Hot Flashes And Insomnia Common Side Effects After Treatment for Breast Cancer

I.Common Symptoms Experienced After Breast Cancer Treatment II.Vasomotor symptoms (Hot flashes) I. Sleep Disturbance

What are the most common lasting side effects? Moving Beyond Cancer Trial  Looked at symptoms at the end of treatment among 558 women from LA, DC, and Kansas City  61% of patients reported being unhappy with their appearance  60% reported having hot flashes  60% reported having aches and pains  56% reported forgetfulness  56% reported breast sensitivity  54% reported joint pains  51% reported muscle stiffness  P Ganz, 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 treatment One study also found differences among women from different races in terms of the symptoms reported  Authors attributed differences to possible differences in physiology and cultural interpretations of symptoms  J Yoon, et al. Symptoms after breast cancer treatment: are they influenced by patient characteristics? 2008

Vasomotor Symptoms Vasomotor refers to anything that changes the size of the blood vessels (e.g. vasodilation - larger or vasoconstriction - smaller) Symptoms can include hot flashes and palpitations Overall, 65% of breast cancer survivors experience these symptoms  N Avis. Breast Cancer Survivors and Hot Flashes: The Search for Nonhormonal Treatments

What causes vasomotor symptoms? The causes of vasomotor symptoms not well understood However, believed to be linked to rapid change in estrogen levels Hot 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 survivors Nonhormonal interventions  Mind-body interventions  Attractive and maybe effective among breast cancer survivors, but difficult to study to find an effect  May work to decrease stress/ nervous system activity and reduce hot flashes  N Avis. Breast Cancer Survivors and Hot Flashes: The Search for Nonhormonal Treatments

Sleep Disturbance A contributing factor in increased fatigue among breast cancer survivors One 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 disturbance Other studies have suggested that 40-50% of cancer survivors experience difficulty sleeping  JA Broekel. Characteristics and Correlates of Fatigue After Adjuvant Chemotherapy for Breast Cancer  J Bower, et al. Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life  J Bower, et al. Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism? 2011.

Why insomnia? Emotional distress that endures after treatment Possible biological roots:  A recent study found fatigue to be linked with inflammatory markers  Vasomotor symptoms like hot flashes can lead to sleep deprivation J 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 treatment Other methods of reducing stress  Shapiro, et al. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study  Carlson and Garland. Impact of Mindfulness-Based Stress Reduction (MBSR) on Sleep, Mood, Stress and Fatigue Symptoms in Cancer Outpatients

Resources at UCSF UCSF Symptom Management Service: UCSF Mindfulness-based stress reduction: based_stress_reduction/index.html, based_stress_reduction/index.html UCSF Psycho-oncology Department

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): Jean 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 March; 108(2):  N Avis. Breast Cancer Survivors and Hot Flashes: The Search for Nonhormonal Treatments. Journal of Clinical Oncology (31).  JA Broekel. Characteristics and Correlates of Fatigue After Adjuvant Chemotherapy for Breast Cancer Journal of Clinical Oncology

Literature, Continued  J Bower, et al. Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. Journal of Clinical Oncology  J 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  Shapiro, 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 of Psychosomatic Research  Carlson and Garland. Impact of Mindfulness-Based Stress Reduction (MBSR) on Sleep, Mood, Stress and Fatigue Symptoms in Cancer Outpatients. International Journal of Behavioral Medicine