Non-hormonal interventions for hot flushes in women with a history of breast cancer.
BACKGROUND
Hot flushes are common in women with a history of breast cancer. Hormonal therapies are known to reduce these symptoms but are not recommended in women with a history of breast cancer due to their potential adverse effects. The efficacy of non-hormonal therapies is still uncertain.


OBJECTIVE
To assess the efficacy of non-hormonal therapies in reducing hot flushes in women with a history of breast cancer.


METHODS
We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, PsycINFO (August 2008) and WHO ICTRP Search Portal. We handsearched reference lists of reviews and included articles, reviewed conference proceedings and contacted experts.


METHODS
Randomized controlled trials (RCTs) comparing non-hormonal therapies with placebo or no therapy for reducing hot flushes in women with a history of breast cancer.


METHODS
Two authors independently selected potentially relevant studies, decided upon their inclusion and extracted data on participant characteristics, interventions, outcomes and the risk of bias of included studies.


RESULTS
Sixteen RCTs met our inclusion criteria. We included six studies on selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors, two on clonidine, one on gabapentin, two each on relaxation therapy and homeopathy, and one each on vitamin E, magnetic devices and acupuncture. The risk of bias of most studies was rated as low or moderate. Data on continuous outcomes were presented inconsistently among studies, which precluded the possibility of pooling the results. Three pharmacological treatments (SSRIs and SNRIs, clonidine and gabapentin) reduced the number and severity of hot flushes. One study assessing vitamin E did not show any beneficial effect. One of two studies on relaxation therapy showed a significant benefit. None of the other non-pharmacological therapies had a significant benefit. Side-effects were inconsistently reported.


CONCLUSIONS
Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer.
Rada
Gabriel
G
Department of Internal Medicine, Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 44, Decanato Primer piso, Santiago, Chile.
Capurro
Daniel
D
Pantoja
Tomas
T
Corbalán
Javiera
J
Moreno
Gladys
G
Letelier
Luz M
LM
Vera
Claudio
C
D015670:Acupuncture Therapy; D000588:Amines / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D003000:Clonidine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D006705:Homeopathy / Q000379:methods; D019584:Hot Flashes / Q000209:etiology / Q000628:therapy*; D006801:Humans; D055909:Magnetic Field Therapy; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D012702:Serotonin Antagonists / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D012702:Serotonin Antagonists; D014815:Vitamins; D014810:Vitamin E; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003000:Clonidine; D009638:Norepinephrine