Rada, G., Capurro, D., Pantoja, T., Corbalán, J., Moreno, G., Letelier, L. M., & Vera, C. (2010). Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database of Systematic Reviews, (9) CD004923.

To assess the efficacy of non-hormonal interventions for the treatment of hot flushes in women with a history of breast cancer

TYPE OF STUDY Combined systematic review and meta analysis

• DATABASES: CENTRAL, CINAHL, PsycINFO, LILACS, MEDLINE, EMBASE, WHO clinical trials registry combined with hand search of reference lists of reviews, included articles, conference proceedings and contacts with experts.
• KEYWORDS:  Detailed key words by database listed in appendix - all included randomized controlled trials of therapies for vasomotor symptoms (hot flashes, night sweats) in women with breast cancer
• INCLUSION CRITERIA: Randomized controlled clinical trials of non-hormonal interventions pertaining to women of any age experiencing hot flashes and with or without a history of breast cancer.  Studies that included women without a history of breast cancer were accepted if data on these cases was presented separately or if these women constituted <20% of the study population  
• EXCLUSION CRITERIA: Studies of hormonal interventions and hormone-like interventions including plant phytoestrogens, black cohosh, and tibolone
• METHOD OF STUDY EVALUATION: Evaluated studies according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2; Two persons evaluated each study and extracted information about the studies onto forms; Bias in studies was assessed and noted.
   

TOTAL REFERENCES RETRIEVED : N =1012

• FINAL NUMBER OF STUDIES INCLUDED: N = 16    
• KEY SAMPLE CHARACTERISTICS: All women with breast cancer and reporting vasomotor symptoms. There were inconsistencies in inclusion criteria related to number or severity of hot flashes required for inclusion.

APPLICATIONS Late Effects and Survivorship

• Outcomes inconsistently reported across studies 
• Outcomes included hot flash frequency, severity, bother, interference, hot flash composite scores (frequency x severity). 
• Secondary outcomes were also inconsistently reported and included side effects, recurrence risk, and health-related quality of life

• Clonidine is effective but may have intolerable side effects.
• Gabapentin and SSRIs/SNRIs may be effective but must be weighed against side effects, cost, dosing, and absolute benefit.
• Vitamin E should not be recommended as it was not effective.
• Evidence for other non-pharmacological therapies is limited.