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Is anxiety associated with hot flashes in women with breast cancer?

Guimond, Anne-Josée MA1,2,3; Massicotte, Elsa BA1,2,3; Savard, Marie-Hélène PhD2,3; Charron-Drolet, Jade BA1,2,3; Ruel, Sophie BSc1,2,3; Ivers, Hans PhD1,2,3; Savard, Josée PhD1,2,3

doi: 10.1097/GME.0000000000000409
Original Articles

Objective Women with breast cancer are at higher risk for experiencing hot flashes (HFs), which is attributable, in large part, to systemic cancer treatments and their effects on estrogen levels. However, other factors, such as anxiety, could also play a role. This study aimed to assess the cross-sectional and temporal relationships between anxiety and HFs among women treated for breast cancer and to clarify the direction of these relationships.

Methods Fifty-six women recently treated for breast cancer were assessed prospectively using a 14-day Hot Flashes and Anxiety Diary (HFAD). Anxiety and HFs were also assessed using the Hospital Anxiety and Depression Scale–anxiety subscale and the Menopause-Specific Quality of Life Questionnaire–vasomotor subscale. In addition, HFs were objectively recorded for a continuous 24-hour period using home-based sternal skin conductance.

Results No cross-sectional relationship was found between anxiety and subjectively assessed HFs, or between anxiety and the frequency and intensity of objectively assessed HFs. However, a greater anxiety level on the HFAD was significantly associated with a shorter time to reach the HF peak, as assessed with sternal skin conductance (partial Spearman correlation coefficient rsp = −0.44). Moreover, greater anxiety predicted more severe self-reported HFs on the following night, both assessed with the HFAD (rsp = 0.13). Conversely, self-reported diurnal and nocturnal HFs on the HFAD did not predict next-day anxiety level.

Conclusions This study reveals a significant relationship between anxiety and faster-developing objectively measured HFs. Furthermore, anxiety has been found to significantly predict subsequent increases in self-reported HFs, suggesting that strategies that target anxiety could potentially have a beneficial effect on HFs in women with breast cancer.

From the 1School of Psychology, Université Laval, Quebec, Canada; 2Centre de recherche du CHU de Québec, Quebec, Canada; and 3Centre de recherche sur le cancer, Université Laval, Quebec, Canada.

Received July 10, 2014; revised and accepted October 30, 2014.

Funding/support: This study was supported by the Canadian Institutes of Health Research (scholarship to M.-H.S.), the Fonds pour la recherche en santé du Québec (scholarship to M.-H.S.), and the Canadian Breast Cancer Research Alliance (grant to J.S.).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Josée Savard, PhD, Laval University Cancer Research Center, 11, Côte du Palais, Québec, Québec, Canada. E-mail:

© 2015 by The North American Menopause Society.