Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions

Abstract

Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

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Acknowledgments

The authors wish to thank Jennifer Ehren, PhD, Diana T. Chingos, MS, MFA, and Michael Krychman, MD, MPH for their contributions to the study. This study was financially supported by the California Breast Cancer Research Program Translational Award 200B-0 144. The funding organization was not involved in the study design, data collection, data analyses, or writing of the manuscript for publication.

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Correspondence to H. Irene Su.

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Supplementary material 2 Risk of bias summaries for trials on pharmacologic treatment dose comparisons, B two different pharmacological treatments, C pharmacological versus non-pharmacological treatments (PNG 134 kb)

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Johns, C., Seav, S.M., Dominick, S.A. et al. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast Cancer Res Treat 156, 415–426 (2016). https://doi.org/10.1007/s10549-016-3765-4

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Keywords

  • Breast cancer
  • Hot flashes
  • Vasomotor symptoms
  • Treatment
  • Non-hormonal
  • Randomized controlled trials