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Supportive Care in Cancer

, Volume 21, Issue 5, pp 1461–1474 | Cite as

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

  • Sylvain L’Espérance
  • Suzanne FrenetteEmail author
  • Anne Dionne
  • Jean-Yves Dionne
  • Comité de l’évolution des pratiques en oncologie (CEPO)
Review Article

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.

Keywords

Hot flashes Breast cancer Antidepressants Antihypertensives Anticonvulsants Natural health products 

Notes

Acknowledgements

The CEPO is a group of oncology specialists that reports to the Direction québécoise de cancérologie du ministère de la Santé et des Services sociaux du Québec. La Direction québécoise de cancérologie provided funding for the work reported in this article, which is an adaptation of CEPO’s original clinical practice guideline published in June 2012, available in French at www.msss.gouv.qc.ca/cancer. The CEPO would like to thank Jamil Asselah MD, Montreal General Hospital (MUHC); Amélie Chartier B.Pharm./M.Sc./BCOP, Montreal General Hospital (MUHC); Renée Simon MD, Hôpital Charles LeMoyne; Dominique Synnott MD, Hôpital du Sacré-Cœur de Montréal and Lucie Vaillancourt MD, Hôpital du St-Sacrement (CHU de Québec) for their contribution as external reviewers for the original clinical practice guideline.

Disclosure

The authors have no financial conflicts of interest to declare.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sylvain L’Espérance
    • 1
  • Suzanne Frenette
    • 2
    Email author
  • Anne Dionne
    • 3
  • Jean-Yves Dionne
    • 4
  • Comité de l’évolution des pratiques en oncologie (CEPO)
    • 5
  1. 1.Comité de l’évolution des pratiques en oncologieQuébecCanada
  2. 2.Department of PharmacyHôpital Maisonneuve-RosemontMontréalCanada
  3. 3.Department of PharmacyHôpital du St-Sacrement (CHU de Québec)QuébecCanada
  4. 4.Mont-RoyalCanada
  5. 5.Direction québécoise de cancérologieMinistère de la Santé et des Services sociaux du QuébecQuébecCanada

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