Weight Gain Is Associated with Increased Risk of Hot Flashes in Breast Cancer Survivors on Aromatase Inhibitors.

Abstract

Hot flashes in breast cancer survivors (BCS) receiving adjuvant aromatase inhibitor (AI) therapy are common, but risk factors for these symptoms are ill-defined. This study tested if body size is associated with hot flashes in BCS on AI therapy. A cross-sectional study of postmenopausal BCS receiving adjuvant AI therapy was performed. The primary outcome was occurrence of patientreported hot flashes. The primary exposures of interest were current body size and weight change since breast cancer diagnosis. Three hundred participants were enrolled at a mean age of 61 years (range 33-86) after an average AI exposure of 23 months (range 1 month-9 years). Fifty-nine percent reported hot flashes, 32% reported moderate to severe hot flashes, and 25% reported significant worsening of hot flashes since starting AI therapy. Sixty-one percent experienced © Springer Science+Business Media, LLC. 2010 Correspondence to: H. Irene Su, hisu@ucsd.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript weight maintenance (±10 lb), while 27% had weight gain (gained 10 lb or more), and 11% had weight loss (lost 10 lb or more). In multivariable analysis, weight gain was independently associated with hot flash occurrence (OR 2.1, 95% CI 1.1-4.4) and hot flash severity (OR 2.6, 95% CI 1.3-5.0) after adjusting for confounding. Current body size was not associated with hot flash occurrence, severity or change with AI therapy. In an outpatient BCS population on AI therapy, weight gain is a risk factor for hot flash occurrence. Women who gained at least 10 lb since breast cancer diagnosis were two times more likely to have hot flashes than women who maintained or lost weight. These results support the thermoregulatory model of hot flashes and argue against a protective effect of body fat in this population.

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

“…One study reported weight gain as a ''bothersome'' symptom at 3 months by 14.7 % of women on AI compared to 6.3 % of cancer-free controls (p = 0.03); at 6 months, the proportions were 17.9 and 7.3 %, respectively (p = 0.004) [40]. In second study of women on AI therapy anywhere from 1 to 3 years, 27 % reported gaining more than 10 pounds, 61 % reported maintaining their weight, and 12 % reported losing weight [41]. In a third study (no information on how long the women were on an AI), 48.7 % reported weight gain-53 % of women whom had natural menopause compared to 43 % who had induced menopause [42].…”

Patient‐reported outcomes in women with breast cancer enrolled in a dual‐center, double‐blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor‐induced musculoskeletal symptoms

“…1 AIs have been associated with worsening patient-reported outcomes (PROs), such as musculoskeletal symptoms and vasomotor symptoms. [2][3][4][5][6] One study demonstrated that 59% of women with early stage breast cancer who were receiving AIs experienced hot flashes, with 32% reporting moderate-to-severe hot flashes and 25% reporting significantly worsening hot flashes after the initiation of AI therapy. 6 The current treatments for AIassociated musculoskeletal and vasomotor symptoms are limited and may lead to drug discontinuation.…”

“…[2][3][4][5][6] One study demonstrated that 59% of women with early stage breast cancer who were receiving AIs experienced hot flashes, with 32% reporting moderate-to-severe hot flashes and 25% reporting significantly worsening hot flashes after the initiation of AI therapy. 6 The current treatments for AIassociated musculoskeletal and vasomotor symptoms are limited and may lead to drug discontinuation. Treatment for hot flashes include nonhormonal pharmacologic agents, such as clonidine, venlafaxine, gabapentin, and pregabalin; however, their use is limited because of suboptimal efficacy and potential side effects.…”

Breast cancer survivors willingness to participate in an acupuncture clinical trial: a qualitative study

“…Incorporating the patients’ perspective into the design of RCTs for acupuncture could inform study designs and facilitate recruitment efforts, thus increasing the probability of completing successful and definitive trials that produce reliable data. We conducted a qualitative study to identify attributes that influenced African American and Caucasian breast cancer survivors’ willingness to participate in clinical trials of acupuncture for hot flashes, a very common symptom affecting this population (17). …”