Hot flashes or vasomotor symptoms occur in up to 80% of women and men receiving treatment for reproductive organ malignancies. These symptoms, which may be debilitating, can interfere with sleep quality, energy, mood, and sexual function. 

The Oncologic Nursing Society (ONS) recently published guidelines on cancer treatment-related hot flashes in women with breast cancer (BC) and men with prostate cancer (PC). The guidelines review the assessment of hot flashes as well as both nonpharmacological and pharmacological interventions. Patients should be encouraged to keep diaries of their symptoms in order for the clinician to better assess their severity and to help inform decision making regarding treatment options.

The guidelines provide 14 recommendations, with five addressing nonpharmacological interventions and nine focusing on pharmacological strategies to relieve hot flashes in BC)and prostate cancer PC patients.

Being engaged in an exercise program or yoga is recommended over no treatment in the management of vasomotor symptoms; however, the certainty of evidence is low. The guidelines recommend against the use of herbal or dietary supplements, such as soy, black cohosh, St. John’s wort, melatonin, and vitamin E, although the certainty of evidence associated with this recommendation is very low. Due to gaps in knowledge, the ONS was unable to make recommendations regarding the use of hypnosis, relaxation therapy, cognitive behavioral therapy, acupuncture, and electroacupunture to relieve hot flashes and recommended that these modalities be studied further in clinical trials. 

The level of certainty is also either low or very low for recommendations involving pharmacological interventions. The use of antidepressants, in particular, venlafaxine, paroxetine, sertraline, fluoxetine, escitalopram, and duloxetine, is recommended  compared with no treatment; however, the certainty of evidence ranged from low to very low. 

A similar recommendation is made for clonidine. The agents that are most preferred are venlafaxine and paroxetine; these should be considered prior to the use of the other selective serotonin reuptake inhibitors, duloxetine, or clonidine in the management of vasomotor symptoms associated with BC treatment. If venlafaxine and paroxetine are used as first-line agents and are ineffective, clonidine may be tried. If clonidine is also ineffective, then sertraline, fluoxetine, escitalopram or duloxetine should be considered in BC patients.

For PC patients experiencing hot flashes, the guidelines recommend the use of paroxetine or clonidine over no treatment. These are preferred over the use of sertraline, fluoxetine, escitalopram, or duloxetine, which would serve as second-line agents. However, just as with BC, these recommendations are associated with low to very low certainty of evidence. The ONS recommended the use of venlafaxine for PC only within the confines of a clinical trial due to observed knowledge gaps that limit making further recommendations regarding the use of this medication.

These guidelines provide one more tool to help pharmacists manage untoward adverse effects of cancer treatment in women with BC and men with PC, thereby enhancing these patients’ quality of life. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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