The current management of vasomotor symptoms in breast cancer patients in the UK: Clinician versus Patient perspective. Mei-Lin Ah-See1,Charlotte Coles 2, Deborah.
Download ReportTranscript The current management of vasomotor symptoms in breast cancer patients in the UK: Clinician versus Patient perspective. Mei-Lin Ah-See1,Charlotte Coles 2, Deborah.
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The current management of vasomotor symptoms in breast cancer patients in the UK:
Clinician versus Patient perspective.
Mei-Lin Ah-See1,Charlotte Coles 2, Deborah Fenlon3, Emma Pennery4, Janet Dunn5 & Adrienne Morgan6 on behalf of the
NCRI Breast CSG Working Party on Symptom Management (Vasomotor)
1Mount
Vernon Cancer Centre, London, UK, 2Cambridge University Hospitals NHS Foundation Trust< Cambridge, UK, 3Faculty of Health Sciences, University of Southampton, Southampton, UK, 4 Breast
Cancer Care, UK, 5University of Warwick, Coventry, UK, 6 Independent Cancer Patients’ Voice, London UK.
Abstract:
Background
Background: The vasomotor symptom of hot flushes (or flashes) is a well recognised, commonly reported side-effect
in breast cancer (BC) patients treated with chemotherapy & endocrine therapy. It can significantly impact on quality
of life &, for some patients, leads to the discontinuation of treatment resulting in worse BC outcomes. Managing this
symptom is challenging & there is currently no consensus on best practise. In response to this challenge, & on the
initiative of patient advocate members, the UK National Cancer Research Institute Breast Clinical Studies Group
(NCRI Breast CSG) has established a multi-disciplinary working party to evaluate & improve vasomotor symptom
management. A starting point for the group was to establish the current opinions & practise of UK clinicians & their
patients.
Materials & Methods: A short questionnaire was circulated to the members of the NCRI UK Breast Intergroup (BC
healthcare professionals). A Separate patient survey was opened on the Breast Cancer Care website & advertised
via the BCC Facebook &Twitter Social media accounts.
Results: There were 185 respondents to the Healthcare professional survey & as yet, 625 respondents to the patient
survey (still ‘live’). 95% of healthcare professional respondents ‘agreed’ or ‘strongly agreed’ that the treatment &
management of hot flushes is currently an unmet need. Treatments vary across the UK & include pharmacological &
non-pharmacological interventions. The most commonly prescribed drugs are the selective serotonin reuptake
inhibitors (58%), such as venlafaxine, followed by clonidine (18%) & gabapentin (11%). Hormone replacement
therapy & progesterone preparations are used by a small number (6.7% & 4.7% respectively). Complementary
therapies are commonly recommended, in particular, evening primrose oil & acupuncture. Access to dedicated
Cancer-related menopaus clinics is poor. The results of the patient survey will be presented at the meeting along
with the final results from the Healthcare Professional survey.
Conclusion: There is currently no consensus regarding best practise for the management of hot flushes in BC
patients within the UK. Lead by patient advocates, the NCRI Breast CSG has established a multi-disciplinary
working party with the aim of addressing this unmet need by increasing awareness, promoting clinical studies &
contributing to the establishment of evidence-based clinical guidelines for BC patients within the planned NICE
guidance on diagnosis & management of menopause.
21
All Hot flush studies,
UK, USA & Europe
since 2006
Current Active Trials in
Breast CSG portfolio
120
Patient advocate members of the National Cancer Research
Institute UK Breast Clinical Studies Group and UK Breast
Intergroup identified that there is very little research into the
management of symptoms after breast cancer treatment and that
this constituted a lack in the current portfolio.
On the initiative of the patient advocate members of the NCRI
Breast Clinical Studies Group, a Working Group on Symptom
Management has been established. The group agreed to work on
the management of hot flushes in the first instance, due to its
prevalence, distressing nature and intractability.
Members of the group all have a particular interest in the management of hot flushes and include
patient advocates, clinical and academic partners, representing oncology, psychology, gynaecology,
complementary therapies and the voluntary sector.
Hot Flushes (vasomotor symptoms) are a serious problem. They impact significantly on daily life and sleep quality, affecting employment, relationships and quality of
life. The only effective treatment for hot flushes is oestrogen which is contraindicated in the 75% of breast cancer patients who’s cancer is oestrogen driven. There are
an estimated 550,000 people living in the UK today who have been diagnosed with breast cancer and up to 70% women experience disabling hot flushes after
treatment for breast cancer. That’s a lot of hot flushes. These can continue for years after treatment and probably contribute to the 50% of patients who have stopping
taking their life-saving antioestrogen drugs before 5 years.
Here we present a Clinician versus Patient Perspective on hot flushes
Clinician Perspective
Patient Perspective
•185 respondents questionnaire
•666 patients responded to BCC questionnaire
•Median age 50 years (range 25-69)
Do you experience hot flushes?
45
If you treat hot flushes medically
what do you use?
40
35
How much of a problem are your hot flushes? (scale
of 1 to 10: 1 not a problem - 10 a major problem)
Gabapentin
30
SSRIs
25
yes
1 to 5
no
6 to 10
no answer
20
Escitalopram
Clonidine
15
Citalopram
Do you experience night sweats?
Desvenlaf…
10
Progesterones
How much of a problem are your night sweats? (scale
of 1 to 10: 1 not a problem, 10 a major problem)
Venlafaxine
5
0
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Don't
know
Roughly what percentage of your breast cancer patients have
severe hot flushes that affect daily living and quality of sleep
I believe treatment of hot flushes is an
unmet need
Paroxetine
HRT
0
50
100
150
yes
0
20
40
60
80
100
120
140
160
180
None
Have any of these health care professionals ever
asked you about hot flushes/night sweats?
Menopausal magnets
700
600
500
400
300
200
100
0
Raspberry leaf Tea
Starflower Oil
Chillo pillow
Agree
Sage
no answer
Are your hot flushes/night sweats bad enough for
you to consider stopping your endocrine therapy?
no answer
no
yes
yes
no
not applicable
no answer
GP
Evening primrose oil
Disagree
6 to 10
not aswered
Red clover
Strongly agree
1 to 5
no
200
Surgeon
Oncologist
Breast Care
Nurse
Black cohosh
Vitamin E
Strongly disagree
0
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
10
20
30
40
50
60
70
80
90
60.0%
Which complementary treatments
would you recommend to your
breast cancer patients for hot
flushes?
In Conclusion: What Do We Want?
Despite the size of this problem, within the UK there are no nationally agreed guidelines for
managing hot flushes after breast cancer, which may limit the access and availability of currently
available and appropriate interventions. There is limited evidence to support a variety of
interventions, none of which are entirely effective at eliminating hot flushes, other than hormone
replacement therapy, which is contraindicated. All the available pharmacological interventions
can have severe side-effects and few are widely acceptable. Our surveys have confirmed the
size of the problem but also show that there is patchy and inequitable management of this
problem (data not shown), which continues to be a cause of considerable distress to many
women after breast cancer. There is an urgent need for research across the field to understand
the physiology of flushing and to develop and test new interventions.
The current management of vasomotor symptoms in breast cancer patients in the UK:
Clinician versus Patient perspective.
Mei-Lin Ah-See1,Charlotte Coles 2, Deborah Fenlon3, Emma Pennery4, Janet Dunn5 & Adrienne Morgan6 on behalf of the
NCRI Breast CSG Working Party on Symptom Management (Vasomotor)
1Mount
Vernon Cancer Centre, London, UK, 2Cambridge University Hospitals NHS Foundation Trust< Cambridge, UK, 3Faculty of Health Sciences, University of Southampton, Southampton, UK, 4 Breast
Cancer Care, UK, 5University of Warwick, Coventry, UK, 6 Independent Cancer Patients’ Voice, London UK.
Abstract:
Background
Background: The vasomotor symptom of hot flushes (or flashes) is a well recognised, commonly reported side-effect
in breast cancer (BC) patients treated with chemotherapy & endocrine therapy. It can significantly impact on quality
of life &, for some patients, leads to the discontinuation of treatment resulting in worse BC outcomes. Managing this
symptom is challenging & there is currently no consensus on best practise. In response to this challenge, & on the
initiative of patient advocate members, the UK National Cancer Research Institute Breast Clinical Studies Group
(NCRI Breast CSG) has established a multi-disciplinary working party to evaluate & improve vasomotor symptom
management. A starting point for the group was to establish the current opinions & practise of UK clinicians & their
patients.
Materials & Methods: A short questionnaire was circulated to the members of the NCRI UK Breast Intergroup (BC
healthcare professionals). A Separate patient survey was opened on the Breast Cancer Care website & advertised
via the BCC Facebook &Twitter Social media accounts.
Results: There were 185 respondents to the Healthcare professional survey & as yet, 625 respondents to the patient
survey (still ‘live’). 95% of healthcare professional respondents ‘agreed’ or ‘strongly agreed’ that the treatment &
management of hot flushes is currently an unmet need. Treatments vary across the UK & include pharmacological &
non-pharmacological interventions. The most commonly prescribed drugs are the selective serotonin reuptake
inhibitors (58%), such as venlafaxine, followed by clonidine (18%) & gabapentin (11%). Hormone replacement
therapy & progesterone preparations are used by a small number (6.7% & 4.7% respectively). Complementary
therapies are commonly recommended, in particular, evening primrose oil & acupuncture. Access to dedicated
Cancer-related menopaus clinics is poor. The results of the patient survey will be presented at the meeting along
with the final results from the Healthcare Professional survey.
Conclusion: There is currently no consensus regarding best practise for the management of hot flushes in BC
patients within the UK. Lead by patient advocates, the NCRI Breast CSG has established a multi-disciplinary
working party with the aim of addressing this unmet need by increasing awareness, promoting clinical studies &
contributing to the establishment of evidence-based clinical guidelines for BC patients within the planned NICE
guidance on diagnosis & management of menopause.
21
All Hot flush studies,
UK, USA & Europe
since 2006
Current Active Trials in
Breast CSG portfolio
120
Patient advocate members of the National Cancer Research
Institute UK Breast Clinical Studies Group and UK Breast
Intergroup identified that there is very little research into the
management of symptoms after breast cancer treatment and that
this constituted a lack in the current portfolio.
On the initiative of the patient advocate members of the NCRI
Breast Clinical Studies Group, a Working Group on Symptom
Management has been established. The group agreed to work on
the management of hot flushes in the first instance, due to its
prevalence, distressing nature and intractability.
Members of the group all have a particular interest in the management of hot flushes and include
patient advocates, clinical and academic partners, representing oncology, psychology, gynaecology,
complementary therapies and the voluntary sector.
Hot Flushes (vasomotor symptoms) are a serious problem. They impact significantly on daily life and sleep quality, affecting employment, relationships and quality of
life. The only effective treatment for hot flushes is oestrogen which is contraindicated in the 75% of breast cancer patients who’s cancer is oestrogen driven. There are
an estimated 550,000 people living in the UK today who have been diagnosed with breast cancer and up to 70% women experience disabling hot flushes after
treatment for breast cancer. That’s a lot of hot flushes. These can continue for years after treatment and probably contribute to the 50% of patients who have stopping
taking their life-saving antioestrogen drugs before 5 years.
Here we present a Clinician versus Patient Perspective on hot flushes
Clinician Perspective
Patient Perspective
•185 respondents questionnaire
•666 patients responded to BCC questionnaire
•Median age 50 years (range 25-69)
Do you experience hot flushes?
45
If you treat hot flushes medically
what do you use?
40
35
How much of a problem are your hot flushes? (scale
of 1 to 10: 1 not a problem - 10 a major problem)
Gabapentin
30
SSRIs
25
yes
1 to 5
no
6 to 10
no answer
20
Escitalopram
Clonidine
15
Citalopram
Do you experience night sweats?
Desvenlaf…
10
Progesterones
How much of a problem are your night sweats? (scale
of 1 to 10: 1 not a problem, 10 a major problem)
Venlafaxine
5
0
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Don't
know
Roughly what percentage of your breast cancer patients have
severe hot flushes that affect daily living and quality of sleep
I believe treatment of hot flushes is an
unmet need
Paroxetine
HRT
0
50
100
150
yes
0
20
40
60
80
100
120
140
160
180
None
Have any of these health care professionals ever
asked you about hot flushes/night sweats?
Menopausal magnets
700
600
500
400
300
200
100
0
Raspberry leaf Tea
Starflower Oil
Chillo pillow
Agree
Sage
no answer
Are your hot flushes/night sweats bad enough for
you to consider stopping your endocrine therapy?
no answer
no
yes
yes
no
not applicable
no answer
GP
Evening primrose oil
Disagree
6 to 10
not aswered
Red clover
Strongly agree
1 to 5
no
200
Surgeon
Oncologist
Breast Care
Nurse
Black cohosh
Vitamin E
Strongly disagree
0
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
10
20
30
40
50
60
70
80
90
60.0%
Which complementary treatments
would you recommend to your
breast cancer patients for hot
flushes?
In Conclusion: What Do We Want?
Despite the size of this problem, within the UK there are no nationally agreed guidelines for
managing hot flushes after breast cancer, which may limit the access and availability of currently
available and appropriate interventions. There is limited evidence to support a variety of
interventions, none of which are entirely effective at eliminating hot flushes, other than hormone
replacement therapy, which is contraindicated. All the available pharmacological interventions
can have severe side-effects and few are widely acceptable. Our surveys have confirmed the
size of the problem but also show that there is patchy and inequitable management of this
problem (data not shown), which continues to be a cause of considerable distress to many
women after breast cancer. There is an urgent need for research across the field to understand
the physiology of flushing and to develop and test new interventions.