[Treatment of hot flashes in women with a previous diagnosis of breast cancer].
Due to the huge prescription of adjuvant chemotherapy and hormonotherapy, the number of breast cancer survivors with hot flashes is to raise. Hormone replacement therapy is typically withheld from women with previous breast cancer. Treatment should begin with a careful patient history, with specific attention to the frequency and severity of hot flashes and their effect on the individual's function. For mild symptoms that do not interfere with sleep or daily activity, behavioural changes or treatments like soy phyto-oetrogens or vitamin E could be a reasonable initial approach. For more severe symptoms, several alternative substances have therefore been investigated. The use of clonidine and gabapentine should be discouraged because of their modest efficacy and adverse effects. Newer antidepressants (selective serotonin reuptake inhibitors) that are the best studied drugs to date, appear promising as therapy for women with hot flashes. The decrease in hot flashes achieved with progestational agents is similar to that seen with oestrogen therapy but there is debate about the safety of long term use of progestational agents in patients with a history of breast cancer. If hot flashes are particularly troublesome and do not respond to alternative approaches, quality of life must be balanced against theoretical risk of tumour promotion before choosing to use hormone replacement therapy to control these symptoms.
Debourdeau
Philippe
P
Service de médecine interne, Hôpital Desgenettes, 108, boulevard Pinel, 69003 Lyon. philippe.debourdeau@9online.fr
Bachelot
Thomas
T
Zammit
Christine
C
Aletti
Marc
M
Gallineau
Cyrille
C
Gligorov
Joseph
J
D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D019587:Dietary Supplements; D005260:Female; D020249:Hormone Replacement Therapy; D019584:Hot Flashes / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D011372:Progestins / Q000627:therapeutic use*; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index
D018931:Antineoplastic Agents, Hormonal; D011372:Progestins