Elsevier

Maturitas

Volume 108, February 2018, Pages 13-17
Maturitas

Self-compassion, physical fitness and climacteric symptoms in oophorectomized BRCA1/2 mutation carriers

https://doi.org/10.1016/j.maturitas.2017.11.002Get rights and content

Highlights

  • Self-compassion is generally high in oophorectomized BRCA1/2 mutation carriers.

  • Low levels of climacteric symptoms are reported 5 or more years after risk-reducing salpingo-oophorectomy.

  • Being self-compassionate and physically fit are associated with fewer climacteric symptoms.

Abstract

Objectives

To reduce the risk of ovarian cancer, BRCA1/2 mutation carriers are advised to undergo salpingo-oophorectomy (RRSO) around the age of 40 years. This may induce severe climacteric symptoms, potentially lowering their quality of life. Personal positive resources such as physical fitness and self-compassion may help women to deal with these symptoms. We investigated the association of climacteric symptoms with self-compassion and physical fitness in oophorectomized BRCA1/2 mutation carriers.

Study design

A cross-sectional study was conducted in 165 BRCA1/2 mutation carriers, aged 40–63 years, who underwent an RRSO at age 45 years or younger and at least 5 years previously.

Main outcome measures: Climacteric symptoms were measured by the Greene Climacteric Scale. Self-compassion was rated using the Self-Compassion Scale–Short Form, and physical fitness using the Duke Activity Status Index.

Results

BRCA1/2 mutation carriers reported low levels of climacteric symptoms (mean 10.28 [SD 6.45], and being highly self-compassionate and physically fit. After adjustment for possible covariates, higher self-compassion (β = −1.65, 95% CI −2.46, −0.84) and physical fitness (β = −0.25, 95% CI −0.34, −0.16) were associated with fewer climacteric symptoms. Current smoking was independently associated with more climacteric symptoms (β = 2.66, 95% CI 0.26, 5.07).

Conclusions

Being self-compassionate and physically fit were associated with fewer climacteric symptoms. Future research is needed to investigate the effect of training in self-compassion and physical fitness on climacteric symptoms in 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.

References (31)

  • J.J. Arch et al.

    Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women

    Psychoneuroendocrinology

    (2014)
  • R. Haimov-Kochman et al.

    Regular exercise is the most significant lifestyle parameter associated with the severity of climacteric symptoms: a cross sectional study

    Eur. J. Obstet. Gynecol. Reprod. Biol.

    (2013)
  • S. Chen et al.

    Meta-analysis of BRCA1 and BRCA2 penetrance

    J. Clin. Oncol.

    (2007)
  • C. Marchetti et al.

    Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers

    BMC women's health.

    (2014)
  • A. Benshushan et al.

    Climacteric symptoms in women undergoing risk-reducing bilateral salpingo-oophorectomy

    Climacteric

    (2009)
  • Cited by (0)

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