quality of life. The treatment could be incorporated into breast cancer survivorship programmes and delivered by trained breast cancer nurses.
  
  
  BACKGROUND
  Cancer Research UK.
authors.affiliation: Institute of Psychiatry, King's College London, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Mann
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hellier
authors.forename: Janet A
authors.initials: JA
authors.lastname: Balabanovic
authors.forename: Hisham
authors.initials: H
authors.lastname: Hamed
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Grunfeld
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
mesh_terms: D000339:Affect; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015928:Cognitive Behavioral Therapy; D005260:Female; D019584:Hot Flashes / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008131:London; D008408:Mastectomy / Q000009:adverse effects*; D008593:Menopause; D008875:Middle Aged; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012890:Sleep; D011795:Surveys and Questionnaires; D013546:Sweating; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents