Non-hormonal interventions for hot flushes in women with a history of breast cancer

Abstract

BACKGROUND: Hot flushes are common in women with a history of breast cancer. Hormonal therapies are known to reduce these symptoms but are not recommended in women with a history of breast cancer due to their potential adverse effects. MAIN RESULTS: Sixteen RCTs met our inclusion criteria. We included six studies on selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors, two on clonidine, one on gabapentin, two each on relaxation therapy and homeopathy, and one each on vitamin E, magnetic devices and acupuncture. The risk of bias of most studies was rated as low or moderate. Data on continuous outcomes were presented inconsistently among studies, which precluded the possibility of pooling the results. Three pharmacological treatments (SSRIs and SNRIs, clonidine and gabapentin) reduced the number and severity of hot flushes. One study assessing vitamin E did not show any beneficial effect. One of two studies on relaxation therapy showed a significant benefit. None of the other non-pharmacological therapies had a significant benefit. Side-effects were inconsistently reported. AUTHORS' CONCLUSIONS: Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer. COMMENTSIn clinical practice, the use of selective serotonin reuptake inhibitors (SSRIs) presents good results with regard to hot flushes, and is especially effective in mild to moderate cases. They are considered to be a good alternative for women with histories of breast cancer.

Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial

“…Moreover, the improvement in social functioning after CBT is relevant because women report finding hot flushes especially difficult to deal with at work and in other social situations 18 . Although randomised controlled trials of non-hormonal drugs for HFNS have shown moderate reductions in HFNS frequency, they have recorded little evidence of improved quality of life 9 . Similarly, some studies show only weak relations between frequency of HFNS and quality of life 21,22 …”

“…A Cochrane review of non-hormonal medical treatments concluded that clonidine (an antihypertensive drug), gabapentin (an anticonvulsant that works through an unknown mechanism), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) showed a mild to moderate effect on the frequency of HFNS in women with a history of breast cancer (reductions of between 15% and 58%; average 37%) 9 . Three trials done since the review was undertaken recorded similar reductions 10–12 .…”

“…Three trials done since the review was undertaken recorded similar reductions 10–12 . Various side-effects of medical treatments were reported—eg, dry mouth, sleep problems, and nausea—and short follow-up limited conclusions about long-term outcomes 9 . Some SSRIs (paroxetine and fluoxetine), but not all, might reduce the effectiveness of endocrine treatments 13 .…”

“…Moreover, many breast cancer survivors prefer to use non-medical treatments 3 . For non-pharmacological therapies—eg, vitamins, magnetic devices, or acupuncture—the Cochrane review concluded that outcomes were either inconsistent or not statistically significant 9 . Consequently, a need exists for safe, acceptable, and effective non-hormonal treatments that are free from side-effects to help these women to manage HFNS 15,16 …”

Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions

“…Non-pharmacologic treatments including acupuncture, yoga, and hypnosis have also shown promise in improving hot flashes [18–25]. Several systematic reviews have summarized outcome data comparing these interventions to placebo [26–29] and provide more precise estimates of the efficacy of particular interventions.…”