EFT and side Effects of Taximofen

1. Barbara Baker, PhD
Senior Research Fellow
Caroline Hoffman, PhD
Clinical and Research Director
The Haven Breast Cancer Support Centres
London – Hereford – Leeds, UK
www.thehaven.org.uk
Registered Charity No. 1061726
To evaluate the effectiveness of Emotional
Freedom Techniques (EFT) to reduce the side
effects caused by Tamoxifen and Aromatase
Inhibitors in women with breast cancer: a
preliminary service evaluation

2. Introduction
The Haven charity provides
welcoming day centres which
provide free in-depth
individualised programmes of
psychological support and
complementary therapies to
anyone affected by breast
cancer

3. Background
• Women with breast cancer show poor adherence to
Tamoxifen and Aromatase Inhibitors (AIs), mainly due to
side effects
• Need for self-help tools to improve quality of life
• Emotional Freedom Techniques (EFT) – gentle tapping
on specific acupuncture points whilst focusing on
negative emotion or symptom
• EFT may improve psychological distress in individuals
with post-traumatic stress disorder, phobias and anxiety
• No research studies published on effect of EFT in cancer

4. Background
• Visitors to the Haven centres say that EFT helps to
relieve both physical and emotional symptoms:
“Tapping for pain in neck helped”
“Can now deal with these things that bother me (that
didn’t before) by tapping which makes things clearer”

5. Aims
• To develop a self-EFT protocol for women with breast
cancer with Tamoxifen or Aromatase Inhibitor-associated
menopausal symptoms, such as fatigue, hot flushes,
joint pains and mood disturbance.
• To test the effectiveness of the self-EFT protocol for
addressing menopausal symptoms.

6. EFT – What is it?
• EFT is a form of emotional acupuncture without the needles based
on the premise that all negative emotions are the result of a
disruption in the body’s energy system.
• EFT works by clearing the blockage by tapping on the end points of
the body’s energy meridians, while tuning the mind to the issue in
question.
• Set-up: tapping on Karate Chop point accompanied by saying out
loud -
Even though I have “this problem” I deeply and completely love and
accept myself
• Sequence: a word that describes “this problem” is repeated aloud
each time the points are tapped in sequence

7. EFT Tapping points

8. Methods
• Invitation emails sent to active Visitors to London and
Leeds Havens
• Three week course of EFT, one session of 3 hours/wk
• Questionnaires on mood, pain, fatigue, endocrine
symptoms and hot flushes/night sweats plus hot flush
diary at baseline, weeks 6 and 12.
• 7-day home practice sheets, each week for first 6 wks
• Feedback form at 6 wks
• Follow-up group at 8 wks

9. EFT Protocol
• Week 1: Taught EFT protocol, given The Haven at Home
DVD
• Week 2: Check progress and troubleshoot
• Week 3: Fine tune according to individual needs
• Weeks 4-8: EFT use for self-help
• Week 8: Follow-up group including EFT session
• Weeks 9-12: EFT use for self-help

10. Analysis of Findings
Non-parametric statistical tests:
• Wilcoxon Signed Rank Test used to compare
questionnaire scores at baseline (T1) with 6 weeks (T2)
and with12 weeks (T3), and to compare T2 and T3
• Friedman Test used to compare all three time-points
• Analysed with SPSS software v20

11. Flow Diagram of Service Evaluation
44 women accepted invitation to take part
31 women
2 dropped out
13 women
1 dropped out
Baseline assessment:
28 completed questionnaires
28 completed hot flush diaries
Baseline assessment:
12 completed questionnaires
11 completed hot flush diaries
Assessment at 6 weeks:
3 dropped out
12 completed questionnaires
12 completed hot flush diaries
Assessment at 6 weeks:
2 dropped out due to illness
6 completed questionnaires
6 completed hot flush diaries
Final Assessment at 12 weeks:
1 dropped out
12 completed questionnaires
11 completed hot flush diaries
Final Assessment at 12 weeks:
6 completed questionnaires
6 completed hot flush diaries
LONDON LEEDS

12. Findings: Comparison of side effects
of Tamoxifen and AIs
• 40 women completed baseline questionnaire:
– Tamoxifen, n=19
– Letrazole (Femara), n=11
– Anastrazole (Arimidex), n=7
– Exemestane (Aromasin), n=3
• Hot flushes/night sweats and fatigue frequent for both
Tamoxifen and AIs users
• Aches and pains more frequent in AIs users
• Mood swings more common in Tamoxifen users
• Less frequent side effects in both groups- nausea,
lowered sex drive and vaginal dryness/discharge

13. Findings: Profile of Mood States
(POMS)
Significant improvements at T2 and T3 vs T1:
• Total Mood Disturbance (TMD)
• Tension/Anxiety
• Depression/Dejection
• Fatigue/Inertia
Significant improvements at T2 vs T1:
• Vigour/Activity
• Confusion/bewilderment
No significant difference between T2 and T3 for TMD or
any of the subscales

14. Findings: POMS significance values
POMS scale *T1 vs T2 **T1 vs T3
Total Mood Disturbance p<0.005 p<0.008
Tension/anxiety p<0.003 p<0.028
Depression/dejection p<0.006 p<0.020
Vigour/Activity p<0.039 NS
Fatigue/Inertia p<0.008 p<0.033
Confusion/bewilderment p<0.004 NS
*Total Mood Disturbance, n=14; POMS subscales, n=17
** Total Mood Disturbance, n=14; POMS subscales, n=16

15. Findings: Profile of Mood States
(POMS)

16. Findings: FACT-Endocrine
Symptoms
There were no significant changes in FACT-ES
scores over the three time periods

17. Findings: Brief Pain Inventory
• 24 of 34 (70%) respondents had pain other than
everyday pain
• Most who took medications for pain had relief to varying
degrees
• Significant decrease in mean pain interference score at
T3 vs T1 (p<0.042, n=11)
• No significant changes in pain severity rates, either
individually (worst, least, on average, right now) or
summed as mean pain severity score
• Trend in increase of average pain at T2 vs T1 (p<0.056,
n=11)

18. Findings: Brief Pain Inventory

19. Findings: Brief Fatigue Inventory
• 28 of 30 (93%) felt unusually fatigued in the last week
• Fatigue now was significantly decreased at both T2 and
T3 vs T1
• Usual fatigue in the last 24 hrs was significantly lower at
T3 vs T1
• Worst fatigue was significantly lower at T2 vs T1
• Mean fatigue interference score significantly decreased
at both T2 and T3 vs T1
• Mean global fatigue score significantly lower at T2 vs T1

20. Findings: Brief Fatigue Inventory
Fatigue scale T1 vs T2 T1 vs T3
Fatigue now
(n=10)
p<0.018 p<0.048
Usual fatigue in last 24 hrs
(n=10)
NS p<0.046
Worst fatigue in last 24 hrs
(n=10)
p<0.041 NS
Mean Fatigue Interference
(n=12)
p<0.025 p<0.041
Mean Global Fatigue
(n=12)
p<0.012 NS

21. Findings: Brief Fatigue Inventory

22. Findings: Hunter’s HFNS Scale
• 21 of 32 (66%) had 1-10 hot flushes/day at T1
• Similar proportion had 1-5 hot flushes/day at T2 and T3
• Severity of hot flushes changed from moderate to mild
• Most who responded had 1-5 night sweats/night
throughout the study period
• Severity of night sweats changed from moderate to mild
• Problem Rating Score significantly decreased at T2
(p<0.026) and T3 (p<0.002) vs T1
• Problem Rating Score significantly decreased between
T2 and T3 (p<0.008)

23. Findings: Hot Flush Diary
• Total and moderate severity hot flushes significantly
decreased at both T2 (p<0.008; p<0.05) and T3
(p<0.015; p<0.035) vs T1.
• Moderate severity hot flushes significantly decreased
between T2 and T3 (p<0.018)

24. Findings: Hot Flush Diary

25. Comments
• Since doing the Emotional Freedom Technique I
have found the hot flushes have become less
severe and not so frequent.
• Whilst I still suffer from bouts of depression they
haven't escalated to a severe, hopeless bout
since I began EFT.

26. Conclusions
This preliminary service evaluation has shown
that EFT shows considerable potential as a self-
help tool to manage the side effects associated
with hormonal therapies, specifically hot
flushes/night sweats, fatigue and mood changes,
in women with breast cancer.

27. barbara.baker@thehaven.org.uk caroline.hoffman@thehaven.org.uk