title: Venlafaxine in management of hot flashes in women with breast cancer: a systematic review and meta-analysis.
abstract: Toxicity due to treatment causes a negative impact on quality of life in breast cancer survivors. Hot flash symptoms, described as intense sensations of heat, sweating and flushing occur in more than 50 % of breast cancer patients taking tamoxifen. We hypothesized that venlafaxine, a selective-norepinephrine reuptake inhibitor drug, was effective for reducing patient-reported hot flash scores among women treated for breast cancer compared to other non-hormonal treatments. We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials from inception till May 2015 for venlafaxine (75 mg once daily or greater) with non-hormonal comparators for the treatment of hot flashes in female breast cancer patients. The primary outcome was hot flash score (derived from patient-reported hot flash severity and frequency) in randomized controlled trials. Standardized mean differences (SMD) were calculated for each study due to variation in the outcome measures. Heterogeneity was determined using I (2) statistics, and publication bias was assessed using a contour funnel plot and Egger's tests. Pooled analyses demonstrated that venlafaxine significantly reduced hot flash scores compared to the trial comparators (overall SMD 2.06; 95% confidence interval (CI) [0.40, 3.72]). There was significant heterogeneity among these studies (I (2) = 98.7%, P < 0.001). Asymmetry in the contour funnel plot suggests the presence of publication bias and a trend towards small study effects (Egger's test, P = 0.096). Venlafaxine is efficacious in managing hot flashes among women with breast cancer. This review highlights methodological issues that arise from eligible trials and recommends a collaborative approach in survivorship studies.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY, 10032, USA.
authors.forename: Ramya
authors.initials: R
authors.lastname: Ramaswami
authors.forename: Marcos Daniel
authors.initials: MD
authors.lastname: Villarreal
authors.forename: Dina Marie
authors.initials: DM
authors.lastname: Pitta
authors.forename: Janet S
authors.initials: JS
authors.lastname: Carpenter
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
mesh_terms: D001943:Breast Neoplasms / Q000150:complications*; D019468:Disease Management; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride / Q000627:therapeutic use*
chemical_list: D000068760:Serotonin and Noradrenaline Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride