Hot flashes: the ongoing search for effective interventions

Virtual Reality Combined with Artificial Intelligence (VR-AI) Reduces Hot Flashes and Improves Psychological Well-Being in Women with Breast and Ovarian Cancer: A Pilot Study

BACKGROUND AND AIMS

Breast and ovarian cancers affect the lives of many women worldwide. Female cancer survivors often experience hot flashes, a subjective sensation of heat associated with objective signs of cutaneous vasodilatation and a subsequent drop in core temperature. Breast and Ovarian cancer patients also suffer from sleep difficulties and mental health issues. The present study aimed to assess the effectiveness of Bubble, a novel artificial intelligence-virtual reality (AI-VR) intervention for the treatment of hot flashes in female breast or ovarian cancer patients.

METHODS

Forty-two women with breast and/or ovarian cancer participated in the study. The mean age was 47 years (range: 25-60 years). Patients suffered from hot flashes at different frequencies. They used Bubble, a virtual reality (VR) mobile psychological intervention based on elements from both cognitive behavioral therapy and mindfulness-based stress reduction. The intervention took place in a VR environment, in a winter wonderland setting called Frosty. Patients were instructed to use Bubble at home twice a day (morning and evening) and when experiencing a hot flash. Participants were asked to use the application for 24 consecutive days. Before and after this 24-day period, patients completed self-report questionnaires assessing hot flashes, general psychiatric distress, perceived stress, illness perception, sleep quality, and quality of life.

RESULTS

Between pre- and post-intervention, participants reported a significant reduction in the daily frequency of hot flashes, stress, general psychiatric distress, several domains of QOL, and sleep difficulties, as well as an improvement in illness perception. In addition, they reported very high satisfaction with Bubble. Importantly, both age and baseline levels of psychopathology moderated the effect of Bubble on sleep difficulties.

DISCUSSION

This study showed preliminary evidence for the potential of VR interventions in alleviating hot flashes and accompanying mental distress among those coping with breast and ovarian cancer. VR is a powerful therapeutic tool, able to address mind-body aspects in a direct, vivid way. More studies are needed in order to fully understand the potential of this unique intervention.

A study of mindfulness-based stress-reduction training effects on menopause-specific quality of life in postmenopausal women: A randomized controlled trial

OBJECTIVES

Physical and psychological changes in most postmenopausal women tend to lower their quality of life. Various medical/psychological interventions have been applied to improve the postmenopausal quality of life. This study set out to investigate the effect of Mindfulness Based Stress Reduction (MBSR) training on the Menopause-specific quality of life (MENQOL).

METHODS

This RCT was conducted on 66 postmenopausal women aged 47-62 in Iran. Participants were randomly assigned to either the MBSR or the control group. The menopause--specific quality of life was assessed in two groups via MENQOL questionnaire prior to, immediately and three months after the intervention.

RESULTS

The findings revealed a significant improvements in MENQOL (P < 0.001),as well as physical(P = 0.001), psychosocial(P = 0.001) and sexual(P < 0.001)dimensions of the intervention groups compared to the control group, immediately and 3 months after the intervention.

CONCLUSION

MBSR program can be safely applied to improve menopausal women's quality of life and curb the postmenopausal symptoms.

TRIAL REGISTRATION NUMBER

IRCT2015072523344N1.

ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer

PURPOSE

Hot flashes are a common and troublesome side effect of surgery or endocrine therapy. They may lead to physical and psychological distress and negatively affect quality of life. This clinical practice guideline presents evidence-based recommendations for pharmacologic, behavioral, and natural health product interventions for treatment-related hot flashes in patients with breast or prostate cancer.

METHODOLOGIC APPROACH

An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of hot flashes. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the evidence and make recommendations.

FINDINGS

The panel agreed on 14 pharmacologic, behavioral, and natural health recommendations.

IMPLICATIONS FOR NURSING

Conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes.

SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS

//onf.ons.org/ons-guidelines-hot-flashes-supplementary-material.

Reduction in menopause-related symptoms associated with use of a noninvasive neurotechnology for autocalibration of neural oscillations

OBJECTIVE

Increased amplitudes in high-frequency brain electrical activity are reported with menopausal hot flashes. We report outcomes associated with the use of High-resolution, relational, resonance-based, electroencephalic mirroring--a noninvasive neurotechnology for autocalibration of neural oscillations--by women with perimenopausal and postmenopausal hot flashes.

METHODS

Twelve women with hot flashes (median age, 56 y; range, 46-69 y) underwent a median of 13 (range, 8-23) intervention sessions for a median of 9.5 days (range, 4-32). This intervention uses algorithmic analysis of brain electrical activity and near real-time translation of brain frequencies into variable tones for acoustic stimulation. Hot flash frequency and severity were recorded by daily diary. Primary outcomes included hot flash severity score, sleep, and depressive symptoms. High-frequency amplitudes (23-36 Hz) from bilateral temporal scalp recordings were measured at baseline and during serial sessions. Self-reported symptom inventories for sleep and depressive symptoms were collected.

RESULTS

The median change in hot flash severity score was -0.97 (range, -3.00 to 1.00; P = 0.015). Sleep and depression scores decreased by -8.5 points (range, -20 to -1; P = 0.022) and -5.5 points (range, -32 to 8; P = 0.015), respectively. The median sum of amplitudes for the right and left temporal high-frequency brain electrical activity was 8.44 μV (range, 6.27-16.66) at baseline and decreased by a median of -2.96 μV (range, -11.05 to -0.65; P = 0.0005) by the final session.

CONCLUSIONS

Hot flash frequency and severity, symptoms of insomnia and depression, and temporal high-frequency brain electrical activity decrease after High-resolution, relational, resonance-based, electroencephalic mirroring. Larger controlled trials with longer follow-up are warranted.

Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats): moderators and mediators of treatment effects

OBJECTIVE

Cognitive-behavior therapy (CBT) has been found in recent randomized controlled trials (MENOS1 and MENOS2) to reduce the impact of hot flushes and night sweats (HFNS). In the MENOS2 trial, group CBT was found to be as effective as self-help CBT in reducing the impact of HFNS. This study investigates for whom and how CBT works for women in the MENOS2 trial.

METHODS

This study performed a secondary analysis of 140 women with problematic HFNS who were recruited to the MENOS2 trial: 48 were randomly assigned to group CBT, 47 were randomly assigned to self-help CBT, and 45 were randomly assigned to usual care. Self-report questionnaires were completed at baseline, 6 weeks postrandomization, and 26 weeks postrandomization. Potential moderators and mediators of treatment effects on the primary outcome-hot flush problem rating-were examined using linear mixed-effects models and path analysis, respectively.

RESULTS

CBT was effective at reducing HFNS problem rating regardless of age, body mass index, menopause status, or psychological factors at baseline. Fully reading the manual in the self-help CBT arm and completing most homework assignments in the group CBT arm were related to greater improvement in problem rating at 6 weeks. The effect of CBT on HFNS problem rating was mediated by changes in cognitions (beliefs about coping/control of hot flushes, beliefs about night sweats and sleep) but not by changes in mood.

CONCLUSIONS

These findings suggest that CBT is widely applicable for women having problematic HFNS, regardless of sociodemographic or health-related factors, and that CBT works mainly by changing the cognitive appraisal of HFNS.