Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up.
BACKGROUND
We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. Following an initial pilot study, which focused on the acceptability and safety of SGB for this important problem, we evaluated its short- and long-term efficacy.


METHODS
Postmenopausal breast cancer survivors with severe vasomotor symptoms resistant to standard nonhormonal pharmacological intervention were eligible. Diaries were used to measure daily hot flash scores (frequency and intensity) and sleep quality (Pittsburgh Sleep Quality Index) during scheduled visits at baseline, 1, 4, 12 and 24 weeks following the SGB. Efficacy data were analyzed using longitudinal regression models.


RESULTS
Thirty-four patients participated and none refused the SGB procedure. Most patients received more than one SGB. The pilot study found SGB to be safe. In the main study, hot flash scores were reduced from baseline by 64% [95% confidence interval (CI) -74% to -49%] and 47% (95% CI -62% to -27%) at weeks 1 and 24, respectively. The odds ratio of better sleep quality relative to baseline was 3.4 at week 1 (95% CI 1.6-7.2) and 4.3 at week 24 (95% CI 1.9-9.8).


CONCLUSIONS
In the short term, SGB appears to be an effective treatment with acceptable morbidity for some breast cancer survivors with therapy-resistant vasomotor symptoms and/or sleep disturbances. Although sleep quality was maintained out to 24 weeks the efficacy of SGB for hot flashes was reduced over time. A randomized controlled trial is needed to confirm these findings.
Department of Obstetrics and Gynecology, University Hospitals Leuven and Katholieke Universiteit Leuven, Belgium.
K
K
Haest
A
A
Kumar
B
B
Van Calster
K
K
Leunen
A
A
Smeets
F
F
Amant
P
P
Berteloot
H
H
Wildiers
R
R
Paridaens
E
E
Van Limbergen
C
C
Weltens
H
H
Janssen
S
S
Peeters
J
J
Menten
I
I
Vergote
B
B
Morlion
J
J
Verhaeghe
M R
MR
Christiaens
P
P
Neven
D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001340:Autonomic Nerve Block; D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D019584:Hot Flashes / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced / Q000628:therapy*; D013233:Stellate Ganglion / Q000187:drug effects / Q000503:physiopathology*; D013375:Substance Withdrawal Syndrome / Q000628:therapy*; D017741:Survivors; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen