title: Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled, multicenter trial.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE), and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning, psychological well-being, and health-related quality of life (secondary outcomes) in patients with breast cancer experiencing treatment-induced menopause.
  
  
  METHODS
  Patients with breast cancer reporting treatment-induced menopausal symptoms (N=422) were randomly assigned to CBT (n=109), PE (n=104), CBT/PE (n=106), or to a waiting list control group (n=103). Self-report questionnaires were completed at baseline, 12 weeks, and 6 months. Multilevel procedures were used to compare the intervention groups with the control group over time.
  
  
  RESULTS
  Compared with the control group, the intervention groups had a significant decrease in levels of endocrine symptoms (Functional Assessment of Cancer Therapy-Endocrine Symptoms; P<.001; effect size, 0.31-0.52) and urinary symptoms (Bristol Female Lower Urinary Tract Symptoms Questionnaire; P=.002; effect size, 0.29-0.33), and they showed an improvement in physical functioning (36-Item Short Form Health Survey physical functioning subscale; P=.002; effect size, 0.37-0.46). The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats (problem rating scale of the Hot Flush Rating Scale; P<.001; effect size, 0.39-0.56) and an increase in sexual activity (Sexual Activity Questionnaire habit subscale; P=.027; effect size, 0.65). Most of these effects were observed at both the 12-week and 6-month follow-ups.
  
  
  CONCLUSIONS
  CBT and PE can have salutary effects on endocrine symptoms and, to a lesser degree, on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause. Future work is needed to improve the design and the planning of these interventions to improve program adherence.
authors.affiliation: Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
authors.forename: Saskia F A
authors.initials: SF
authors.lastname: Duijts
authors.forename: Marc
authors.initials: M
authors.lastname: van Beurden
authors.forename: Hester S A
authors.initials: HS
authors.lastname: Oldenburg
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
authors.forename: Jacobien M
authors.initials: JM
authors.lastname: Kieffer
authors.forename: Martijn M
authors.initials: MM
authors.lastname: Stuiver
authors.forename: Miranda A
authors.initials: MA
authors.lastname: Gerritsma
authors.forename: Marian B E
authors.initials: MB
authors.lastname: Menke-Pluymers
authors.forename: Peter W
authors.initials: PW
authors.lastname: Plaisier
authors.forename: Herman
authors.initials: H
authors.lastname: Rijna
authors.forename: Alexander M F
authors.initials: AM
authors.lastname: Lopes Cardozo
authors.forename: Gertjan
authors.initials: G
authors.lastname: Timmers
authors.forename: Suzan
authors.initials: S
authors.lastname: van der Meij
authors.forename: Henk
authors.initials: H
authors.lastname: van der Veen
authors.forename: Nina
authors.initials: N
authors.lastname: Bijker
authors.forename: Louise M
authors.initials: LM
authors.lastname: de Widt-Levert
authors.forename: Maud M
authors.initials: MM
authors.lastname: Geenen
authors.forename: Gijsbert
authors.initials: G
authors.lastname: Heuff
authors.forename: Eric J
authors.initials: EJ
authors.lastname: van Dulken
authors.forename: Epie
authors.initials: E
authors.lastname: Boven
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015444:Exercise / Q000523:psychology*; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D008593:Menopause / Q000502:physiology* / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome