title: Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.
abstract: Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.
authors.affiliation: School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143-0401, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Johns
authors.affiliation: School of Medicine, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Seav
authors.affiliation: Department of Reproductive Medicine, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Dominick
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97331-6406, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Gorman
authors.affiliation: Department of Biostatistics, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
authors.forename: Hongying
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Family Medicine & Public Health, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.affiliation: The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York City, NY, 10021, USA.
authors.forename: Jun James
authors.initials: JJ
authors.lastname: Mao
authors.affiliation: Department of Reproductive Medicine, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA. hisu@ucsd.edu.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-6671-5151
authors.initials: H
authors.lastname: Irene Su
mesh_terms: D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy*; D006801:Humans; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D000068760:Serotonin and Noradrenaline Reuptake Inhibitors
keywords: Breast cancer; Hot flashes; Non-hormonal; Randomized controlled trials; Treatment; Vasomotor symptoms