For Immediate Use
July 5, 2000
Kambra McConnel ([email protected])
(310) 206-3769
Kim Irwin ([email protected])
(310) 206-2805
FIRST-OF-ITS-KIND STUDY AT UCLA'S JONSSON CANCER CENTER SHOWS SUPPORTIVE CARE HELPS BREAST CANCER SURVIVORS MANAGE MENOPAUSAL SYMPTOMS, IMPROVE SEXUAL HEALTH
(Note to editors: Patient quoted in this story is available for media interviews.)
Breast cancer survivors who experience severe menopausal symptoms such as hot flashes, vaginal dryness and urinary incontinence can find significant relief from those symptoms and improve their sexual health through a comprehensive program that emphasizes supportive care in addition to medication, according to a new study by researchers at UCLA's Jonsson Cancer Center.
Women who did not receive the additional supportive care did not fare as well in managing their menopausal symptoms or experience better sexual health, which suggests that healthcare professionals should consider the benefits of a program that addresses patients' individual needs as completely as possible.
"This is the first study to look at the whole person, the complete woman, in managing menopausal symptoms," said Dr. Patricia Ganz, director of the Division of Cancer Prevention and Control Research at UCLA's Jonsson Cancer Center and lead author of the study. "Most scientific studies focus on understanding individual symptoms for a limited period of time. And in clinical practice, the standard approach among physicians is to prescribe a drug to treat one menopausal symptom at a time.
"Many physicians don't take an extra 30 to 40 minutes to consult with patients in depth, but our study shows that a nurse practitioner specially trained to conduct in-depth consultations can make a big difference in helping patients successfully manage their menopausal symptoms and improve their sexual health," said Ganz, who also is a professor at UCLA's schools of Medicine and Public Health.
The study, published in the July 5, 2000, issue of the Journal of the National Cancer Institute, showed that on average, 33 postmenopausal breast cancer survivors who received the comprehensive menopausal assessment and management program over four months experienced a significant decrease in the severity of menopausal symptoms compared with 39 survivors who received standard care for the same period of time.
Postmenopausal breast cancer survivors in the comprehensive program also reported improvements in their sexual health, but no significant change in their energy levels compared with survivors who received standard care.
Dr. Charles Loprinzi, professor and chairman of medical oncology at the Mayo Clinic in Rochester, Minn., said, "This study represents a very positive step forward for breast cancer survivors. It will pave the way for researchers to learn even better means for alleviating menopausal symptoms and sexuality concerns in these women, and to understand how to transfer the results from this UCLA effort to other sites."
At the beginning of the study, all patients received physical examinations and completed questionnaires. After four months, they completed questionnaires a second time to re-evaluate their symptoms.
Patients in the comprehensive program received a detailed assessment of their symptoms and extensive education by a nurse practitioner, followed by counseling on behavioral strategies to relieve symptoms, referrals to a psychologist, if necessary, and non-estrogen medications as needed. The nurse practitioner spent an average of 45 minutes with these patients during their initial in-person visits, and her follow-up visits with them two months later usually lasted 15 to 30 minutes. The nurse practitioner also was available by phone to advise patients in between visits.
In contrast, patients in the standard care group had no further contact with the nurse practitioner after their physical examinations. They underwent symptom evaluations and received education and health counseling only at the end of the study. During their participation in the study, they were not prevented from seeking medical or non-medical help to relieve their symptoms, but they were not encouraged to do so.
Many women take estrogen replacement therapy to alleviate menopausal symptoms. Although estrogen replacement therapy is considered standard treatment for healthy women with menopausal symptoms, researchers are not certain that it is safe for breast cancer survivors to take because it may increase their risk of breast cancer development or recurrence, Ganz said. So postmenopausal breast cancer survivors, who report higher rates of hot flashes, vaginal dryness and urinary incontinence than healthy postmenopausal women, often feel at a loss about what they can do to manage severe symptoms.
Laura Zibecchi, the clinical research nurse practitioner involved in the study, said many of the participants were reluctant to try some of the conventional medications used to relieve menopausal symptoms because of potential side effects.
"After surviving something as challenging as breast cancer, some women are willing to experience a few side effects, but others have bad memories from treatments like chemotherapy and they are unwilling to risk the possibility of having side effects again," Zibecchi said. "So it's critical to find ways to help breast cancer survivors manage their symptoms more effectively, both medically and psychologically, even if it's as basic as helping a woman identify lifestyle changes that she can make. It's all about trying to minimize the impact of symptoms on women's everyday lives."
Gloria Moore, a 57-year-old breast cancer survivor who was randomly assigned to the comprehensive program, said participating in the study gave her life back to her. Severe hot flashes that interfered with her sleep every night for a year left her sleep deprived and unable to function normally during the day.
"All I could do was work, sleep, walk for exercise and do yoga," Moore said. "I'd totally stopped doing anything socially. I shut myself off from everyone because I didn't have time for a life. Whenever I had a chance to sleep, I slept."
Through consultations with Zibecchi, Moore's hot flashes were brought under control by adjusting the dosage of her non-estrogen medication. Zibecchi also referred Moore to a therapist, who helped her deal successfully with some personal and relationship issues associated with her cancer diagnosis. Lack of energy, caused by sleep deprivation, had forced Moore to live a more secluded life. But regular therapy sessions helped her rebuild an active lifestyle and dramatically improved her overall quality of life.
"I didn't realize what a basket case I was until I went through therapy," Moore said. "I'm happy to have been able to get extra help through the UCLA study and to have the chance to get my life back."
Ganz said that the "full package" of the comprehensive program-tailoring medications, providing educational counseling and taking a detailed assessment of patients' symptoms and concerns-provides an effective way to "arm postmenopausal breast cancer survivors with strategies that are specific to a unique set of problems that they may have."
"For women, our findings mean that breast cancer survivors need not be helpless, that they don't have to grin and bear severe hot flashes, urinary incontinence or vaginal dryness," she said. "And for healthcare providers, our results offer a strategy with which they can more thoroughly address these problems in female patients. Taking extra time with these patients yields good results."
-UCLA-
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