Internet-based cognitive behavioral therapy for breast cancer survivors with treatment-induced menopausal symptoms

Abstract

Many young breast cancer (BC) survivors are confronted with menopausal symptoms caused by their BC treatment. The most prevalent and disruptive menopausal symptoms are hot flushes and night sweats (HF/NS) which negatively affect health-related quality of life and can result in women discontinuing their endocrine treatment. Previous studies have demonstrated that face-to-face cognitive behavioral therapy (CBT) is effective in alleviating menopausal symptoms in women with breast cancer. However, compliance with face-to-face CBT programs can be problematic. We, therefore, developed an Internet-based format of the CBT program, making it more accessible and feasible for patients. This study is evaluating the efficacy and cost-effectiveness of an Internetbased CBT program (iCBT), with or without therapist support, in alleviating menopausal symptom burden. In addition, moderators and mediators of treatment effects were identified. We randomly assigned 254 BC survivors to a therapist guided or a self-managed iCBT group or to a waiting list control group. The six-week iCBT program included psychoeducation, behavioral monitoring and cognitive restructuring. Questionnaires were administered at baseline, and at 10 weeks and 24 weeks post-randomization. The results indicate that iCBT, with or without therapist support, 1] has clinically significant, salutary effects on the perceived impact and frequency of HF/NS, overall levels of menopausal symptoms and sleep quality, 2] is acceptable in terms of cost-utility, cost-effectiveness and budget impact parameters and 3] women with a high school or vocational degree benefit most and the development of healthier HF/NS beliefs contribute significantly to the observed positive effect of iCBT on menopausal symptom burden