Modeling the hot flash experience in breast cancer survivors

Objective: To evaluate relationships among different measures of hot flashes, perceived hot flash interference, and associated outcomes (positive affect, negative affect) while controlling potential covariates. Design: Breast cancer survivors (N = 236) provided demographic data, objective hot flash frequency data via sternal skin conductance monitoring, prospective diary-based hot flash frequency and severity data, and questionnaire data via the Hot Flash Related Daily Interference Scale and the Positive and Negative Affect Scale. Results: Objective hot flash frequency and subjective hot flash severity emerged as separate factors in the structural equation model. Subjective hot flash frequency was associated with a high degree of unexplained variance (error) and seemed to be a potentially less accurate measure of either frequency or severity. Objective frequency was directly related to greater positive affect. In contrast, greater hot flash severity was (1) directly related to greater perceived hot flash interference and (2) indirectly related to more negative affect and lower positive affect through interference. Conclusions: Findings provide a theoretical basis for selecting among Symptom measures and anticipating how interventions aimed at different hot flash measures might affect perceived hot flash interference or associated outcomes. Because objective hot flash frequency and subjective hot flash severity seemed to measure different dimensions, measuring both may provide a more comprehensive picture of women's symptom experiences.