Background
Cancer and hot flushes
Women with breast cancer are at an increased risk for experiencing menopausal symptoms. A recent survey found that women breast cancer survivors were 5.3 (95% CI 2.7-10.2) times more likely to experience menopausal symptoms than non-cancer patients. Of these women, tamoxifen users reported a higher prevalence of symptoms than non tamoxifen users (Harris et al. 2002). Tamoxifen users are also reported to experience flush symptoms for a longer time after the menopause, compared to other postmenopausal women (Bachmann 1999). 54% were still having flushes more than 10 years after the menopause as compared with 35% of healthy postmenopausal women (Carpenter et al. 1998). Vasomotor symptoms in men usually persist for over 5 years (Karling et al. 1994).
Menopausal symptoms include hot flushes, night sweats and vaginal discharge or dryness which have an adverse effect on quality of life. Hot flushes are a substantial problem in women who have survived breast cancer for a number of reasons (Bonneterre et al. 2001, Mouridsen et al. 2001, Couzi et al. 1995, Nabholtz et al. 2000). First many women treated for breast cancer when pre-menopausal undergo premature menopause from chemotherapy. Second, survivors of breast cancer are generally denied oestrogen therapy because of concerns about potential recurrence. Third, many women are given tamoxifen, the most prevalent side effect of which is hot flushes (Love et al. 1991, Zahasky et al. 1999). Studies suggest the incidence of National Cancer Institute grade 3-4 hot flushes within the randomised trials of tamoxifen versus anastrozole or letrozole are between 25-30% (Thomas 2003). Community based surveys put the incidence much higher at over 45% (Demissie et al. 2001). Menopausal symptoms in men result from bilateral orchidectomy or medical castration with gonadotropin-releasing hormone (Gn-RH) analogues (Hammar et al. 1999).
Many agents have been investigated as potential means for alleviating hot flushes in survivors of breast cancer. The best-described non-oestrogenic treatments for hot flushes are progestogens. For example, low doses of megestrol acetate results in a reduction of about 80% compared to a decrease with placebo of 20% (Loprinzi et al. 1994). At present, there are no convincing data that megestrol acetate has any adverse effect on breast cancer morbidity or mortality. Nevertheless, some physicians are concerned about its use in breast cancer survivors (Loprinzi et al. 1994). Furthermore, patients are concerned about the extra potential risk of fluid retention, weight gain and thromboembolism. Thus, a range of non-hormonal manoeuvres, such as anti-hypertensives (Nesheim and Saetre 1981, Goldberg et al. 1994), clonidine and complementary therapies such as vitamin E (Barton et al. 1998) and soy extracts have been investigated, some of which have demonstrated marginal benefits (Faure et al. 2002, Quella et al. 2000, Quella et al. 1999). Other complementary therapies (including herbal remedies, chiropractic, meditation) are also reportedly used for symptom management (Kronenberg 2002, p.805), The efficacy of such therapies is, however, yet to be established. From a sample of cancer patients surveyed, women using tamoxifen were 2.5 times more likely (95% CI) to report using alternative therapies for menopausal symptoms than non-tamoxifen users (Harris et al. 2002).
Clinicians have some concerns regarding the use of dietary measures or supplements which include plant oestrogens in the form of isoflavins or phytoestrogens, although direct evidence for a deleterious effect has not been found (Quella 2000). Lifestyle advice such as avoiding caffeinated drinks and smoking whilst increasing light exercise has been shown to improve quality of life and reduce hot flushes and is free from risk (www.cancernet.co.uk).
A Cochrane review of ‘ Non hormonal interventions for hot flushes in women with a
Search terms
Cancer terms
neoplasms (exp) or neoplas* or tumor* or tumour* or melanoma* or cancer* or malignan* or leukemia* or leukaemia* or carcin* or metastas* or sarcoma* or antineoplastic agents (exp) or chemotherapy or palliative care or palliative care (exp) or palliative treatment (exp) or palliative therapy (exp) or terminal care or terminal care (exp).
and
Hot flushes terms
hot flush* or hot flash* or hot flashes (exp) or menopaus* or menopause (exp) or climacteric or climacteric (exp) or menopause –and climacterium (exp) or premenopaus* or postmenopaus* or perimenopaus* or climacteri* or
vasomotor symptom* or andropaus*.
Further resources
Cancer information sources
National Library for Health Cancer Specialist Library (UK) at http://libraries.nelh.nhs.uk/cancer/
National Cancer Institute (US) at
http://www.nci.nih.gov/
