Evidence-based, clinical practice guidelines from the Oncology Nursing Society (ONS) on the management of hot flashes associated with surgery or drug-related therapy in women with breast cancer and men with prostate cancer were published in the Oncology Nursing Forum.

It has been estimated that over half of women undergoing breast cancer treatment and approximately 80% of men receiving androgen-deprivation therapy (ADT) for prostate cancer will experience hot flashes. Hot flashes can negatively affect patient quality of life, and potentially interfere with a patient’s adherence to their cancer treatment.

The interprofessional panel that developed the ONS guidelines emphasized that “nurses and other healthcare professionals need to know which patients are at risk for hot flashes and assess if hot flashes are present as well as their degree of frequency, severity, and level of interference with quality of life.”  

Other motivations for development of these guidelines, which were based on findings from a systematic review and meta-analysis of the relevant medical literature, were to evaluate the evidence associated with different interventions (including associated benefits, harms, and burdens), provide recommendations based on these evaluations, identify knowledge gaps in order to demonstrate the need for research in specific areas, and promote policy and advocacy related to the management of hot flashes in these patients.


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For women with breast cancer who experience hot flashes, the guideline panel suggested the use of an antidepressant over no treatment. Specifically, venlafaxine and paroxetine were mentioned as an initial approach, with clonidine suggested for use in those not responding to the former agents, and sertraline, fluoxetine, escitalopram, or duloxetine suggested for those not responding to venlafaxine, paroxetine, or clonidine.

For men with prostate cancer experiencing cancer treatment–related hot flashes, the guideline panel suggested the use of paroxetine or clonidine over no treatment, and the use of sertraline, fluoxetine, escitalopram, or duloxetine in those not responding to paroxetine or clonidine.

Furthermore, they suggested that women with breast cancer and men with prostate cancer experiencing hot flashes may benefit from physical activity, such as exercise or yoga, compared with no intervention.

However, the panel recommended against the use of gabapentin or pregabalin, as well as herbal or dietary supplements, such as soy, black cohosh, St. John’s wort, melatonin, and vitamin E to manage symptoms of hot flashes in either group of patients.

Of note, the strength of all of the intervention-based recommendations were classified as “conditional” because the certainty of their associated evidence was classified as “low” or “very low.”

Moreover, areas for which no recommendation was offered due to insufficient evidence in this setting included the use of hypnosis, relaxation therapy, cognitive behavioral therapy, acupuncture, and electroacupuncture. The guideline panel recommended that patients should undergo these interventions for the management of hot flashes only within the context of a clinical trial.

In summarizing some of the clinical implications of these guidelines for nurses, the guideline panel stated that “conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes.”

Reference

Kaplan M, Ginex PK, Michaud LB, et al. ONS Guidelines™ for cancer treatment-related hot flashes in women with breast cancer and men with prostate cancer. Oncol Nurs Forum. 2020;47:374-399.

This article originally appeared on Oncology Nurse Advisor