Severity of Hot Flashes Worse in Breast Cancer Survivors

PONTE VEDRA BEACH, Fla—Breast 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 diaries.

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. Carpenter said.

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 afterward.

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.

New Scale

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 said.

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.