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Ask breast cancer patients about hot flushes, urges nurse researcher

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Nurses must do more to help breast cancer patients cope with the hot flushes that are a common side effect of hormone therapy, according to the nursing academic who has led new research into the problem.

Research by the National Cancer Research Institute’s (NCRI) Breast Clinical Studies Group included a survey of more than 660 breast cancer patients.

The survey revealed a quarter had considered stopping hormone therapy – commonly prescribed after surgery to remove a tumour – because the impact of hot flushes and night sweats was so severe.

“We have is a situation where nurses rarely ask people if they are having hot flushes”

Debbie Fenlon

This is despite the fact other studies have shown that stopping taking the drugs before five years can increase the risk of dying from the disease.

The research, launched at the NCRI conference in Liverpool, also uncovered a huge disparity in the way the problem of hot flushes was perceived by patients compared to doctors and nurses, and wide variation in the advice and treatment given.

It found 75% of patients had never been asked about hot flushes, even though it is a common side effect of ongoing treatment. Some breast cancer patients may also be experiencing hot flushes as a result of the menopause but are unable to have HRT to help control them.

The research was prompted by patient members of the group, who described how hot flushes and night sweats  had in some ways had a worse impact on day to day life than having cancer itself.

Lead researcher and nurse Deborah Fenlon, associate professor at the University of Southampton, said it was vital nurses did ask questions and explore possible solutions.

University of Southampton

Deborah Fenlon

“What we have is a situation where nurses rarely ask people if they are having hot flushes,” she told Nursing Times. “Yet patients say that even simply acknowledging that this is a problem can actually be helpful – the fact that someone listens to how difficult it is instead of just brushing it aside.

“There are a lot of behavioural things you can do that can help and for me this is the ideal place for nurses because while doctors can give out drugs, people don’t necessary want them and are pleased to try alternatives,” she said.

As well as simple steps to reduce core body temperature and avoid triggers for hot flushes, she said there was evidence acupuncture and cognitive behavioural therapy (CBT) could help women manage the worst symptoms.

However, few patients were able to access this kind of support due to a lack of services.

“The plan is to commission some research to see whether we can train breast care nurses to effectively deliver the CBT themselves”

Debbie Fenlon

Work is now under way with breast cancer charity Macmillan Cancer Support to develop guidance for health professionals about what is currently available.

Meanwhile, Ms Fenlon revealed plans to train breast care nurses to offer CBT in a bid to open up this option to more people. She said the Breast Cancer Campaign was set to commission a small-scale trial to test the idea.

“CBT can be helpful but it is not that widely available, so the plan is to commission us to do some research to see whether we can train breast care nurses to effectively deliver the CBT themselves,” she said.

“We’re going to go to about five centres and train a couple of nurses at each initially just to see if it is going to work,” she added.

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Readers' comments (3)

  • Prostate cancer patients also suffer from hot flushes when treated with GnRH agonists to suppress their testosterone production. Nurses could also help these men with practical advice and, if available CBT etc

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  • At last someone is listening. As a nurse and a patient I understand both sides of the equation. The side effects of hormonal treatments can be quite debilitating and significantly affect quality of life but if longer life is the aim then life versus side effects needs to be weighed. ANYTHING that can be done to ameliorate some of the side effects including the hot flushes and cramp which goes very under recognised has to be a positive to help some comply with the life saving treatment.

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  • As a CNS who works with patients with prostate cancer asking men about hot flushes is one of the main questions I ask. Any further education to help these patients would be great so learning CBT would be a way forward

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