Cancer Survivorship: Managing Hot Flashes

By Barrie Cassileth, MS, PhD

Hot flashes are a common side effect of treatment in people with hormone-dependent cancers, such as breast and prostate cancer. Hormone replacement therapy, which may be used to reduce hot flashes in postmenopausal women, cannot be used in breast cancer patients because it could stimulate growth of estrogen-sensitive tumors. Although some other drugs may help, they can have their own side effects. Many patients turn to complementary therapies, such as acupuncture and herbal supplements, in hopes of finding safe and effective relief. Although much of the research on complementary therapies for hot flashes has been done with breast cancer patients, those results are likely applicable to prostate and other hormone-dependent cancers as well.

Managing Hot Flashes with Acupuncture

A growing body of evidence suggests that acupuncture may help alleviate cancer treatment–related hot flashes. In one study an analysis of 194 breast and prostate cancer patients found that hot flashes were reduced by about half in nearly 80 percent of the patients who received acupuncture. In a similar study, men who had received castration therapy for prostate cancer experienced a 70 percent reduction in the number of hot flashes after 10 weeks of acupuncture.

In recent years there has been an increasing number of high-quality randomized controlled trials of acupuncture for this symptom. One noteworthy study compared true acupuncture with sham acupuncture (essentially a placebo) in breast cancer patients who had previously undergone surgery and were currently taking tamoxifen. The trial found a significant reduction in hot flash frequency (both daytime and nighttime) in the true acupuncture group over 22 weeks. Moreover, a follow-up study further suggested that acupuncture may have had long-lasting benefits. In a questionnaire conducted two years later, several women stated that their hot flashes had remained “fewer and milder.”

Another trial, however, found that true and sham acupuncture both reduced hot flashes, with no statistically significant difference between the groups. Other studies have had similar effects, leading a few recent review articles to conclude that there is not yet sufficient evidence that acupuncture reduces hot flashes. In sham acupuncture, needles are usually inserted at non-acupoints, so it is possible that the simple act of inserting a needle may have beneficial effects. Alternatively, the observed benefits could be due at least in part to the interaction between acupuncturist and patient.1

Though it is not entirely clear how acupuncture works or what specific aspect of acupuncture treatment is effective, the fact remains that people who have acupuncture treatment for hot flashes generally experience an improvement. You may well find it helpful. Acupuncture is very safe when practiced by a trained provider, and most people find the experience enjoyable. Just be sure to find an acupuncturist who is trained and certified to work with cancer patients.

Managing Hot Flashes with Herbs and Other Dietary Supplements

Herbal remedies are often the first place people turn when looking for complementary remedies for hot flashes. Soy, yam, flaxseed, red clover, evening primrose oil, and a Chinese herb called dong quai are among the commonly used botanical products. Each contains estrogen-like compounds (phytoestrogens) that may mimic estrogen in the human body and thus ease symptoms of estrogen deprivation, such as hot flashes. Unfortunately, few studies have found these effective at providing relief. Moreover, there is some concern that they could exacerbate estrogen-sensitive cancers by promoting tumor growth, especially when taken in high doses.

Studies of black cohosh (a popular herb) for treating hot flashes in breast cancer patients have had mixed results and have generally failed to prove that it reduces hot flashes any more than a placebo. Black cohosh does not seem to have estrogenic activity, however, so it should not stimulate the growth of hormone-sensitive tumors, as is a concern for certain other herbs.

Though not traditionally recommended for menopausal symptoms, vitamin E may benefit cancer patients suffering from hot flashes. A clinical trial found that 800 international units (IU) of vitamin E daily reduced hot flashes in breast cancer patients.2 The effect was not that large, but vitamin E may be worth taking, especially because it is relatively safe and inexpensive. High doses of greater than 400 IU per day should not be taken for long periods of time or by patients with heart disease. Always be sure to consult your doctor before taking any herbs or supplements to be sure that they are safe for your condition and won’t interfere with your treatment.

As noted, herbs and other dietary supplements are biologically active products that may interfere with cancer treatment and reduce its ability to stop the cancer. It is essential that you not take any herb or herbal compound during active cancer treatment. Memorial Sloan Kettering Cancer Center has developed a website and free app containing everything you need to know about herbs and other dietary supplements. Visit mskcc.org/aboutherbs for more information and to download the app. Providers can obtain additional information under the For Healthcare Professionals tab.


 

Excerpted with permission from Survivor­ship: Living Well during and after Cancer (Spry Publishing, 2014; $16.95) by Barrie Cassileth, MS, PhD. © Copyright 2014 Spry Publishing. Available for purchase everywhere books are sold.


 

Prescribed Reading

In Survivorship: Living Well during and after Cancer (Spry, 2014; $16.95), Barrie Cassileth, MS, PhD, offers a comprehensive overview of evidence-based integrative cancer treatment, providing a welcome resource for patients and their loved ones. Dr. Cassileth provides background on complementary therapies, describing various options and their potential to alleviate symptoms of cancer treatment and including important information about current research related to each topic. Written in a clear, accessible style, the book provides insight throughout to differentiate effective, evidence-based treatments from dangerous “alternative” therapies. The result of Dr. Cassileth’s work is a book that is at once easy to understand and backed by considerable research—a valuable resource for anyone facing a cancer diagnosis.


References

  1. Rada G, Capurro D, Pantoja T, et al. Non-hor­monal interventions for hot flushes in women with a history of breast cancer. Cochrane Database of Systematic Reviews. 2010;9:CD004923. doi: 10.1002/14651858.CD004923.pub2.
  2. Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Journal of Clinical Oncology. 1998;16(2):495-500.