Menopausal Hot Flashes More Severe in Cancer Survivors

In the first large-scale study to compare menopausal symptoms in women who have survived cancer with those in women who have never had the disease, cancer survivors were found to have more frequent, severe, and troubling hot flashes.

The study, published online July 15 in Menopause, involved 934 cancer survivors (90% of whom had breast cancer) and 155 control subjects who never had cancer.

There was no difference between the groups in age at menopause (46 years) or age at first clinic visit (51 years), note the authors, headed by Jennifer Marino, MPH, PhD, from the Department of Obstetrics and Gynecology at the University of Melbourne in Australia.

Cancer survivors were more likely than control subjects to be severely troubled by hot flashes and night sweats (odd ratio, 1.71). Cancers survivors reported more frequent hot flushes in 24 hours than control subjects (6.0 vs 3.1; P < .001), and more severe or very severe hot flushes (60% vs 40%).

In contrast, cancer survivors were significantly less troubled by psychologic and somatic symptoms, and reported better quality of life than control subjects. Cancer survivors were also less likely to have severe mood swings or sadness and reported significantly better social and family well-being.

Dr. Marino and colleagues describe these findings as rather surprising and suggest that the better emotional and social well-being could be the result of the good support available for cancer survivors.

They also note that there were no significant differences between the 2 groups in physical or functional well-being, gynecologic symptom severity, or sexual function.

Better Mental State "Intriguing"

Margery Gass, MD, executive director of the North American Menopause Society, who was asked by Medscape Medical News to comment on the findings, said it is not surprising that cancer survivors report more severe hot flushes, which are likely related to the cancer treatments they received.

For instance, breast cancer is often treated with antiestrogens, which are associated with hot flashes, she explained. Aromatase inhibitors result in very low estrogen levels, and could account for some of the severity of the hot flashes that breast cancer survivors experience. In addition, woman with ovarian and endometrial cancer are usually treated with hysterectomy and removal of the ovaries. Loss of the ovaries results in a very low estrogen state that can produce more bothersome hot flashes, Dr. Gass noted.

In addition, patients who have other pain syndromes can experience new pain more acutely. The cancer survivors might have undergone surgery, radiotherapy, and/or chemotherapy. Even if this treatment was some time ago, the survivors could be more aware of physical symptoms because they want to be alert to any signs of recurrence, she explained.

More surprising, and rather intriguing, is the finding that cancer survivors had a better psychologic state than the control subjects, Dr. Gass told Medscape Medical News. Maybe having survived a life-threatening disease gave these women a different perspective on life, she said, making them better able to deal with psychologic symptoms such as anxiety and depression.

The study findings should "encourage all clinicians to pay attention to menopausal symptoms in cancer survivors and not to minimize them," Dr. Gass concluded.

"I know cancer doctors often feel very pleased that they have saved someone from cancer, and anything else pales by comparison, but when they are aware of the fact that these women may experience more severe symptoms of menopause, perhaps that will encourage them to give this legitimate consideration and to be more proactive in helping women alleviate those symptoms," she added.

The study was supported by the King Edward Memorial Hospital, AstraZeneca, the National Breast and Ovarian Cancer Center, and the National Breast Cancer Foundation of Australia.

Menopause. Published online July 15, 2013. Abstract

 

-- Zosia Chustecka

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