December 01, 2012
2 min read

Cognitive-behavioral therapy, physical exercise have positive effect on endocrine symptoms

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Cognitive-behavioral therapy and physical exercise ease endocrine symptoms among patients with breast cancer who experience treatment-induced menopause, according to study results.

They also improve sexuality and physical functioning, researchers said.

Saskia F. A. Duijts, MD, of The Netherlands Cancer Institute, and colleagues conducted a controlled, multicenter trial to assess how cognitive-behavioral therapy and physical exercise effect menopausal symptoms.

The cognitive-behavioral therapy consisted of six weekly group sessions of 90 minutes each, including relaxation exercises. This therapy was primarily focused on hot flashes and night sweats.

The physical exercise program was a 12-week, individually tailored, home-based, self-directed exercise program of 2.5 to 3 hours each week.

Duijts and colleagues randomly assigned the 422 participants to four groups: cognitive-behavioral therapy (n=109), physical exercise (n=104), a combination of cognitive-behavioral therapy/physical exercise (n=106) and waiting list control (n=103). Participants completed self-report questionnaires at baseline, 12 weeks and 6 months.

Patients in the intervention groups experienced significant decreases in endocrine symptoms based on the Functional Assessment of Cancer Therapy–Endocrine Symptoms scale (P<.001; effect size, 0.31-0.52). They also experienced significant decreases in urinary symptoms as calculated with the Bristol Female Lower Urinary Tract Symptoms Questionnaire (P=.002; effect size, 0.29-0.33).

Patients in the intervention groups also demonstrated improved physical functioning as measured by the 36-Item Short Form Health Survey physical functioning subscale (P=.002; effect size, 0.37-0.46).

In addition, patients in intervention groups who underwent cognitive-behavioral therapy showed a significant decrease in the perceived burden of hot flashes and night sweats (P<0.001; effect size, 0.39-0.56), as well as an increase in sexual activity (P=.27; effect size, 0.65).

“These results tend to support the hypothesis that cognitive and emotional factors can modify the experience of menopausal symptoms, whereas stress reduction techniques and physical exercise may have a more direct effect on menopausal symptoms via the thermoregulatory system and an improvement in overall physical condition,” Duijts and colleagues wrote.

The findings demonstrate that psychosocial elements play an important role in how patients experience symptoms, Debra L. Barton, PhD, and Charles L. Loprinzi, MD, both of Mayo Clinic in Rochester, Minn., wrote in an accompanying editorial.

“Although the trial reported by [Duijts and colleagues] provides helpful information, much more work needs to be completed to best understand the ideal way to clinically apply nonpharmacologic therapies for the treatment of hot flashes, night sweats and other estrogen deficiency symptoms,” Barton and Loprinzi wrote. “Available pilot data do suggest, however, that this effort is worthwhile.”


Duijts SFA. J Clin Oncol. 2012;doi:10.1200/JCO.2012.41.8525.