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Venlafaxine in management of hot flashes in women with breast cancer: a systematic review and meta-analysis

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Abstract

Toxicity due to treatment causes a negative impact on quality of life in breast cancer survivors. Hot flash symptoms, described as intense sensations of heat, sweating and flushing occur in more than 50 % of breast cancer patients taking tamoxifen. We hypothesized that venlafaxine, a selective-norepinephrine reuptake inhibitor drug, was effective for reducing patient-reported hot flash scores among women treated for breast cancer compared to other non-hormonal treatments. We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials from inception till May 2015 for venlafaxine (75 mg once daily or greater) with non-hormonal comparators for the treatment of hot flashes in female breast cancer patients. The primary outcome was hot flash score (derived from patient-reported hot flash severity and frequency) in randomized controlled trials. Standardized mean differences (SMD) were calculated for each study due to variation in the outcome measures. Heterogeneity was determined using I 2 statistics, and publication bias was assessed using a contour funnel plot and Egger’s tests. Pooled analyses demonstrated that venlafaxine significantly reduced hot flash scores compared to the trial comparators (overall SMD 2.06; 95 % confidence interval (CI) [0.40, 3.72]). There was significant heterogeneity among these studies (I 2 = 98.7 %, P < 0.001). Asymmetry in the contour funnel plot suggests the presence of publication bias and a trend towards small study effects (Egger’s test, P = 0.096). Venlafaxine is efficacious in managing hot flashes among women with breast cancer. This review highlights methodological issues that arise from eligible trials and recommends a collaborative approach in survivorship studies.

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Conflict of interest

Dr. Kalesan is employed by PPD (Contract research organization) after this study was completed. This study was not done at PPD. This does not pose a conflict of interest.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY, 10032, USA

    Ramya Ramaswami, Marcos Daniel Villarreal, Dina Marie Pitta & Bindu Kalesan

  2. School of Nursing, Indiana University, Indianapolis, IN, USA

    Janet S. Carpenter

  3. Medical Oncology, Imperial College London, London, UK

    Ramya Ramaswami & Justin Stebbing

Authors
  1. Ramya Ramaswami
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  2. Marcos Daniel Villarreal
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  3. Dina Marie Pitta
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  4. Janet S. Carpenter
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  6. Bindu Kalesan
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Correspondence to Bindu Kalesan.

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Ramaswami, R., Villarreal, M.D., Pitta, D.M. et al. Venlafaxine in management of hot flashes in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 152, 231–237 (2015). https://doi.org/10.1007/s10549-015-3465-5

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  • DOI: https://doi.org/10.1007/s10549-015-3465-5

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