Self-compassion, physical fitness and climacteric symptoms in oophorectomized BRCA1/2 mutation carriers
Introduction
Women with germline BRCA1/2 mutations have a high risk of developing breast and ovarian cancer. The lifetime risk for ovarian cancer in BRCA1 mutation carriers is 39% (95% confidence interval [CI] 34, 44) and for BRCA2 mutation carriers 16% (95% CI 12, 20) [1]. Therefore, a risk-reducing salpingo-oophorectomy (RRSO) is recommended to all BRCA1/2 mutation carriers around the age of 40 years, reducing the ovarian cancer risk by more than 80% [2].
RRSO in pre-menopausal women immediately induces menopause, which, to a different extent, may lead to vasomotor symptoms (VMS) (hot flushes and nights sweats), sexual dysfunction and other physical and psychological complaints [3], [4], [5]. Hormone replacement therapy (HRT) has a positive effect on surgically induced VMS, but may not fully alleviate all symptoms, especially not sexual dysfunction [3]. Furthermore, HRT is contraindicated in BRCA1/2 mutation carriers with prior breast cancer [6].
Hence, BRCA1/2 mutation carriers could benefit from other interventions with potential for reducing climacteric symptoms. Earlier research on the impact of VMS on daily life functioning showed a possible positive effect of self-compassion [7]. Self-compassion, as described by Neff [8], [9], involves being open to and moved by one’s own suffering, and being kind to oneself when dealing with difficult experiences. Self-compassion entails 3 basic components: self-kindness, common humanity, and mindfulness. Self-kindness is defined as being kind and understanding, rather than judgemental or critical toward the self. The sense of common humanity involves recognizing that all people make mistakes and are challenged with serious life stressors, which leads to seeing one’s experiences as part of the greater human experience, rather than as separating and isolated. Mindfulness in the context of self-compassion entails being aware of one’s painful thoughts and feelings in balanced awareness, rather than over-identifying with them [8]. Being self-compassionate yields benefit for individuals’ well-being and is viewed as a protective factor for psychopathology, in particular anxiety and depression [10], [11] One of the promising interventions is a Mindful Self-Compassion (MSC) programme, an 8-week training programme designed to cultivate self-compassion; this appeared to be effective at enhancing self-compassion and well-being [12].
Another way to diminish the burden of climacteric symptoms may be enhancing physical fitness. Physical (or cardio-respiratory) fitness can be modified by physical activity, and it is generally associated with better health outcomes [13]. The effect of physical activity on climacteric symptoms is studied extensively with predominately positive effects on psychological and somatic symptoms, and inconsistent results on VMS and sexual symptoms [14]. There have been fewer studies relating to physical fitness and climacteric symptoms; however, increasing fitness appears to decrease climacteric symptoms, and it is associated with better quality of life in early postmenopausal women [15], [16].
In particular, BRCA1/2 mutation carriers with prior breast cancer or being reluctant to use HRT can profit from non-hormonal treatment, such as self-compassion training or enhancing physical fitness. The aim of this study is to investigate our hypothesis that higher self-compassion and physical fitness are associated with fewer climacteric symptoms in oophorectomized BRCA1/2 mutation carriers, and to explore which domains of climacteric symptoms are associated with self-compassion and physical fitness.
Section snippets
Participants and procedure
A cross-sectional study using self-report questionnaires was performed at the Radboud university medical center (Radboudumc), Nijmegen, the Netherlands between June and November 2015, as being part of a study on cardiovascular risk assessment in BRCA1/2 mutation carriers (not published yet). All BRCA1/2 mutation carriers known by the Department of Human Genetics and/or the Department of Obstetrics and Gynaecology were eligible to participate if an RRSO was performed at age 45 years or younger
Results
A total of 165 BRCA1/2 mutation carriers (response rate of 62%), aged 40–63 years, agreed to participate and gave informed consent. Demographic and clinical characteristics of all 165 participants are displayed in Table 1. Of these participants, all but 3 were Caucasians. Time since RRSO ranges from 5 to 24 years, and the age at RRSO ranges from 30 to 45 years. Of the 111 BRCA1/2 mutation carriers (67.3%) without breast cancer, 82 (73.9%) had ever used HRT, for a mean duration of 6.6 years (SD
Discussion
In this study, oophorectomized BRCA1/2 mutation carriers are highly compassionate towards themselves, and experience few climacteric symptoms 5 or more years after RRSO. We confirmed our hypothesis that higher self-compassion and physical fitness are associated with fewer climacteric symptoms, showing particular associations with psychological and somatic symptoms. In our sample, reported climacteric symptoms were consistently and significantly lower than the normative data from post-menopausal
Contributors
Marieke Arts-de Jong conceived and designed the study, conducted the study, and analysed and interpreted the data.
Liselore L. van Westerop conducted the study, and analysed and interpreted the data.
Nicoline Hoogerbrugge conceived and designed the study.
Leon F. Massuger conceived and designed the study.
Angela H. Maas conceived and designed the study, and analysed and interpreted the data.
Maria H. van Beek conceived and designed the study, and analysed and interpreted the data.
Joanne A. de Hullu
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
The study was approved by the Medical Ethics Committee of the Radboudumc (CMO: 2014-1430).
Informed consent was obtained from all participants.
Provenance and peer review
This article has undergone peer review.
Acknowledgement
None.
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