Hot FlashesAnd Insomnia2.27.12
Common Side Effects After Treatment for Breast Cancer
Common Symptoms Experienced After Breast Cancer TreatmentVasomotor symptoms (Hot flashes)Sleep Disturbance
What are the most common lasting side effects?
Moving Beyond Cancer TrialLooked at symptoms at the end of treatment among 558 women from LA, DC, and Kansas City61% of patients reported being unhappy with theirappearance60% reported having hotflashes60% reported having aches andpains56% reportedforgetfulness56% reported breastsensitivity54% reported jointpains51% reported musclestiffnessPGanz, et al. Quality of Life at the End of Primary Treatment of Breast Cancer. 2004
Side effects vary from person to person
Some studies have found greater symptom severity for younger women who have completed treatmentOne study also found differences among women from different races in terms of the symptoms reportedAuthors attributed differences to possible differences in physiology and cultural interpretations of symptomsJ Yoon, et al. Symptoms after breast cancer treatment: are they influenced by patient characteristics? 2008
Vasomotor Symptoms
Vasomotor refers to anything thatchangesthe sizeof the blood vessels (e.g. vasodilation- largerorvasoconstriction - smaller)Symptoms can include hot flashes and palpitationsOverall, 65% of breast cancer survivors experience these symptomsN Avis.Breast Cancer Survivors and Hot Flashes: The Search forNonhormonalTreatments. 2008.
What causes vasomotor symptoms?
The causes of vasomotor symptoms not well understoodHowever, believed to be linked to rapid change in estrogen levelsHot flashes may also be related to stress levels and increased levels of norepinephrine (a substance released in the body)
How to address them?
Estrogen therapy usually given for women with these symptoms, but it is not recommended for breast cancer survivorsNonhormonalinterventionsMind-body interventionsAttractive and maybe effective among breast cancer survivors, but difficult to study to find an effectMay work to decrease stress/ nervous system activity and reduce hot flashesN Avis.Breast Cancer Survivors and Hot Flashes: The Search forNonhormonalTreatments. 2008.
Sleep Disturbance
A contributing factor in increased fatigue among breast cancer survivorsOne study found one third of the breast cancer survivors reported more severe fatigue, which was linked with significantly higher levels of depression, pain, and sleep disturbanceOther studies have suggested that 40-50% of cancer survivors experience difficulty sleepingJA Broekel. Characteristics and Correlates of Fatigue After Adjuvant Chemotherapy for Breast Cancer. 1998.J Bower, et al. Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. 2000.J Bower, et al. Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism? 2011.
Whyinsomnia?
Emotional distress that endures after treatmentPossible biological roots:A recent study found fatigue to be linked with inflammatory markersVasomotor symptoms like hot flashes can lead to sleep deprivationJ Bower, et al. Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism? 2011.
What are some ways to reduce sleep disturbance?
A number of studies have found benefit from mindfulness-based stress reduction interventions(guided imagery, relaxation)for sleep disturbance after cancer diagnosis and treatmentOther methods of reducing stressShapiro, et al. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. 2003.Carlson and Garland. Impact of Mindfulness-Based Stress Reduction (MBSR) on Sleep, Mood, Stress and Fatigue Symptoms in Cancer Outpatients. 2005.
Resources at UCSF
UCSF Symptom Management Service:http://cancer.ucsf.edu/sms/, 415-885-7671UCSF Mindfulness-based stress reduction:http://www.ucsfhealth.org/services/mindfulness-based_stress_reduction/index.html, 415-353-7718UCSF Psycho-oncology Departmenthttp://cancer.ucsf.edu/psycho-oncology/
Additional Literature
P Ganz, et al. Quality of Life at the End of Primary Treatment of Breast Cancer: First Results From the Moving Beyond Cancer Randomized TrialJNCI J Natl Cancer Inst (2004) 96(5): 376-387http://jnci.oxfordjournals.org/content/96/5/376.fullJean Yoon, Jennifer L. Malin, May Lin Tao, Diana M. Tisnado, John L. Adams, Martha J. Timmer, Patricia A. Ganz, Katherine L. Kahn. Symptoms after breast cancer treatment: are they influenced by patient characteristics? Breast Cancer Res Treat. 2008 March; 108(2): 153 -165.http://www.ncbi.nlm.nih.gov/pubmed/17492377N Avis. Breast Cancer Survivors and Hot Flashes: The Search for Nonhormonal Treatments. Journal of Clinical Oncology 2008. 26(31).http://jco.ascopubs.org/content/26/31/5008JA Broekel. Characteristics and Correlates of Fatigue After Adjuvant Chemotherapy for Breast Cancer. 1998. Journal of Clinical Oncologyhttp://jco.ascopubs.org/content/16/5/1689.full.pdf+html
Literature, Continued
J Bower, et al. Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. Journal of Clinical Oncology 2000.http://www.jcojournal.org/content/18/4/743.shortJ Bower, et al. Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism? Journal of Clinical Oncology 2011.http://171.66.121.246/content/29/26/3517.full.pdf+htmlShapiro, et al. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study.Journal of Psychosomatic Research. 2003.http://www.sciencedirect.com/science/article/pii/S0022399902005469Carlson and Garland. Impact of Mindfulness-Based Stress Reduction (MBSR) on Sleep, Mood, Stress and Fatigue Symptoms in Cancer Outpatients. International Journal of Behavioral Medicine 2005.http://www.springerlink.com/content/x143w6q346g19663/fulltext.pdf
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