PONTE VEDRA BEACH, FlaBreast cancer survivors
experienced significantly worse hot flashes, compared with age-matched healthy
women, in a Vanderbilt University study. The Research also raised doubts about
the accuracy of hot flash reports in patient
Janet S. Carpenter, PhD, RN, assistant professor, Vanderbilt
University School of Nursing, and deputy director for the Research Team on
Cancer Pain and Symptom Management at the Vanderbilt-Ingram Cancer Center,
presented the research at the Oncology Nursing Society’s Sixth National
Conference on Cancer Nursing Research.
"We found that breast cancer survivors’ hot flashes were
more frequent and more severe, lasted longer, and interfered more with quality
of life, " she told ONI in an interview.
Breast cancer survivors and healthy women alike under-reported
symptoms in the diaries, which are widely used by menopause researchers, Dr.
Many women recorded far fewer hot flashes than the researchers
documented using electrodes attached to the women’s skin (see Figure). In one
case, a breast cancer survivor said she had seven hot flashes in a 24-hour
period when a measuring device recorded 26 hot flashes.
"I don’t think diaries are accurate, and I don’t think
menopause research to date is accurate because the researchers relied on these
diaries," Dr. Carpenter said. She reported that, in her study, women slept
through one or more hot flashes before waking up. Some had multiple flashes
while driving, but only recorded one
The project focused on menopause symptoms because breast cancer
treatment often causes early menopause, and survivors are generally precluded
from taking hormone replacement therapy (HRT) to relieve symptoms. More than
65% of survivors have hot flashes, 59% rate them as severe, and 44% say they
are extremely distressed by hot flashes, Dr. Carpenter said.
In this study, Dr. Carpenter supplemented existing research
tools with a new tool, the Hot Flash Related Daily Interference Scale (HFRDIS).
It measures (as a score of 0 to 10) the effect of hot flashes on overall
quality of life and on nine specific activities: work, social activities,
leisure activities, sleep, mood, concentration, relations with others,
sexuality, and enjoyment of life.
The study compared 69 breast cancer survivors with 63 healthy
age-matched controls. Survivors were more likely to be postmenopausal.
The overall severity of the survivors’ hot flashes was almost
three times as great: Their mean on a 1 to 10 scale was 3.84, compared with
1.35 for the controls. Analysis of a subset of 35 healthy women and 22
survivors who reached menopause naturally showed that the survivors scored
overall severity more than twice as high: 3.23 vs 1.46.
Breast cancer survivors with moderate to severe hot flashes
(overall severity rating of 5 or more) had a mean HFRDIS score measuring the
effect of hot flashes on overall quality of life of 2.73, compared with 0.44
for breast cancer survivors with no or mildly severe hot flashes (overall
severity rating less than 5) (see Table).
The survivor group included women who had received a variety of
cancer treatments, Dr. Carpenter said. Some of the women were taking tamoxifen
(Nolvadex) at the time of the study. She suggested that the therapy was
causing menopausal symptoms to become more severe, possibly by lowering hormone
levels. "It’s not just hot flashes. It’s more negative mood, vaginal
drying, tiredness, and body aches," she said.
More Research Urged
Dr. Carpenter urged more research into the effect of breast
cancer treatments on menopausal symptoms. "This issue is getting more and
more attention, but I think the severity of it isn’t recognized," she
The research is being funded by a joint grant from the Oncology
Nursing Foundation and Sigma Theta Tau International Honor Society of Nursing.
Support is also provided by the Vanderbilt University School of Nursing Joint
Center for Nursing Research.