Crabb, Simon, Morgan, Alannah, Stefanopoulou, Evengia, Fleure, Louisa, Griffiths, Gareth, Boxall, Cherish, Wilding, Sam, Nearchou, Theodora, Ewings, Sean, Nuttall, Jacqueline, Eminton, Zina, Tilt, Emma, Whitby, Emma, Sui, Bernard, Ridley, Paul, Robson, Lynsey, Nobes, Jenny, Preece, Joanne, Bacon, Roger, Martin, Jonathan, Chamberlain, Sarah, Fenlon, Deborah R, Hunter, Myra S. and Richardson, Alison (2026) Self-help cognitive behavioural therapy for hot flushes and night sweats during androgen deprivation therapy for prostate cancer: the MANCAN2 randomized controlled trial. British Journal of Cancer. (doi:10.1038/s41416-026-03375-4).
Abstract
Background: androgen deprivation therapy (ADT) causes hot flushes and night sweats (HFNS) and is associated with sleep disturbance, anxiety, low mood and cognitive impairment. We tested self-help cognitive behavioural therapy (CBT), when guided by prostate cancer nurse specialist teams, for mitigation of the long-term impact of HFNS, and associated symptoms.
Methods: prostate cancer patients receiving ADT, with a HFNS Problem Rating Scale ≥2, were randomised (1:1) to treatment as usual (TAU) or CBT + TAU, stratified by centre and treatment intent. CBT was a 4-week self-help intervention with pre- and post-intervention group workshops guided by trained prostate cancer nurse specialists. Primary endpoint: 6-month HFNS Problem Rating Scale. Secondary endpoints included HFNS frequency, ADT compliance and rating scales for HFNS beliefs and behaviours, quality of life, anxiety, depression and sleep.
Results: 162 patients were randomised. 6 month mean HFNS Problem Rating Scale score was not significantly different between the TAU and CBT + TAU groups (mean 4.08 vs 4.04, 95% confidence interval (CI) for difference: −0.89, 0.80; p = 0.97), although was improved at 6 weeks (mean 4.47 vs 3.79, 95% CI: −1.26, -0.09; p = 0.03), when depression, anxiety scores and ADT compliance also favoured CBT + TAU.
Conclusions: the addition of CBT in prostate cancer patients receiving ADT improved short-term HFNS severity, in addition to improved anxiety and depression scores, but these were not maintained at 6 months. Clinical trial registration: ISRCTN58720120.
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