Purpose The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE),
and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning,
psychological well-being, and health-related quality of life (secondary outcomes) in patients with breast cancer experiencing
Patients and Methods Patients with breast cancer reporting treatment-induced menopausal
symptoms (N = 422) were randomly assigned to CBT (n = 109), PE (n = 104), CBT/PE (n = 106), or to a waiting list control group
(n = 103). Self-report questionnaires were completed at baseline, 12 weeks, and 6 months. Multilevel procedures were used
to compare the intervention groups with the control group over time.
Results Compared with the control group, the
intervention groups had a significant decrease in levels of endocrine symptoms (Functional Assessment of Cancer Therapy-Endocrine
Symptoms; P < .001; effect size, 0.31-0.52) and urinary symptoms (Bristol Female Lower Urinary Tract Symptoms Questionnaire;
P = .002; effect size, 0.29-0.33), and they showed an improvement in physical functioning (36-Item Short Form Health Survey
physical functioning subscale; P = .002; effect size, 0.37-0.46). The groups that included CBT also showed a significant decrease
in the perceived burden of hot flashes and night sweats (problem rating scale of the Hot Flush Rating Scale; P < .001;
effect size, 0.39-0.56) and an increase in sexual activity (Sexual Activity Questionnaire habit subscale; P = .027; effect
size, 0.65). Most of these effects were observed at both the 12-week and 6-month follow-ups.
Conclusion CBT and PE
can have salutary effects on endocrine symptoms and, to a lesser degree, on sexuality and physical functioning of patients
with breast cancer experiencing treatment-induced menopause. Future work is needed to improve the design and the planning
of these interventions to improve program adherence.