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01-05-2013 | Review Article

Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations

Authors: Sylvain L’Espérance, Suzanne Frenette, Anne Dionne, Jean-Yves Dionne, Comité de l’évolution des pratiques en oncologie (CEPO)

Published in: Supportive Care in Cancer | Issue 5/2013

Abstract

Purpose

Breast cancer patients frequently report hot flashes. Given that conventional hormone replacement therapy is generally contraindicated for them, other therapeutic modalities must be considered. The purpose of this review was to develop evidence-based recommendations on non-hormonal pharmacological interventions, including natural health products, for managing hot flashes in women undergoing treatment for breast cancer or with a history of breast cancer.

Methods

A review of the scientific literature published between January 2000 and December 2011 was performed. A total of 26 randomized trials were identified.

Results

Studies showed that serotonin–norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, antihypertensives and anticonvulsants significantly reduced the frequency and severity of hot flashes in breast cancer patients.

Conclusions

Considering the evidence available to date, the CEPO recommends the following: (1) for breast cancer patients being treated with tamoxifen: (a) the use of venlafaxine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) the use of paroxetine and fluoxetine be avoided, given that they may reduce the efficacy of tamoxifen; (2) for breast cancer patients not being treated with tamoxifen: (a) the use of venlafaxine, paroxetine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) fluoxetine not be used to treat hot flashes, given that there is insufficient evidence for its therapeutic efficacy and (3) for breast cancer survivors, sertraline, phytoestrogens, black cohosh and St. John’s wort not be used to treat hot flashes.

Comité Directeur de la Société Canadienne du Cancer. Statistiques Canadiennes sur le Cancer 2012. Société Canadienne du Cancer, Toronto

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Title: Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations
Authors: Sylvain L’Espérance
Suzanne Frenette
Anne Dionne
Jean-Yves Dionne
Comité de l’évolution des pratiques en oncologie (CEPO)
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 5/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1732-8

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