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

Abstract

The independent commentary was written by Jarbas Magalhães 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. The efficacy of non-hormonal therapies is still uncertain. OBJECTIVE: To assess the efficacy of non-hormonal therapies in reducing hot flushes in women with a history of breast cancer. METHODS: Search methods: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL (The Cochrane Library), Medline, Embase, Lilacs, CINAHL, PsycINFO (August 2008) and WHO ICTRP Search Portal. We handsearched reference lists of reviews and included articles, reviewed conference proceedings and contacted experts. Selection criteria: Randomized controlled trials (RCTs) comparing nonhormonal therapies with placebo or no therapy for reducing hot flushes in women with a history of breast cancer. Data collection and analysis: Two authors independently selected potentially relevant studies, decided upon their inclusion and extracted data on participant characteristics, interventions, outcomes and the risk of bias of included studies. 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.

Hot flushes still occur in a population of 85-year-old Swedish women

“…Therefore it is not surprising that the women who reported being troubled by hot flushes were more likely to use nitroglycerin than were those who were not troubled by hot flushes. Other types of medications may also interfere with the occurrence of hot flushes, for example antihypertensive medicines and antidepressants [12,13]. We have included these categories of medicines in our logistic regression analyses.…”

Endocrine Therapy in Older Women with Early-Stage Hormone Sensitive Breast Cancer

“…SSRI=serotonin selective reuptake inhibitor; SNRI=serotonin norepinephrine reuptake inhibitor **Potent inhibitor of CYP2D6-consider avoiding in patients on tamoxifen Multiple studies and two systematic reviews found that selective serotonin reuptake inhibitors (SSRIs), such as paroxetine and citalopram, and serotonin norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, decrease vasomotor symptoms in patients with breast cancer compared to placebo [73][74][75]. In patients on tamoxifen, however, avoidance of moderately-potent inhibitors of CYP2D6 such as paroxetine and fluoxetine (Table 2), which may decrease the efficacy of tamoxifen, should be avoided if possible.…”

“…In patients on tamoxifen, however, avoidance of moderately-potent inhibitors of CYP2D6 such as paroxetine and fluoxetine (Table 2), which may decrease the efficacy of tamoxifen, should be avoided if possible. Gabapentin, pregabalin, and clonidine also decrease the frequency and severity of hot flashes compared to placebo [73,74,[76][77][78] and are also reasonable options.…”

Caring for the breast cancer survivor’s health and well-being

“…A 2010 Cochrane review of 16 randomized controlled trials of nonhormonal interventions for VMS management in breast cancer survivors showed a mild-to-moderate effect with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, clonidine, and relaxation therapy [32] .…”