Internet-based cognitive behavioral therapy aimed at alleviating treatment-induced menopausal symptoms in breast cancer survivors: Moderators and mediators of treatment effects.

Results from our recently conducted randomized controlled trial (RCT) indicated that Internet-based cognitive behavioral therapy (iCBT), with or without therapist support, is effective in reducing the perceived impact of hot flushes and night sweats (HF/NS) and overall levels of menopausal symptoms in breast cancer survivors with treatment-induced menopausal symptoms. We used data of 235 women and compared the iCBT groups combined (n = 156) with the control group (n = 79). Bootstrapped multiple regression analyses with interaction terms (group x potential moderator) or indirect effects (mediation pathway) were conducted. Reductions in perceived impact of HF/NS and overall levels of menopausal symptoms. Women with lower levels of education benefited most from the iCBT. Age, time since diagnosis, current endocrine treatment, oophorectomy, frequency of HF/NS, and psychological distress did not moderate the treatment effects. Factors that mediated treatment effects were the development of healthier beliefs about experiencing hot flushes in a social context, about the impact of night sweats on sleep and daily functioning, and about the ability to control and cope with hot flushes. The acquisition of behavioral coping strategies and decreased psychological distress did not mediate treatment effects. The results suggest that women with lower levels of education may benefit most from the current iCBT program, with or without therapist support. The development of healthier HF/NS beliefs contribute significantly to the observed positive effect of iCBT on the burden of menopausal symptoms. NCT02672189.

Atema V ，van Leeuwen M ，Kieffer JM ，Oldenburg HSA ，van Beurden M ，Hunter MS ，Aaronson NK ... -  《-》

Design of a randomized controlled trial of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors.

Atema V ，van Leeuwen M ，Oldenburg HS ，Retèl V ，van Beurden M ，Hunter MS ，Aaronson NK ... -  《BMC CANCER》

Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial.

Atema V ，van Leeuwen M ，Kieffer JM ，Oldenburg HSA ，van Beurden M ，Gerritsma MA ，Kuenen MA ，Plaisier PW ，Lopes Cardozo AMF ，van Riet YEA ，Heuff G ，Rijna H ，van der Meij S ，Noorda EM ，Timmers GJ ，Vrouenraets BC ，Bollen M ，van der Veen H ，Bijker N ，Hunter MS ，Aaronson NK ... -  《-》

Cost-utility, cost-effectiveness, and budget impact of Internet-based cognitive behavioral therapy for breast cancer survivors with treatment-induced menopausal symptoms.

Verbeek JGE ，Atema V ，Mewes JC ，van Leeuwen M ，Oldenburg HSA ，van Beurden M ，Hunter MS ，van Harten WH ，Aaronson NK ，Retèl VP ... -  《-》

Cognitive behaviour therapy for menopausal symptoms following breast cancer treatment: Who benefits and how does it work?

Cognitive behaviour therapy (CBT) has been found to reduce the impact of menopausal symptoms, hot flushes and night sweats. This study investigates the moderators and mediators of CBT for women who had problematic menopausal symptoms following breast cancer treatment. Analysis of 96 patients with breast cancer induced menopausal symptoms recruited to the MENOS1 trial; 47 were randomly assigned to Group CBT and 49 to usual care. Questionnaires were completed at baseline, 9 and 26 weeks post randomisation. Potential moderators and mediators, including sociodemographic, clinical and psychological factors, of the treatment effect on the primary outcome were examined. Hot Flush Problem Rating. CBT was effective at reducing problem rating at 9 weeks regardless of age, BMI, time since breast cancer diagnosis, menopausal status at time of diagnosis, or type of cancer treatment (radiotherapy or chemotherapy or endocrine treatment). The treatment effect was significantly greater in women not receiving chemotherapy, those with higher levels of psychological distress at baseline and for non-white women. Beliefs about control/coping with hot flushes were the main mediators of improvement in problem rating following CBT. Beliefs about hot flushes in a social context, depressed mood and sleep problems were also identified as mediators. These findings suggest that CBT is widely applicable for breast cancer patients who are experiencing treatment related menopausal symptoms, and that CBT works mainly by changing beliefs and improving mood and sleep.

Chilcot J ，Norton S ，Hunter MS 《-》