Bordeleau, L., Pritchard, K., Goodwin, P., & Loprinzi, C. (2007). Therapeutic options for the management of hot flashes in breast cancer survivors: An evidence-based review. Clinical Therapeutics, 29, 230–241.

DOI Link

Purpose

STUDY PURPOSE: To explore the effectiveness of pharmalogic and nonpharmalogic agents in treating hot flashes in breast cancer survivors

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Medline and EMBASE
 
YEARS INCLUDED: 1990–July 2006
 
INCLUSION CRITERIA: Included randomized, controlled trials with large samples; subheadings menopause, breast tumor, breast cancer, menopause, and hot flashes
 
EXCLUSION CRITERIA: Pilot studies excluded

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 14 studies, 7 complementary alternative medicine (CAM) and 7 pharmacologic (nonhormonal)
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Although the authors stated that only select large sample studies were included, they included a miscellanea of randomized studies and did not describe study quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 4 nonpharmacologic and 22 pharmacologic
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,930 patients (779 nonpharmacologic; 1,151 pharmacologic) 
  • SAMPLE RANGE ACROSS STUDIES: 47–347
  • KEY SAMPLE CHARACTERISTICS: Breast cancer survivors, clinical characteristics not specified and length of follow-up not described

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after active treatment
 
APPLICATIONS: Elder care

Results

Seven randomized, controlled studies of complementary alternative medicines (CAM) with soy, black cohosh, or vitamin E. Soy was not more effective than placebo. No significant difference existed in experimental groups with black cohosh, and a small difference was observed in only one study with vitamin E, so it is unlikely clinical significant.
 
Seven randomized, controlled studies of clonidine. Transdermal clonidine was associated with constipation, drowsiness, dryness, and itching episodes. Antidepressants like venlafaxine were significant in decreasing hot flashes with less side effects with a 75 mg dose than a 150 mg. Paroxetine (20 mg) was statistically significant, but nausea was reported. Fluoxetine and sertraline were better than placebo in controlling hot flashes. Other symptoms related to hot flashes, such as sleeplessness, depression, loss of libido, and anxiety, were better controlled with antidepressants. These drugs are associated with some side effects, such as anorexia, nausea, dry mouth, somnolence, and headache.
 
A large controlled study showed that gabapentin (900 mg per day) was highly effective in decreasing hot-flash disturbances but was also associated with somnolence, dizziness, rash, edema, and fatigue. Six hormonal interventional trials were reviewed and had conflicting results for breast cancer recurrence. The authors noted selection bias with several of them.

Conclusions

CAM therapies and vitamin E appear to have some effect, but data are limited. Gabapentin and some of the newer antidepressants were the most effective, with some side effects. These studies had small to moderate sample sizes, which makes overall effectiveness difficult to establish.

Limitations

  • Limited search
  • No quality evaluation
  • High heterogeneity
  • Older article (2007)
  • Hormone replacement therapy was not accepted by women

Nursing Implications

Nurses need to know the negative effects of hormonal agents on safety. Nonpharmacologic agents, such as soy phytoestrogens, black cohosh, and vitamin E, appear to be ineffective and limited because of the methodological limitations of studies. Gabapentin and some of the newer antidepressants were the most effective but still have side effects.

Legacy ID

6365