scholarly journals Nonhormonal Hot Flash Management for Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Jian Liu ◽  
Guangning Nie ◽  
Yang Li ◽  
Zehuai Wen ◽  
Liming Lu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Meta Analysis ◽  
Hot Flashes ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
General Effect ◽  
Hot Flash

Aim of the Study. Hot flashes impair the quality of life of breast cancer survivors. Nonhormonal management is an important consideration. The objective of this network meta-analysis (NMA) is to compare the therapeutic efficacy and safety of nonhormonal hot flash treatments for breast cancer survivors. Materials and Methods. We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP up to May 2018. Randomized controlled trials (RCTs) reporting nonhormonal hot flash treatments for breast cancer survivors were included. Primary outcome measurements were hot flash frequency and hot flash score of posttreatment. The methodological quality of each study was assessed with Cochrane’s risk of bias tool. Results. 16 RCTs involving 2,349 participants were included. The nonhormonal therapies used in the included studies were classified as follows: lifestyle changes, mind-body techniques, dietary/supplements, SSRIs/SNRIs, other medications, and other therapies. Pairwise meta-analysis showed that the general effect of nonhormonal management was statistically more effective than no treatment/placebo/sham in reducing hot flash frequency (SMD = −0.60, 95% CI [−1.13, −0.06]; P=0.03)) and hot flash score (SMD = −0.38, 95% CI [−0.68, −0.08]). For hot flash frequency, results from the NMA showed that there was no statistically significant difference between any two of the nonhormonal treatments. Another NMA result indicated that acupuncture (other therapies) was 16.05 points more effective in reducing hot flash scores than no treatment/waitlist (SMD = −16.05, 95% CI [−30.2, −1.99]). These results were statistically significant. Acupuncture was also ranked the optimal nonhormonal therapy for both hot flash frequency and hot flash score. The safety analysis showed that there were few related adverse events during acupuncture and that drug related adverse reactions could have also occurred in studies using drug interventions Conclusions. This network meta-analysis comparing nonhormonal treatments suggested that acupuncture might be more effective in improving hot flashes for breast cancer survivors. A pronounced placebo response was found during hot flash treatments. The evidence of safety for nonhormonal therapies was also insufficient. Therefore, at present, we cannot make confirmative recommendations of nonhormonal hot flash management for breast cancer survivors. This study is registered with PROSPERO (CRD42018082008).

scholarly journals The impact of lifestyle interventions on therapy associated side effects in postmenopausal breast cancer survivors: systematic reviews and meta-analysis

2019 ◽  
Author(s):  
Jean Paul Muambngu Milambo ◽  
Maritha Kotze ◽  
John Akudugu
Keyword(s):  
Breast Cancer ◽  
Adverse Events ◽  
Breast Cancer Survivors ◽  
Meta Analysis ◽  
Postmenopausal Breast Cancer ◽  
Controlled Trials ◽  
Lifestyle Interventions ◽  
Breast Cancer Patients ◽  
Related Quality

Abstract Background: Medically Supervised Exercise (MSE) are advisable for the prevention and treatment related side effects among breast cancer survivors. Aerobic and resistance either exercise, separately or in combination, have been shown to improve physical functioning and manage some symptoms in breast cancer patients. However, the level of evidence on the effects of lifestyle interventions on therapy related adverse events and the required dose responses of exercises are not yet systematically reviewed. This review was conducted to assess the efficacy of medically supervised exercises(MSE) coupled with diet in preventing/managing aromatase inhibitors induced adverse events and improving range of motion(ROM) and heath related quality of life (HRQOL) in postmenopausal breast cancer patients following treatment. Methods: Two independent authors extracted data using PRISMA guidelines of published clinical trials. We searched the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, EMBASE, as well as clinical practice guidelines. We included only randomized controlled trials that examined exercise interventions coupled with diet interventions in postmenopausal breast cancer women. Health related quality of life (HRQOL) and range of motion were assessed as the main outcomes. Results: Random effects meta-analysis was conducted for pooling of the effect size. The age of patients varied from 50 to 60 years. The results illustrate that the mean difference (MD) in improving ROM in the MSE group versus no supervised exercises was 1.35% (95% CI: 0.63 to 2.07%, P = 0.0002; heterogeneity: Tau² = 0.71; Chi² = 112.14, df = 5 (P < 0.00001); I² = 96%). A summary of the data shows that supervised exercises significantly improved ROM and HRQOL in postmenopausal BCS on endocrine therapy compared to no supervised exercises 3.02 (95% CI: 2.59 to 3.45, P < 0.00001). These outcomes show that lifestyle interventions (MSE +diet) have positive effects on AI-associated adverse events and likely improve ROM and HRQOL in postmenopausal BC patients. Conclusion: The evidence was based on a body of research with moderate study quality. Moreover, further studies are recommended to assess the effect of lifestyle interventions on markers of inflammation as the predictors of treatment non-response and associated comorbidities.

Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors.

1998 ◽  
Vol 16 (7) ◽  
pp. 2377-2381 ◽  
Author(s):  
C L Loprinzi ◽  
T M Pisansky ◽  
R Fonseca ◽  
J A Sloan ◽  
K M Zahasky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Low Dose ◽  
Hot Flashes ◽  
Daily Diary ◽  
Clinical Problem ◽  
Baseline Period ◽  
Hot Flash ◽  
Venlafaxine Hydrochloride

PURPOSE Hot flashes can be a prominent clinical problem for breast cancer survivors and men who undergo androgen-deprivation therapy. Anecdotal information suggested a low dose of a relatively new antidepressant, venlafaxine, could abrogate this clinical problem. MATERIALS AND METHODS This study included 28 consecutive assessable patients entered onto a phase II clinical trial. Hot flash data were collected by daily diary questionnaires during a 1-week baseline period and then for 4 weeks, during which time patients received venlafaxine 12.5 mg orally twice daily. RESULTS Fifty-eight percent of patients who completed the study had a greater than 50% reduction in hot flash scores (frequency times severity) during the fourth treatment week as compared with the baseline week. Median weekly hot flash scores were reduced by 55% from baseline during the fourth week of venlafaxine therapy. Therapy was generally well tolerated and appeared to alleviate fatigue, sweating, and trouble sleeping. CONCLUSION Venlafoxine appears to represent an efficacious new method to alleviate hot flashes. Further evaluation of this compound for alleviating hot flashes is indicated.

Multicenter, Randomized, Cross-Over Clinical Trial of Venlafaxine Versus Gabapentin for the Management of Hot Flashes in Breast Cancer Survivors

2010 ◽  
Vol 28 (35) ◽  
pp. 5147-5152 ◽  
Author(s):  
Louise Bordeleau ◽  
Kathleen I. Pritchard ◽  
Charles L. Loprinzi ◽  
Marguerite Ennis ◽  
Olivera Jugovic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Patient Preference ◽  
Breast Cancer Survivors ◽  
Negative Mood ◽  
Hot Flashes ◽  
Baseline Period ◽  
Open Label ◽  
Group Sequential ◽  
Hot Flash

Purpose Nonhormonal pharmacologic interventions are recommended for the treatment of hot flashes in breast cancer survivors. Antidepressants and gabapentin have been shown to be both effective and well tolerated; however, it is not clear which is preferred. Patients and Methods This was a group-sequential, open-label, randomized, cross-over trial of 4 weeks of venlafaxine (37.5 mg daily for 7 days followed by 75 mg daily for 21 days) versus gabapentin (300 mg once per day for 3 days, then 300 mg twice per day for 3 days, then 300 mg three times per day for 22 days), with patient preference as the primary outcome. Postmenopausal women with at least 14 bothersome hot flashes per week for the prior month were eligible. A 2-week baseline period and a 2-week tapering/washout time was used before the first and second treatment periods, respectively. Diaries were used to measure hot flashes and potential toxicities throughout the study. Participants completed a preference questionnaire at the end of the study. A predefined Pocock stopping rule was applied. Patient preference and hot flash and toxicity outcomes were compared between treatments. Results Sixty-six patients were randomly assigned, 56 of whom provided a preference (eight dropped out and two had no preference); 18 (32%) preferred gabapentin and 38 (68%) preferred venlafaxine (P = .01). Both agents reduced hot flash scores to a similar extent (66% reduction). Venlafaxine was associated with increased nausea, appetite loss, constipation, and reduced negative mood changes compared with gabapentin, whereas gabapentin was associated with increased dizziness and appetite compared with venlafaxine (all P < .05). Conclusion Breast cancer survivors prefer venlafaxine over gabapentin for treating hot flashes.

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