An internet-based cognitive behavioral therapy (iCBT) program effectively diminished the perceived negative impact of treatment-induced menopausal symptoms in breast cancer survivors who were 50 or younger at diagnosis. This study was published in the Journal of Clinical Oncology.

Adverse effects of adjuvant chemotherapy and/or endocrine therapy for breast cancer can be associated with a range of menopausal symptoms, particularly in younger women, and can lead to quality of life detriments as well as decreased adherence to long-term endocrine therapy.

Randomized clinical trials of a previously developed group-based, face-to-face cognitive behavioral therapy program showed the benefits of this approach for diminishing the perceived negative impact of menopausal symptoms on breast cancer survivors and healthy women. An internet version of this cognitive behavioral therapy program was developed to increase its accessibility and flexibility.

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This study included women with a breast cancer diagnosis at or before age 50 experiencing frequent treatment-induced hot flushes/night sweats, who were without disease at the time of study enrollment. All women had stopped receiving active breast cancer treatment for at least 4 months and no more than 5 years, with the possible exceptions of endocrine therapy and trastuzumab.

Study participants, identified through hospital registries or The Netherlands Cancer Registry, were randomly assigned (1:1:1) to a therapist-guided iCBT program (n=86), a self-managed iCBT program (n=85), or a waiting list for iCBT (n=84; control group) following completion of a baseline questionnaire assessing sociodemographic information.

The 6-week iCBT program included 6 modules and covered issues related to the management of hot flushes, stress, sleep disturbances, and sexual problems, as well as the importance of developing an action plan. All modules included elements of self-reflection, psycho-education, and assignments. Those women in the guided arm received a telephone interview at the start of the program and written feedback each week of the program. Feedback from study participants was obtained using standardized self-report questionnaires.

All 6 modules were completed by 85.9% in the guided intervention arm and 62.4% in the self-managed intervention arm. Due to the limitations of sample size, a direct comparison between the 2 intervention groups was not performed for all end points. Study findings included significant decreases in the perceived impact of hot flushes/night sweats (P <.001) and improvement in sleep quality (P <.001) for the combined intervention groups compared with the control group. These results remained significant at 6-month follow-up.

In future analyses, the investigators plan to evaluate cost effectiveness of iCBT and to identify patient-related moderating factors that enhance or detract from the efficacy of the intervention.


Atema V, van Leeuwen M, Kieffer JM, et al. [published online February 14, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.00655