Management of hot flashes in breast cancer survivors and men with prostate cancer.
Hot flashes are a significant complaint among many breast cancer survivors and many men undergoing androgen deprivation therapy for prostate cancer. Several therapeutic approaches are available to the suffering man or woman. Many of these individuals have tried nonpharmacologic and nonconventional approaches. However, most nonpharmacologic treatments have not been compared with placebo or were not more effective than placebo in prospective, randomized clinical trials. The most effective nonhormonal treatments for hot flashes include agents from the selective serotonin or noradrenergic reuptake inhibitor (SSRI/SNRI) family. Paroxetine, 10 mg/d, or venlafaxine, 37.5 mg/d, are reasonable initial dosages, and if symptoms do not improve within a week or two, the dosage can be doubled. Gabapentin appears to provide similar benefits, but direct comparisons have not been reported. Because of the strong association between gonadal hormones and breast and prostate cancer, the use of hormonal agents to treat hot flashes in these patients has been limited. However, such hormonal therapies as depomedroxyprogesterone acetate can be prescribed for an informed individual who experiences bothersome symptoms despite nonhormonal treatments.
Stearns
Vered
V
Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Bunting-Blaustein Cancer Research Building, 1650 Orleans Street, Room 1M53, Baltimore, MD 21231-1000, USA. vstearn1@jhmi.edu
D000588:Amines / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy*; D000529:Complementary Therapies; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003511:Cyclohexanols / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D000077206:Gabapentin; D019584:Hot Flashes / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008525:Medroxyprogesterone / Q000627:therapeutic use; D008594:Menopause, Premature; D017374:Paroxetine / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D017741:Survivors; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D014151:Anti-Anxiety Agents; D003280:Contraceptives, Oral, Synthetic; D003509:Cyclohexanecarboxylic Acids; D003511:Cyclohexanols; D000077206:Gabapentin; D008525:Medroxyprogesterone; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride; D005680:gamma-Aminobutyric Acid