Inadequately management of hot flushes leave women vulnerable

Hot flushes are one of the most distressing conditions faced by women who have been treated for breast cancer, but they are not being adequately addressed by health care professionals. Some women consider giving up their post cancer medication to try to stop them, a new study has shown. The research was presented at the 2014 National Cancer Research Institute Cancer Conference.

More than 70% of women who have had breast cancer experience menopausal problems, hot flushes in particular, which are among the most prevalent and potentially distressing problems following breast cancer treatment. These can also be long lasting, persisting for more than 5 years once cancer treatment has ended and affecting all aspects of life, including sleep, social situations, intimate relationships, and ability to work.

Research has shown that there are differences between what the patient experiences and what is recognized, and then managed, by health care professionals.

Led by Debbie Fenlon, PhD, at the University of Southampton in the United Kingdom, the study surveyed both specialist health professionals and women who had been treated for breast cancer.

Although clinicians recognize that their patients experienced hot flushes and their quality of life is diminished, the way the condition is treated was mixed. The majority (94%) of respondents agreed or strongly agreed that hot flushes are an unmet need.

Results from the women's survey showed that they perceived the impact of hot flushes as being much greater than the health care professionals reported.

The majority of the health care professions reported that only 10% to 30% of breast cancer patients have severe hot flushes that affect daily living and quality of sleep. In contrast, when the women were asked to give a problem rating on a scale of 1 to 10 for their hot flushes in the past week, most respondents rated both how much of a problem hot flushes were and how distressed the women were by the hot flushes between 6 and 10.

Furthermore, of 666 women who responded to the questionnaire, 94% said that they suffered from hot flushes and 75% rated them as a major problem in their life. However, only 25% had ever been spoken to by a health professional about their hot flushes.

"It is clear from our surveys that clinicians are left making individual decisions based on personal experience and availability of local services,” said Fenlon. “There is a need for research to understand the physiology of flushing and to develop and test new interventions to address this intractable problem, which continues to be a cause of considerable distress to many women after breast cancer."

A troubling result from the women's survey was that a third of women having hot flushes considered discontinuing their estrogen blocking drugs to prevent the flushes from happening.

"There are no agreed guidelines for managing hot flushes after breast cancer, which may limit the access and availability of appropriate interventions. There is also little evidence to support a variety of interventions, none of which are entirely effective at removing hot flushes, other than hormone replacement therapy, which is contraindicated. This needs to be changed to ensure this patient group is not left vulnerable."

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