Talk Therapy Eases Hot Flashes After Breast Cancer Treatment

PHOTO: Sheryl Alberico has hourly hot flashes after having chemotherapy for breast cancer.PlayCourtesy Sheryl Alberico
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It was a bad dream that prompted 38-year-old Sheryl Alberico of Los Angeles to demand the mammogram that saved her life.

Although it was small, the pea-size tumor in Alberico's left breast was aggressive. Within weeks, doctors would remove both breasts and pump toxic drugs throughout her body "just in case."

Now, one day after her fourth and final round of chemotherapy, something else is haunting Alberico's sleep: Unrelenting hot flashes.

"Last night I woke up every hour," said Alberico, who is currently on disability leave from her job as an architect. "It just hits you. It feels like there's a fire inside you."

Up to 85 percent of women treated for breast cancer experience hot flashes and night sweats, the often debilitating symptoms of menopause brought on by the hormone-disrupting cancer treatments.

"I wake up my husband kicking off the covers. Neither of us gets any sleep," said Alberico, who routinely irons the cotton sheets to keep them "crisp and cold." "Sometimes I have to get up and take a shower just to cool down."

Certain drugs can provide some relief, but they don't work for everyone.

"Hormone therapy generally isn't recommended for these women because of its association with breast cancer," said Myra Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry. "And many women want to take a non-medical approach."

Hunter and colleagues investigated whether group cognitive-behavioral therapy, a psychotherapy aimed at tackling perceptions rather than physical symptoms, could help breast cancer survivors cope with hot flashes and night sweats by changing the way they think about them.

"There is some evidence that cognitive-behavioral therapy can help well women [who do not have breast cancer] cope with hot flashes and night sweats related to menopause," said Hunter. "If we can help them to counter their negative thoughts, they can learn to really let the flash flow over them."

In a study of 96 breast cancer survivors, women who received six 90-minute cognitive-behavioral therapy sessions reported significantly fewer problems with hot flashes and night sweats than women who received the usual care. The findings were published Tuesday in the Lancet Oncology.

"They're still having hot flashes, but they don't notice them as much," said Hunter.

Using relaxation techniques such as "paced breathing," the women learned to counteract the stress and embarrassment of hot flashes and their effects on mood and sleep.

Holly Prigerson, director of psychosocial oncology at the Dana-Farber Cancer Institute, said the study "demonstrates the power of the mind as medicine."

"By encouraging someone to think about physical symptoms in a different way -- a way that's less stigmatizing and more normalizing -- you can substantially improve her quality of life," said Prigerson, who wrote an editorial accompanying the study. "Just like anxiolytics or antidepressants, how you think about something can have a dramatic influence on how you feel physically and mentally."

An online version of the therapy sessions could improve access for women limited by money, geography and busy schedules, Prigerson said. But there are advantages to sharing the experience with a group of women in the same boat.

"This study didn't really parse out the effect of sharing with a group of other breast cancer survivors -- how the social support of sisters in suffering might also prove empowering and make women more resilient," Prigerson said.

Learning to counter negative emotions can give women back some of the control they feel they lost during their cancer diagnosis and treatment, Hunter said.

"I think it's very empowering, actually, because they've been going through a process where they feel as if their bodies are being managed by other people," she said. "The cognitive-behavioral therapy approach lets them feel as though they've got some control, and think they can apply that to different areas of their life."

After a double mastectomy and aggressive chemotherapy, Alberico said she likes the sound of cognitive-behavioral therapy.

"I'm just sick of all the pills and needles," she said. "If I can do something more natural, that's better. I'm in my 30s, and this is going to go on for a while, so it can't hurt to try."