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“Hot flashes and night sweats can be treated with lifestyle changes, behavioral changes, or sometimes with over-the-counter or prescribed medications,” Dr Partridge said. “For vaginal dryness, patients can use lubricants or moisturizers, and there are other emerging strategies having early success.”
Behavioral therapy can also help to improve sleep disturbances and other menopausal symptoms. In addition, combining complementary and integrative medicine, such as acupuncture, exercise, or yoga, with more traditional medications, like SSRIs or SSNIs, can also help to reduce common symptoms.
Although these treatments can help women manage their symptoms, Dr Partridge explained that additional research is needed to understand, prevent, and manage the long-term and late effects of anti-estrogen therapy.
Lifestyle Recommendations
The second speaker, Melinda Irwin, PhD, MPH, professor of epidemiology at Yale School of Public Health, New Haven, CT, discussed the effect of weight loss and exercise trials on outcomes in breast cancer, as well as some future opportunities for research in this area.
According to Dr Irwin, observational and prospective cohort studies have shown for some time that there is a connection between obesity and outcomes in breast cancer and mortality. Early randomized, controlled studies looking at the connection focused mostly on dietary modification, but had mixed results. The 3 major trials were the Women’s Health Initiative (WHI) Dietary Modification Trial, the Women’s Intervention Nutrition Study (WINS), and the Women’s Healthy Eating and Living study (WHEL).
“The WHI and WHEL studies did not find an effect of improving diet; however, the WINS trial was suggestive of a connection,” Dr Irwin said. “The difference between WINS and the other 2 trials was that there was a weight loss observed with the intervention arm.”
Women in WINS lost an average of 6 lbs during the study period; however, it was unclear from the study if the improved survival seen in women assigned to the low-fat intervention (hazard ratio [HR] 0.76; 95% CI, 0.60 – 0.98; P = .03) was because of the low-fat diet or the associated weight loss.5
“Many years after these trials [conducted] in the late 1990s and early 2000s, we now finally realize that it is not necessarily about diet composition but weight loss or prevention of weight gain,” Dr Irwin stated.
Research has shown that exercise or physical activity performed after a diagnosis may lower a woman’s risk for disease recurrence and death. A 2011 meta-analysis of studies looking at physical activity and survival after breast cancer diagnosis showed that physical activity reduced breast cancer deaths by 34% (HR 0.66; 95% CI, 0.57 – 0.77; P < .00001), all-cause mortality by 41% (HR 0.59; 95% CI, 0.53 – 0.65; P < .00001), and disease recurrence by 24% (HR 0.76; 95% CI, 0.66 – 0.87; P = .0001).6
Looking to future research, The National Cancer Institute has funded a large cooperative trial called the Alliance for Clinical Trials in Oncology: the Breast Cancer Weight Loss (BWEL) study (ClinicalTrials.gov Identifier: NCT02750826) that will test the effect of a weight loss intervention on invasive disease-free survival in women with stage II to III breast cancer. The goal will be a 5% weight loss gained via exercise and healthy eating.
Other future directions include studies that look at the effect of weight loss on biological markers associated with breast cancer such as C-reactive protein, leptin, or insulin, according to Dr Irwin. For example, the Lifestyle, Exercise, and Nutrition (LEAN) study randomly assigned overweight or obese breast cancer survivors to in-person or telephone weight loss counseling or usual care for 6 months.7
“[The trial] showed a 30% decrease in C-reactive protein, which is a marker of chronic inflammation, and inflammation is thought to be a related to breast cancer,” Dr Irwin said.
In addition, Dr Irwin and colleagues will be looking at initiating lifestyle interventions at diagnosis instead of waiting until after treatment is complete.
“I am in the school of thought that obesity is associated with breast cancer and that it may be reversible,” Dr Irwin said. “There are adverse effects of a high [body mass index] and poor diet or physical inactivity, and by changing those behaviors for the positive we may reverse the risk for developing or dying from breast cancer.”
