Hot flushes in women with breast cancer: state of the art and future perspectives

Abstract

Although not life-threatening, vasomotor symptoms might have a detrimental effect on quality of life and represent a major determinant of poor therapeutic compliance in breast cancer patients. Limitations of hormonal therapies have fostered the use of non-estrogenic pharmacological agents, which mainly include centrally acting compounds, antidepressant drugs, serotonin-norepinephrine reuptake inhibitors and serotonin reuptake inhibitors. Integrating therapeutic tools have recently come from a wide range of heterogeneous approaches varying from phytoestrogens use to ganglion block. We herein critically review the most updated evidence on the available treatment options for management of vasomotor symptoms. The need for a patient-oriented approach following systematic evaluation of the presence and degree of vasomotor disturbances is also discussed and future perspectives in therapeutics are summarized.

Keywords::

• breast cancer therapy
• complementary and alternative medicine
• hot flushes
• non-hormonal therapy
• vasomotor symptoms

Financial & competing interests disclosure

The authors have no relevant affiliation or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript have been disclosed. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties.

No writing assistance was used in the production of this manuscript.

Key issues

• Hot flushes are common and distressing symptoms of menopause occurring in over 75% of healthy postmenopausal women and in 65–85% of breast cancer (Bca) patients.

• In Bca patients the occurrence and persistency of hot flushes represent a major cause of scarce adherence or actual discontinuation of treatment.

• Hormonal therapy has proven efficacy in alleviating hot flushes. However, in Bca patients, this approach is generally contraindicated due to risk of disease recurrence.

• For mild hot flushes, the North American Menopause Society recommends the adoption of lifestyle changes including dressing in layers, consuming cool/cold food and beverages, using fan and limiting exposure to alcohol, smoke and caffeine.

• If persisting or worsening, vasomotor symptoms might require an approach based on cognitive behavioral therapy or drug administration, depending on the individual patient preferences. Given the possible long-term risks of hormonal therapy, patients should be referred in the first instance to non-hormonal therapies.

• In patients not being treated with tamoxifen, the use of venlafaxine, paroxetine, citalopram, clonidine, gabapentin and pregabalin is recommended.

• In patients under tamoxifen, paroxetine and fluoxetine should be avoided due to the strong CYP2D6 inhibiting effect.

• Main limitations to the available evidence on pharmacological treatments stem from the paucity of studies comparing different interventions by efficacy and safety, lack of long term data and tendency toward the conduct of inadequately sized studies.

• Among the approaches suggested by the complementary and alternative medicine, cognitive behavioral therapy and stellate ganglion block are particularly promising. However, the existing evidence is still insufficient to draw firm conclusions.