Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial

Atema, Vera; van Leeuwen, Marieke; Kieffer, Jacobien M.; Oldenburg, Hester S.A.; van Beurden, Marc; Gerritsma, Miranda A.; Kuenen, Marianne A.; Plaisier, Peter W.; Lopes Cardozo, Alexander M.F.; van Riet, Yvonne E.A.; Heuff, Gijsbert; Rijna, Herman; van der Meij, Suzan; Noorda, Eva M.; Timmers, Gert-Jan; Vrouenraets, Bart C.; Bollen, Matthé; van der Veen, Henk; Bijker, Nina; Hunter, Myra S.; Aaronson, Neil K.

doi:10.1200/jco.18.00655

Cited by 105Cancer survivorship and careDigital Mental Health InterventionsMenopause: Health Impacts and Treatments

Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial

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Atema, Vera, van Leeuwen, Marieke, Kieffer, Jacobien M., Oldenburg, Hester S.A., van Beurden, Marc, Gerritsma, Miranda A., Kuenen, Marianne A., Plaisier, Peter W. +13 more·2019·Journal of Clinical Oncology

DOI 10.1200/jco.18.00655

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Abstract

PURPOSE: We evaluated the effect of Internet-based cognitive behavioral therapy (iCBT), with or without therapist support, on the perceived impact of hot flushes and night sweats (HF/NS) and overall levels of menopausal symptoms (primary outcomes), sleep quality, HF/NS frequency, sexual functioning, psychological distress, and health-related quality of life in breast cancer survivors with treatment-induced menopausal symptoms. PATIENTS AND METHODS: We randomly assigned 254 breast cancer survivors to a therapist-guided or a self-managed iCBT group or to a waiting list control group. The 6-week iCBT program included psycho-education, behavior monitoring, and cognitive restructuring. Questionnaires were administered at baseline and at 10 weeks and 24 weeks postrandomization. We used mixed-effects models to compare the intervention groups with the control group over time. Significance was set at P < .01. An effect size (ES) of .20 was considered small, .50 moderate and clinically significant, and .80 large. RESULTS: Compared with the control group, the guided and self-managed iCBT groups reported a significant decrease in the perceived impact of HF/NS (ES, .63 and .56, respectively; both P < .001) and improvement in sleep quality (ES, .57 and .41; both P < .001). The guided group also reported significant improvement in overall levels of menopausal symptoms (ES, .33; P = .003), and NS frequency (ES, .64; P < .001). At longer-term follow-up (24 weeks), the effects remained significant, with a smaller ES for the guided group on perceived impact of HF/NS and sleep quality and for the self-managed group on overall levels of menopausal symptoms. Additional longer-term effects for both intervention groups were found for hot flush frequency. CONCLUSION: iCBT, with or without therapist support, has clinically significant, salutary effects on the perceived impact and frequency of HF/NS, overall levels of menopausal symptoms, and sleep quality.

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“71 While specific trials in RRSO populations are absent, the parallel with cancer-induced menopause makes it reasonable to apply this modality to surgically-induced menopause on clinical grounds and symptom similarity.”
Interventions to Improve Sexual Health in Women Living with and Surviving Cancer: Review and Recommendations
Sopfe, J., Pettigrew, J., Afghahi, A., Appiah, L. A., & Coons, H. L. (2021) · Cancers · doi:10.3390/cancers13133153 · Cited by 49 · see citing works
“The results of this study prompted additional trials by the same investigator team using internet-based CBT for treatment-induced menopausal symptoms in breast cancer survivors [110].”
Result
Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis
Ye, M., Shou, M., Zhang, J., Hu, B., Liu, C., Bi, C., Lv, T., Luo, F., Zhang, Z., Liang, S., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291721005407 · Cited by 53 · see citing works
Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis
Tao, T. J., Lim, T. K., Yeung, E. T. F., Liu, H., Shris, P. B., Lawrence, K., Lee, T. M. C., & Hou, W. K. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00809-8 · Cited by 49 · see citing works
Effects of internet-based cognitive behavioral therapy on anxiety and depression symptoms in cancer patients: A meta-analysis.
Liu, T.-T., Xu, J., Cheng, H., Zhang, Y.-Y., Wang, S., Lin, L., & Tian, L. (2022) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2022.09.003 · Cited by 37 · see citing works
The Patient’s Voice: Adherence, Symptoms, and Distress Related to Adjuvant Endocrine Therapy After Breast Cancer
Jacobs, J. M., Walsh, E. A., Park, E. R., Berger, J., Peppercorn, J. M., Partridge, A. H., Horick, N., Safren, S. A., Temel, J. S., & Greer, J. A. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09908-2 · Cited by 37 · see citing works
“cognitive behavioral therapy, can be effective in reducing menopausal symptoms for patients taking AET [29, 30].”
Background
Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis
Zhang, T., Ren, Z., Wakefield, C. E., Hui, B. P. H., Akechi, T., Shi, C., Du, X., Chen, W., Lai, L., Zhao, C., et al. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102520 · Cited by 41 · see citing works
Behavioral interventions for improving sleep outcomes in menopausal women: a systematic review and meta-analysis
Lam, C. M., Hernández-Galán, L., Mbuagbaw, L. C. E., Ewusie, J. E., Thabane, L., & Shea, A. K. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002051 · Cited by 34 · see citing works
Management of Menopause Symptoms and Quality of Life during the Menopause Transition
Ye, L., Knox, B., & Hickey, M. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.04.006 · Cited by 31 · see citing works
Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms?
Hunter, M. S., & Chilcot, J. (2021) · British Journal of Health Psychology · doi:10.1111/bjhp.12543 · Cited by 29 · see citing works
“In order to increase accessibility to CBT for this population, we investigated the efficacy of Internet-delivered CBT (iCBT), with and without therapist support, adapted from the MENOS protocols (Atema et al., 2019).”
MethodSelf-citation
For whom and what outcomes does cognitive-behavioral-therapy work among cancer survivors: a systematic review and meta-analysis
Zhang, A., Wang, K., Blumenstein, K. G., Brose, A., Kemp, C., Meister, D., & Solomon, P. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07337-3 · Cited by 31 · see citing works
The Impact of Psychiatric Diagnoses on Patient-reported Satisfaction and Quality of Life in Postmastectomy Breast Reconstruction
Shamsunder, M. G., Chu, J. J., Polanco, T. O., Yin, S., Costas-Muñíz, R., James, M. C., Mehrara, B. J., Pusic, A. L., Voineskos, S. H., & Nelson, J. A. (2022) · Annals of Surgery · doi:10.1097/sla.0000000000005478 · Cited by 28 · see citing works
“Data Source and Study Population An institutional review board–approved study (18-202) was performed to evaluate patient-reported outcomes in postmastectomy reconstruction patients (a component of routine clinical care).”
Method
Effects of and Lessons Learned from an Internet-Based Physical Activity Support Program (with and without Physiotherapist Telephone Counselling) on Physical Activity Levels of Breast and Prostate Cancer Survivors: The PABLO Randomized Controlled Trial
van de Wiel, H. J., Stuiver, M. M., May, A. M., van Grinsven, S., Aaronson, N. K., Oldenburg, H. S. A., van der Poel, H. G., Koole, S. N., Retèl, V. P., van Harten, W. H., et al. (2021) · Cancers · doi:10.3390/cancers13153665 · Cited by 25 · see citing works
“We hypothesized that additional physiotherapy counselling might increase adherence and effectiveness of the web-based intervention, based on reported benefits of low-level remote supervision by telephone in other RCT’s [19,20].”
BackgroundSelf-citation
Application and Mechanisms of Internet-Based Cognitive Behavioral Therapy (iCBT) in Improving Psychological State in Cancer Patients
Bai, P. (2023) · Journal of Cancer · doi:10.7150/jca.82632 · Cited by 23 · see citing works
Effectiveness of Internet-Based Cognitive Behavioral Therapy for Patients With Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Yu, S., Liu, Y., Cao, M., Tian, Q., Xu, M., Yu, L., Yang, S., & Zhang, W. (2025) · Cancer Nursing · doi:10.1097/ncc.0000000000001274 · Cited by 22 · see citing works
Systematic review on the effectiveness of mobile health applications on mental health of breast cancer survivors
Schäfer, A., Jírů-Hillmann, S., Widmann, J., Montellano, F. A., Salmen, J., Pryss, R., Wöckel, A., & Heuschmann, P. U. (2025) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01470-6 · Cited by 23 · see citing works
“…studies that directly compared guided and non-guided interventions reported higher usage rates for the guided intervention, which is consistent with existing research on the relevance of guidance in motivating intervention use and potentially supporting intervention effectiveness [36, 40, 59, 60].”
Influential
Cost-utility, cost-effectiveness, and budget impact of Internet-based cognitive behavioral therapy for breast cancer survivors with treatment-induced menopausal symptoms
Verbeek, J. G. E., Atema, V., Mewes, J. C., van Leeuwen, M., Oldenburg, H. S. A., van Beurden, M., Hunter, M. S., van Harten, W. H., Aaronson, N. K., & Retèl, V. P. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05410-w · Cited by 21 · see citing works
Self-citation
The effectiveness of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes in patients with laryngectomy: Randomized controlled trial
Yang, Y., Zhang, H., Li, Y., Liu, Z., Liu, S., Li, X., Fan, G., Xu, Y. J., & Wang, B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.068 · Cited by 20 · see citing works
Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer
Franzoi, M. A., Degousée, L., Martin, E., Semedo, P. M., Aupomerol, M., Soldato, D., Di Meglio, A., Chiodi, C., Barbier, A., Chaouachi, H., et al. (2023) · JCO Oncology Practice · doi:10.1200/op.23.00016 · Cited by 18 · see citing works
Internet-based cognitive behavioral therapy aimed at alleviating treatment-induced menopausal symptoms in breast cancer survivors: Moderators and mediators of treatment effects
Atema, V., van Leeuwen, M., Kieffer, J. M., Oldenburg, H. S. A., van Beurden, M., Hunter, M. S., & Aaronson, N. K. (2019) · Maturitas · doi:10.1016/j.maturitas.2019.09.007 · Cited by 19 · see citing works
Self-citation
Evaluating a Mobile Digital Therapeutic for Vasomotor and Behavioral Health Symptoms Among Women in Midlife: Randomized Controlled Trial
Duffecy, J. L., Rehman, A., Gorman, S. N., Huang, Y., & Klumpp, H. (2025) · JMIR mhealth and uhealth · doi:10.2196/58204 · Cited by 19 · see citing works
“Although there are a few other self-guided digital interventions for menopause symptoms, the DCP performs favorably in comparison, with a higher effect for hot flash distress, and a similar impact on sleep [39].”
Effectiveness of telemedicine-based psychosocial intervention for breast cancer patients: a systematic review and meta-analysis
Ma, Z., Shi, Y., Yao, S., Lu, N., & Cheng, F. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08052-3 · Cited by 17 · see citing works
“There were 15 website-based interventions ( n = 15) [24, 25, 28, 30, 32, 36, 38–40, 44, 46, 48–51], 3 telephone-based interventions ( n = 3) [29, 31, 43], and 8 app-based interventions ( n = 8) [26, 27, 35, 37, 41, 42, 45, 52].”
Management of vasomotor symptoms in cancer patients
Zhu, L., Hshieh, T. T., Iyer, T. K., Morgans, A. K., & Hamnvik, O. R. (2025) · The Oncologist · doi:10.1093/oncolo/oyaf002 · Cited by 17 · see citing works
Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors
Tran, S., Hickey, M., Saunders, C. M., Ramage, L., & Cohen, P. A. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05754-w · Cited by 18 · see citing works
eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens
van Deursen, L., Versluis, A., van der Vaart, R., Standaar, L. M. B., Struijs, J. N., Chavannes, N. H., & Aardoom, J. J. (2022) · JMIR Cancer · doi:10.2196/37093 · Cited by 15 · see citing works
Systematic review and meta-analysis of digital interventions for mental health in cancer patients and survivors
Nezenega, Z. S., Aychiluhm, S. B., Ross, A. G., Kassa, Z. Y., Bore, M. G., Leshargie, C. T., Allan, J., Thapa, S., Astawesegn, F. H., Mahmood, S., et al. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-02266-x · Cited by 13 · see citing works
Internet-Based Cognitive Behavioural Therapy for Individuals With Depression and Chronic Health Conditions: A Systematic Review
Adhikary, D., Barman, S., & Ranjan, R. (2023) · Cureus · doi:10.7759/cureus.37822 · Cited by 16 · see citing works
“The initial search process yielded 134 studies across all databases, which were refined, leading to 18 studies in the last review data set [4,12,13,23-37].”
Background
Cognitive-Behavioral Therapy to Alleviate Treatment-Induced Menopausal Symptoms in Women With Breast Cancer
Chang, Y., Hu, W., & Chang, Y. (2020) · Cancer Nursing · doi:10.1097/ncc.0000000000000827 · Cited by 13 · see citing works
“Of the 9 articles included in this review, 4 had a waiting-list control group (patients who received no additional treatment during the study period but had the opportunity to undergo a 6-week CBT program after the last follow-up assessment was completed).(1,13,24,28) One study had a “usual care” control group,(12) an…”
BackgroundInfluential
Effects of Psychological Intervention Based on Digital Health Technology on Psychological Outcomes in Cancer Survivors: Systematic Review and Meta‐Analysis
Dong, M., Huang, Y., Zhang, X., Wu, L., Ghazal, L., & Cao, F. (2025) · Psycho-Oncology · doi:10.1002/pon.70166 · Cited by 12 · see citing works
Potential effects of virtual interventions for menopause management: a systematic review
Zou, P., D'Souza, D. M., Luo, Y., Sun, W., Zhang, H., & Yang, Y. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002020 · Cited by 11 · see citing works
Randomized Controlled Trial of a Virtually Delivered Exercise and Stress Management Program to Improve Physical Performance of Hematopoietic Cell Transplant Survivors
Ma, D. D. F., Liu, Z., Au, K., Tran, M. J., Artuz, C. M., Greenwood, M. J., Bilmon, I., & Kliman, D. S. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.24.00333 · Cited by 11 · see citing works
Sexual health counseling improves the sexual satisfaction of breast cancer survivors: a randomized controlled trial
Haghighi, F. R., Bokaie, M., Sefidkar, R., & Enjezab, B. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08957-7 · Cited by 7 · see citing works
“Although no prior studies have examined the impact of ACT on treatment-induced menopause, some studies have shown that cognitive-behavioral therapy (CBT) improves these symptoms [51–53].”
Impact of e-Health Interventions on Mental Health and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Mitsis, A., Filis, P., Karanasiou, G. S., Georga, E. I., Mauri, D. N., Naka, K. Κ., Constantinidou, A., Keramida, K., Tsekoura, D., Mazzocco, K., et al. (2025) · Cancers · doi:10.3390/cancers17111780 · Cited by 9 · see citing works
“Sixteen studies [20,23–25, 27 , 33–41, 45, 46 The subgroup analysis based on the delivery method showed that studies using web-based interventions ( n = 6) [38–41, 45,46] yielded a”
Influential
A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol
Akkol-Solakoglu, S., Hevey, D., & Richards, D. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100367 · Cited by 8 · see citing works
“…revised form 8 January 2021; Accepted 13 January 2021 Internet Interventions 24 (2021) 100367 problems among people as they adjust to the illness (Baqutayan, 2012; Croyle and Rowland, 2003; Fann et al., 2008; Hopko et al., 2016b; Puigpinós-Riera et al., 2018; Reich et al., 2008; Spiegel and…”
Background
If we build it, will they come? A scoping review of objective engagement metrics in asynchronous psychosocial telehealth interventions for breast cancer survivors
Walsh, E. A., Safren, S. A., Penedo, F. J., & Antoni, M. H. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102374 · Cited by 8 · see citing works
Sleep effects of psychological therapies for menopausal symptoms in women with hot flashes and night sweats: A systematic review
Carmona, N. E., Starick, E., Millett, G. E., Green, S. M., & Carney, C. E. (2024) · Post Reproductive Health · doi:10.1177/20533691241246365 · Cited by 9 · see citing works
RETRACTED: The Efficacy of Internet-Based Cognitive Behavioral Therapy for Patients With Breast Cancer: A Systematic Review and Meta-Analysis
Yang, L., Hao, S., Tu, D., Gu, X., Chai, C., Ding, H., Gu, B., & Yang, X. (2024) · Integrative Cancer Therapies · doi:10.1177/15347354241293449 · Cited by 9 · see citing works
“In 17-20 Additionally, ICBT consists of two main formats, self-managed and guided ICBT.”
BackgroundInfluential
Retracted
Impact of the CBT-Meno protocol on menopause-specific beliefs, dysfunctional attitudes, and coping behaviors
Donegan, E., Frey, B. N., McCabe, R. E., Streiner, D. L., Fedorkow, D. M., Furtado, M., & Green, S. M. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002003 · Cited by 8 · see citing works
Enhancing Patient-Centered Care in Oncology through Telehealth: Advanced Data Analytics and Personalized Strategies in Breast Cancer Treatment
Singh, D., Bhogawar, S., Nuthakki, S., & Ranganathan, N. (2021) · International Journal of Science and Research (IJSR) · doi:10.21275/sr24108012724 · Cited by 8 · see citing works
Telemedizin in der rehabilitativen Nachsorge von Frauen mit Brustkrebs – Eine systematische Übersicht
Tokgöz, P., & Dockweiler, C. (2021) · Die Rehabilitation · doi:10.1055/a-1480-3712 · Cited by 7 · see citing works
Effects of Web‐Based Interventions on Anxiety and Depression in Patients With Breast Cancer: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Kim, M., Kang, K. J., & Ryu, S. (2025) · Psycho-Oncology · doi:10.1002/pon.70167 · Cited by 6 · see citing works
Narrative Analyses: Cognitive Behavior Group Therapy for Women with Menopause and Bipolar or Major Depressive Disorders
Conklin, D. Y., Carpenter, J. S., Whitney, M. S., et al. (2021) · Women s Health Reports · doi:10.1089/whr.2021.0025 · Cited by 6 · see citing works
Effects of web‐based interventions on quality of life among patients with breast cancer: A systematic review and meta‐analysis of randomized controlled trials
Coombs, L. A., & Kim, M. (2024) · Cancer Medicine · doi:10.1002/cam4.70230 · Cited by 6 · see citing works
Hormone replacement therapy in gynecologic cancer: oncologic safety and alternative therapies
Aznar, A. L., Elyashiv, O., Dababou, S., Palasz, N. A., Cantürk, M. M., Macias, R. M., Pavone, M., Jayraj, A. S., Hsu, H., & Ramirez, P. T. (2025) · International Journal of Gynecological Cancer · doi:10.1016/j.ijgc.2025.102809 · Cited by 5 · see citing works
Empowerment-Led Guided Self-Help Intervention for Symptom Burden in Breast Cancer Women Treated With Ovarian Function Suppression: A Randomized Trial Protocol
Li, Y., Chen, Y. Y., Wang, S. X., Dai, Z. Y., Cui, J. S., Xing, Y. F., Wu, Q., & Fang, Q. (2024) · World Journal of Oncology · doi:10.14740/wjon1817 · Cited by 6 · see citing works
“GSH aims to pursue the most significant balance between healthcare workload and patient outcomes [57].”
Background
Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis
Zhang, D., Zhao, W., Yuan, L., Xu, Q., & Bi, H. (2024) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2024.10.022 · Cited by 5 · see citing works
RETRACTED: Effect of Internet‐Based Cognitive Behavioral Therapy on Psychological Distress and Quality of Life Among Breast Cancer Survivors: A Meta‐Analysis of Randomized Controlled Trials
Li, M., Liu, F., Han, X., Li, J., & Fan, Y. (2024) · Psycho-Oncology · doi:10.1002/pon.70014 · Cited by 5 · see citing works
“In terms of breast cancer staging, three studies included patients with stages I‐III [25, 26, 30], and two encompassed stages 0‐III [32, 36], two studies focused on either stages I‐II [34] or I‐IV [37].”
Influential
Retracted
Internet-based cognitive behavioral therapy for anxiety and depression in breast cancer survivors: a meta-analysis
Zhang, D., Bi, H., & Zhao, W. (2024) · Journal of Cancer Survivorship · doi:10.1007/s11764-024-01712-1 · Cited by 4 · see citing works
Meme Kanserli Kadınlarda Bilişsel Davranışçı Terapilerin Etkililiği: Sistematik Derleme Çalışması
Aksan, A. T. (2021) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.718479 · Cited by 4 · see citing works
Clinical hypnosis and cognitive behavioral therapy for hot flashes: a scoping review.
Muñiz, V., Padilla, V. J., Alldredge, C. T., & Elkins, G. (2025) · Women's Health Reports · doi:10.1089/whr.2024.0144 · Cited by 6 · see citing works
Efficacy of Web‐Based Interventions in Psychological Distress Among Patients With Cancer: A Systematic Review and Meta‐Analysis
Coombs, L. A., & Kim, M. (2025) · Psycho-Oncology · doi:10.1002/pon.70321 · Cited by 3 · see citing works
Effects of cognitive behavioral therapy on sleep quality and insomnia severity index in women with menopausal insomnia: a systematic review and meta-analysis
Moon, H.-J., Yu, S.-N., & Hur, M. (2025) · Women s Health Nursing · doi:10.4069/whn.2025.09.07 · Cited by 3 · see citing works
“As presented in Table 2, face-to-face CBT interventions were predominant, being applied in eight studies [3,14,18-23], whereas two studies employed remote delivery [15,25] and one study utilized both delivery modes [24].”
Effectiveness, feasibility, and acceptability of interactive digital interventions for treatment of sexual difficulties: a systematic review, meta-analysis, and thematic analysis
Hobbs, L. J., Hertel, J., Walton, L., Schartau, P., & Bailey, J. (2025) · Sexual & Relationship Therapy · doi:10.1080/14681994.2025.2508826 · Cited by 3 · see citing works
“Four studies reported behavioural outcomes eligible for meta-analysis (Figure 6) all of which had minimal intervention comparators (Atema et al., 2019; Hucker & McCabe, 2014; Hummel et al., 2017; Jones & McCabe, 2011).”
Influential
Group cognitive behavioural therapy of physical and psychological menopausal symptoms of Chinese women, delivered via Internet and mobile phone versus face to face: A protocol for a randomized non-inferiority trial
Li, D., Kong, J., Yang, Y., Wang, S., Wu, J., & Chao, J. (2019) · Maturitas · doi:10.1016/j.maturitas.2019.08.005 · Cited by 3 · see citing works
Management of Early Menopause/Premature Ovarian Insufficiency in Women with or at High Risk of Breast Cancer
Brennan, A., & Hickey, M. (2020) · Seminars in Reproductive Medicine · doi:10.1055/s-0041-1726467 · Cited by 3 · see citing works
A service evaluation of an online Cognitive Behaviour Therapy program for troublesome menopausal Hot Flushes and Night Sweats in work settings
Stefanopoulou, E., Chapelle, S., Lewis, D., Larkin, J., & Hunter, M. S. (2025) · Post Reproductive Health · doi:10.1177/20533691251352044 · Cited by 2 · see citing works
Self-citation
Cognitive-behavioral and mindfulness-based therapies for mental health and quality of life of breast cancer patients: a meta-analysis of randomized controlled trials
Su, R. J., Wang, R., Li, Z., Wang, Y., Zhao, X., Sun, Y., Ni, J., Zhu, Y., Luan, J., Tian, G., et al. (2025) · International Journal of Clinical Oncology · doi:10.1007/s10147-025-02875-2 · Cited by 2 · see citing works
Management of menopausal symptoms following treatment for hormone receptor positive breast cancer
McGrath, S., Pomeranc, A., Karmali, Y., Taylor, S., Morgan, A. A., Turner, L., & Armstrong, A. C. (2025) · British Journal of General Practice · doi:10.3399/bjgp.2025.0264 · Cited by 2 · see citing works
Psychological treatments for sexual concerns in perimenopausal and postmenopausal women: a systematic review and meta-analysis
Green, S. M., Furtado, M., Peak, J., & Babiy, Z. (2025) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002698 · Cited by 2 · see citing works
Effectiveness of Cognitive Behavioral Therapy for depression and anxiety in people with cancer: a meta-analysis of randomized controlled trials.
Ajele, K. W., & Idemudia, E. (2026) · Journal of psychosocial oncology · doi:10.1080/07347332.2026.2679584 · Cited by 2 · see citing works
Breast Cancer Survivors’ Attitudes toward eMental Health: A Cross-Sectional Study
Mendes-Santos, C., Campos, T., Ferreira, D., Weiderpass, E., Santana, R. M., & Andersson, G. (2023) · Healthcare · doi:10.3390/healthcare11131920 · Cited by 2 · see citing works
“Recently, various randomized controlled trials (RCT) targeting BCS attested to the efficacy of internet interventions in improving depression [16], anxiety [17], distress [18], fear of cancer recurrence [19], sleep quality [20,21], sexual functioning [22], and HRQoL [23,24] in this population.”
Background
Virtual reality for menopause symptom management: opportunities, challenges, and next steps
Safwan, N., Suchak, K. K., Liran, O., Kingsberg, S. A., Spiegel, B. M. R., SHUFELT, C. L., & Faubion, S. S. (2025) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002529 · Cited by 2 · see citing works
“38 These innovations not only provide an adjunct option to traditional CBT but also offer continuous support, reinforcing therapeutic concepts between sessions.”
Influential
Efficacy of acupuncture treatment for breast cancer-related insomnia: study protocol for a multicenter randomized controlled trial
Yin, P., Fan, Q., Liu, L., Yang, M., Zhang, S.-X., Xu, L., Hou, W., Feng, Q., Wang, X., Jin, Z., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1301338 · Cited by 3 · see citing works
Telemedizin in der rehabilitativen Nachsorge von Frauen mit Brustkrebs
Tokgöz, P., & Dockweiler, C. (2023) · TumorDiagnostik & Therapie · doi:10.1055/a-2078-1718 · Cited by 1 · see citing works
“[20] Atema V, van Leeuwen M, Kieffer JM et al.”
BackgroundInfluential
Care process for breast cancer patients with sleep disturbances: a best practice implementation project
Chuang, C.-W., Li, C.-F., Chiang, M.-C., et al. (2024) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000485 · Cited by 1 · see citing works
“21,22 How to apply iCBT for breast cancer patients should be considered and integrated into the care process.”
Cognitive Behavior Therapy in Menopause
Pramana, C., Soetrisno, S., & Pramono, N. (2024) · Springer eBooks · doi:10.1007/978-981-96-0239-1_14 · Cited by 1 · see citing works
A randomized controlled trial comparing mobile-app-based cognitive behavioral therapy with and without therapist support versus face-to-face therapy: study protocol
Pourshahrokhi, N., Hunter, M. S., Bazrafshan, F., & Ahmadian, L. (2025) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2025.114662 · Cited by 1 · see citing works
Self-citation
Identifying the content, capabilities, and design features of a mobile-based cognitive behavioral therapy intervention for managing menopausal symptoms
Pourshahrokhi, N., Hunter, M. S., Farokhzadian, J., & Ahmadian, L. (2025) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2025.106163 · Cited by 1 · see citing works
Self-citation
Cognitive Behavioral Therapy for Menopause Symptoms
Wilkins, V. M. (2025) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-025-00452-y · Cited by 1 · see citing works
“Adaptation of CBT for internet delivery also showed significant reduction in VMS in breast cancer survivors, with greater sustainability of benefits at 24-weeks post-treatment for therapist-guided internet CBT in comparison with self-guided internet CBT [20].”
Efficacy of Psychological Interventions on Psychological and Vasomotor Symptoms in Menopausal Women with Breast Cancer: A Systematic Review and Meta-Analysis
Chang, Y.-C., Sayar, S., Ahmadzadeh, A., Ghazanfarpour, M., Asgari, M. R., & Babakhanian, M. (2026) · International Journal of Cancer Management · doi:10.5812/ijcm-162733 · Cited by 1 · see citing works
Caring for the Whole Patient After Breast Cancer Therapy: A Survivorship Guide for Radiation Oncologists
Jimenez, R., & Rabinovitch, R. A. (2021) · Practical Radiation Oncology · doi:10.1016/j.prro.2021.08.005 · Cited by 1 · see citing works
Comparing the Mechanism of Change of Cognitive-Behavioral Therapy and Emotion Efficacy Therapy in Improving Psychological Adjustment of Women with Breast Cancer: the Role of Cognitive and Emotional Flexibility, Illness Perception, and Valued Action
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Internet-based cognitive behavioral therapy aimed at alleviating treatment-induced menopausal symptoms in breast cancer survivors: Moderators and mediators of treatment effects
Atema, V., van Leeuwen, M., Kieffer, J. M., Oldenburg, H. S. A., van Beurden, M., Hunter, M. S., & Aaronson, N. K. (2019) · Maturitas · doi:10.1016/j.maturitas.2019.09.007 · Cited by 19 · see citing works
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Design of a randomized controlled trial of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors
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An Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a pilot study
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Internet-based cognitive behavioral therapy to alleviate treatment-induced menopausal symptoms in breast cancer survivors: Results of the EVA-online pilot study
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145P The potential benefits of internet-based cognitive behavioural therapy for improving psychosocial aspects, sexual functioning, and treatment-induced menopausal symptoms among breast cancer survivors: Systematic review and meta-analysis
Putra, B. P., & Putra, F. N. (2021) · Annals of Oncology · doi:10.1016/j.annonc.2021.03.159

Authors: Atema, V., van Leeuwen, M., Kieffer, J. M., Oldenburg, H. S. A., van Beurden, M., Gerritsma, M. A., Kuenen, M. A., Plaisier, P. W., Lopes Cardozo, A. M. F., van Riet, Y. E. A., Heuff, G., Rijna, H., van der Meij, S., Noorda, E. M., Timmers, G.-J., Vrouenraets, B. C., Bollen, M., van der Veen, H., Bijker, N., Hunter, M. S., & Aaronson, N. K.
Affiliations: The Netherlands Cancer Institute (NL)
The Netherlands Cancer Institute, Amsterdam, the Netherlands
Albert Schweitzer Ziekenhuis (NL)
Noordwest Hospital Group Alkmaar, Alkmaar, the Netherlands
Catharina Hospital, Eindhoven, the Netherlands
Spaarne Ziekenhuis (NL)
Spaarne Gasthuis (NL)
Flevo Hospital, Almere, the Netherlands
Isala (NL)
Ziekenhuis Amstelland (NL)
OLVG (NL)
Medical Centre Zuiderzee, Lelystad, the Netherlands
Red Cross Hospital, Beverwijk, the Netherlands
Amsterdam University Medical Centers (NL)
King's College London (GB)
ORCID: Atema, Vera
Kieffer, Jacobien M.
Oldenburg, Hester S.A.
Plaisier, Peter W.
Bijker, Nina
Hunter, Myra S.
Aaronson, Neil K.
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2019-04-01
Volume: 37
Issue: 10
Pages: 809-822
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.18.00655
OpenAlex: W2912016527
Semantic Scholar: 17694bd59f238120825ef9da13c477b97e8ead10
Cited by: 105
References: 60
Citations by year: 2026: 13 · 2025: 22 · 2024: 15 · 2023: 15 · 2022: 11 · 2021: 14 · 2020: 12 · 2019: 3
FWCI: 4.21
Type: journal article
Language: en
Open access: green
pure.amsterdamumc.nl
Licence: other-oa
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
UvA-DARE (University of Amsterdam) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords: internet-based cognitive behavioral therapy, treatment-induced menopause, breast cancer survivors, hot flashes, night sweats, sleep quality, sexual function, psychological distress, health-related quality of life, therapist-guided intervention
MeSH terms: Cancer Survivors, Adult, Breast Neoplasms, Female, Humans, Middle Aged, Pilot Projects, Psychotherapy, Group, Surveys and Questionnaires, Sleep Wake Disorders, Sweating, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Hot Flashes, Neoadjuvant Therapy, Internet

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Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial

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