Zusammenfassung
Viele Brustkrebspatientinnen leiden unter den Nebenwirkungen ihrer antihormonellen Therapie. Klimakterische Beschwerden in Form von Hitzewallungen, Nachtschweiß, Libidoverlust, Ängsten, Depressionen oder auch Muskel- und Gelenkschmerzen führen in vielen Fällen zu einer Verschlechterung der Therapieadhärenz. Die Effektivität einer Begleittherapie mit selektiven Serotonin-Wiederaufnahmehemmern (SSRI), Gabapentin oder Clonidin konnte in verschiedenen randomisierten klinischen Studien (RCT) belegt werden. Allerdings lehnen viele Patientinnen eine Behandlung mit diesen Medikamenten ab, u. a. weil sie zusätzliche Nebenwirkungen fürchten. Demgegenüber besteht eine große Nachfrage nach komplementären Therapiemöglichkeiten, aber erst in den letzten Jahren gibt es zunehmend mehr und auch qualitativ bessere klinische Studien zu ihrer wissenschaftlichen Erforschung. Drei RCT mit isolierten Soja-Isoflavonen zeigten keine Überlegenheit gegenüber Placebo. Drei von fünf klinischen Studien mit Extrakt aus der Traubensilberkerze ergaben eine Reduktion der Hitzewallungen, die vierte Studie wies keinen Effekt auf Hitzewallungen nach, jedoch auf die Intensität des Schwitzens; in der fünften war das Verum dem Placebo nicht überlegen. In einer Phase-II-Studie reduzierten sich unter Einnahme von Leinsamenschrot die Hitzewallungen, eine placebokontrollierte Folgestudie ergab jedoch keinen signifikanten Unterschied zur Kontrolle. Ebenso wurden in einer unkontrollierten Kohortenstudie unter homöopathischer Behandlung positive Effekte auf die klimakterischen Beschwerden der behandelten Patientinnen erreicht, während zwei nachfolgende RCT zu einem Nullergebnis führten. Demgegenüber ergab eine Metaanalyse für die Verum-Akupunktur eine signifikante Überlegenheit gegenüber Sham-Akupunktur. Auch mit einem komplexen Entspannungstraining mit Yoga, Meditation und Atemübungen ließen sich Hitzewallungen im Vergleich zur Kontrolle statistisch signifikant reduzieren. Zwei kleine unkontrollierte Pilotstudien zeigten nach Stellatumblockade einen deutlichen Rückgang von Anzahl und Schwere der Hitzewallungen.
Abstract
Many breast cancer patients suffer from the side-effects of endocrine therapy. Climacteric complaints with hot flashes, night sweats, sexual dysfunction, anxiety, depression and musculoskeletal pain lead to a worsening of therapy adherence in many cases. Concurrent therapy with selective serotonin reuptake inhibitors (SSRIs), gabapentin or clonidine have been shown to be effective in several randomized clinical trials (RCT) but many patients refuse to use these medications because they are afraid of additional side-effects. Complementary therapies are popular but the quality and quantity of clinical research in this field has only increased relatively recently. The three RCTs with isolated soy isoflavones did not show superiority compared to placebo. In three out of five clinical studies with black cohosh a reduction of hot flashes was shown, in the fourth study there was no effect on hot flashes but sweating was reduced in the treatment group, in the fifth study there was no difference between verum and placebo. In a phase II study a daily intake of 40 g bruised flax seed reduced hot flashes by 50%. Nevertheless, a placebo-controlled study could not confirm these data. Homeopathic treatment was helpful in an observational study but positive effects were not reproducible in two following RCTs. In a recent meta-analysis of acupuncture in treating hot flashes in breast cancer patients, verum acupuncture was significantly more effective than sham acupuncture. Also a complex 8 week treatment group with yoga, meditation and breathing exercises reduced hot flashes in breast cancer patients and the results of two small pilot studies suggest that stellate ganglion block might also decrease the number and severity of hot flashes.
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Rostock, M., Saller, R. Komplementärmedizin in der Behandlung klimakterischer Beschwerden bei Patientinnen mit Brustkrebs. Forum 26, 30–34 (2011). https://doi.org/10.1007/s12312-011-0678-3
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DOI: https://doi.org/10.1007/s12312-011-0678-3