Management of hot flashes in breast cancer patients

Hot flashes, commonly experienced by women during menopause, can significantly and negatively impact quality of life. Women receiving hormone therapy for breast cancer are particularly prone to developing these symptoms and hot flashes in this patient population can be more challenging to manage. Although hormonal agents are the most effective treatment options, they are avoided in these patients due to concerns over increased risk of breast cancer recurrence. This issue has prompted research into many nonhormonal therapies in randomized, placebo-controlled trials. Paroxetine, venlafaxine, desvenlafaxine, fluoxetine, citalopram, gabapentin, and pregabalin are among those shown to have some efficacy. There have also been several studies of nonpharmacologic therapies that have demonstrated varying levels of success. In addition, special consideration should be given to interactions of several commonly used medications with the metabolism of tamoxifen. This article presents a discussion of the current literature, through December 2009, primarily related to nonhormonal therapeutic options for hot flashes, including considerations for patients receiving tamoxifen for the prevention or the treatment of breast cancer.