Breast Cancer Survivors Dealing with Hot Flashes

January 19, 2010

Hot flashes or flushes are common symptoms of menopause, but an estimated 65-85% of breast cancer survivors experience hot flashes after commencing treatment and outside the normal age range for menopause. Often therapy-induced hot flashes are reported to be more severe than natural menopause-induced hot flashes, and it is hypothesized by researchers that exaggerated flashes can lead to depression, anxiety, sleep loss, general fatigue, and sexual dysfunction. It is difficult to know for certain if the reported symptoms are a direct result of only the hot flashes because breast cancer survivors’ bodies are under extreme stress from the disease and multiple treatments; it is easy to understand how the symptoms could be generated by any one factor or complexity of factors associated with breast cancer. Also, very troubling is the association researchers have observed between hot flashes and medication improper adherence. In other words, it seems that many survivors who experience hot flashes after treatment begins subsequently modify their treatment regimens without consulting their doctors. We all understand this to be a bad idea! Researchers who have looked at this issue have focused on tamoxifen. In a Scottish study of breast cancer survivors who were prescribed tamoxifen, the mortality due to breast cancer was 10% higher among the individuals who were less than 80% adherent when compared to those individuals who were at least 80% adherent or more.

Researchers from London recently conducted an extraordinary review of the research on the topic in an effort to identify the best course(s) of action for breast cancer survivors dealing with hot flashes. The researchers hoped to help survivors avoid the annoying, painful, and persisting fallout of hot flashes. The team looked at many treatment options and assessed each treatment’s efficacy. Pharmacological options included Clonidine, Gabapentin, selective serotonin reuptake inhibitors (a.k.a. anti-depressants), and selective norepinephrine reuptake inhibitors (most commonly used to treat ADHD). Alternatives to pharmacological therapies included isoflavones (active chemical in soy), Chinese medicinal herbs, exercise, yoga, acupuncture, aromatherapy, and stellate ganglion block (an injection of local anesthetic into the front of the neck).

It would be nice to be able to write that researchers found a magic bullet, but they did not. They begin their conclusions by saying, “From the myriad of available therapies for hot flushes in breast cancer patients, only a few emerge as being efficacious and safe.” The researchers go on to say that little consistency exists across results, but desvenlafaxine (a selective norepinephrine reuptake inhibitor) showed some promising clinical trial results, and the stellate ganglion block results are promising but not fully tested because a double-blind randomized clinical trial is not possible for the treatment. None of the non-pharmacological and relatively benign treatments (e.g., exercise, yoga, acupuncture) reported any significant improvement of symptoms.

The take-home message is two-fold. First, there is not a magic bullet that seems to work for the majority of individuals. Second, there are many options available, and each carries with its promise a certain level of risk. If you are considering any of the options, you should discuss the risks and benefits with your treating physician, and you should carefully consider your options.

Click here for the PubMed link to the article

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