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Study Targets Strategy to Help Breast Cancer Survivors Cope With Menopausal Symptoms (dateline July 10, 2000)


Coping with menopausal symptoms can be particularly difficult for breast cancer survivors. Certain breast cancer treatments such as chemotherapy can induce early menopause and other drug therapies such as tamoxifen can cause severe hot flashes. However, according to a new study, guidance and attention from a trained medical professional can significantly improve menopausal symptoms in breast cancer survivors without the use of hormone replacement therapy (HRT).

Symptoms of menopause may include hot flashes, vaginal dryness, and urinary incontinence. Many women cope with menopausal symptoms by taking HRT, synthetic estrogen with or without progestin. However, breast cancer patients and survivors are usually told to avoid HRT because researchers believe HRT may increase the growth rate of cancer. Therefore, breast cancer patients may find it more difficult to cope with menopausal symptoms than women who have not had cancer.

To study how differences in patient care can influence the severity of menopausal symptoms, researcher Patricia Ganz, MD and her colleagues organized a "comprehensive menopausal assessment program." The program consisted of one nurse practitioner who counseled, educated, and helped to assess the symptoms of newly post-menopausal breast cancer survivors. For example, patients received instruction on breathing techniques and exercises to prevent incontinence. If necessary, the nurse practitioner could prescribe medications.

The researchers then compared the care breast cancer survivors received in their program to the standard of care that most women typically receive from their physicians. The women in the researchers’ "usual care" group had no contact with the nurse practitioner after their initial physical exam. The women were not prohibited to seek professional assistance to help manage their menopausal symptoms, but they were not encouraged to seek assistance either.

Each of the 72 women (average age 55) who completed the study was randomly assigned to one of the groups, either the "usual care" group or the "comprehensive menopausal assessment" group. The women completed questionnaires before and after the study. None of the women in either group received HRT.

At the end of the four-month study, the researchers found that the women who received education and counseling from the nurse practitioner experienced significant improvements with their menopausal symptoms and sexual functioning compared with the women in the "usual care" group. The researchers attribute the results to the amount of time the nurse practitioner spent with each patient in her group compared with the women who received standard care. On average, the nurse practitioner spent 45 minutes with each patient during her initial visit and 15 to 30 minutes during each follow-up visit.

According to Dr. Ganz, this is the first study that takes into account the "whole person" when managing menopausal symptoms. Dr. Ganz believes that a physician or nurse who takes the extra 30 to 40 minutes with a patient can have a significant impact on her outcome. In an accompanying editorial published in the Journal of the National Cancer Institute, Charles Loprinzi, MD and Debra Barton, RN of the Mayo Clinic in Rochester, Minnesota agree that the comprehensive menopausal assessment program greatly improved menopausal symptoms.

While the researchers stress that the patients in the study were treated by one nurse practitioner and that it may be difficult to maintain consistency of comprehensive menopausal assessment programs at various institutions, the results of the study show that increased physician/nurse practitioner involvement may help alleviate many menopausal symptoms in breast cancer survivors.

While comprehensive menopausal assessment programs are not available at many institutions, breast cancer survivors should talk openly with their physician or nurse about coping with menopausal symptoms. The study shows that breast cancer survivors do not just have to "grin and bear" menopausal symptoms, said Dr. Ganz. The study also shows that health care providers may have a new strategy to help breast cancer survivors manage menopausal symptoms, through increased patient-physician communication, education, and counseling.

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