Comparison of subjective and objective hot flash measures over time among breast cancer survivors initiating aromatase inhibitor therapy

Abstract

Objective-Hot flashes are valuable indicators of physiologic condition and drug effect; however, subjective and objective measures do not always agree. No study has examined both subjective and objective hot flashes in women prescribed aromatase inhibitors. The study (1) compared subjective and objective hot flash measures, (2) examined changes in subjective and objective hot flashes over time, and (3) evaluated predictors of change in hot flashes in aromatase inhibitor-treated women.Design-Subjects (n=135) were enrolled in a randomized clinical trial comparing exemestane and letrozole for the treatment of breast cancer. Hot flashes were assessed prior to starting drug and 1, 3, and 6 months later. Subjects wore a sternal skin conductance monitor for ≥ 24 hours at each time point. With each perceived hot flash, women pressed an event button and rated intensity and bother in a paper diary.Results-Subjects were a mean age of 60 years and mainly Caucasian (92%). Across time points, monitor hot flashes were (1) significantly more frequent than diary and/or event button flashes (p<. 05) and (2) moderately correlated with subjective measures (.35< r <.56). Monitor hot flashes did not significantly change over time with aromatase inhibitor therapy, whereas both diary and event button frequency significantly varied but in dissimilar patterns (51% non-linear). No consistent predictors of hot flashes across measures or time points were identified.Conclusions-Findings indicated dissimilarities between subjective and objective measures of hot flashes. Despite statistical significance, there was little clinically meaningful change in hot flashes after initiating aromatase inhibitor therapy.Address for correspondence and reprints: Julie L. Otte, PhD, RN, Indiana University, 1111 Middle Drive NU236, Indianapolis, IN 46220, (email) jlelam@iupui.edu. Objective and subjective hot flash measures were analyzed after initiation of two aromatase inhibitors for the treatment of breast cancer. Findings indicated dissimilarities among measures, hot flash frequency and hot flash intensity and bother did not significantly change over time, diary and event button flashes significantly changed but in dissimilar patterns, and few consistent predictors of change in hot flashes were identified.

Weight Gain Is Associated with Increased Risk of Hot Flashes in Breast Cancer Survivors on Aromatase Inhibitors.

“…While higher than reported by clinical trial data in BCS [9], this prevalence is similar to smaller observational studies of BCS [1,2] and the general menopausal population [20]. Data on whether AI therapy is associated with higher risk of hot flashes is conflicting [9,21]. Nonetheless, this high prevalence indicates that hot flashes are a common problem for the growing population of BCS on AI therapy.…”

Acupuncture for the Treatment of Hot Flashes in Patients with Breast Cancer Receiving Antiestrogen Therapy: A Pilot Study in Korean Women

“…Kim et al 39 assessed hot flashes by using Mexameter, Skin Thermometer, Corneometer, and Laser Doppler Perfusion Imager objectively, and results indicated weak correlation between subjective and objective measurements of hot flashes. Although previous studies show no objective measures of changes in hot flashes, [37][38][39] the authors tried to include objective measure to explain the phenomena of hot flashes. On the basis of the findings that the subjective sensation of Heat is the predominant feature of a hot flash, infrared thermography was used.…”

“…37 There are several studies to compare subjective and objective method for assessing hot flashes. [37][38][39] Carpenter et al 37 and Otte et al 38 assessed hot flash frequency using self-report and sternal skin conductance monitoring, and the findings indicated dissimilarities between subjective and objective measures. Kim et al 39 assessed hot flashes by using Mexameter, Skin Thermometer, Corneometer, and Laser Doppler Perfusion Imager objectively, and results indicated weak correlation between subjective and objective measurements of hot flashes.…”

“…However, the relationship between differences in facial temperature and hot flashes was dissimilar at each measurement point from baseline to the end of the study, which is consistent with the results of previous studies. [37][38][39] Acupuncture is a relatively safe treatment modality. 30,41 In previous studies, [18][19][20] no reported adverse events were serious enough to warrant concern.…”

Long-term Chinese herbs decoction administration for management of hot flashes associated with endocrine therapy in breast cancer patients

“…Either original Kupperman index or complicated QOL questionnaires [27] , they are in the category of subjective measurement. One randomized clinical trial compared subjective and objective hot flash measures [40] among breast cancer survivors initiating aromatase inhibitor therapy. A sternal skin conductance monitor was used in trial to provide objective measure of hot flashes; findings indicated dissimilarities between subjective and objective measures of hot flashes.…”