Ramaswami, R., Villarreal, M.D., Pitta, D.M., Carpenter, J.S., Stebbing, J., & Kalesan, B. (2015). Venlafaxine in management of hot flashes in women with breast cancer: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 152, 231–237. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effectiveness of venlafaxine to reduce hot flashes among women with breast cancer
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Medline, Scopus, and Cochrane Central Register of Controlled Trials
 
KEYWORDS: Breast cancer, venlafaxine, hot flash, symptoms, meta-analysis, review
 
INCLUSION CRITERIA: Randomized clinical trials, quasi-randomized, any language, reviewed conference proceedings. Comparing venlafaxine with nonhormonal antidepressants and Selective Serotonin Reuptake Inhibitors (SSRI), amitriptyline, clonidine, vitamin E, and acupuncture.
 
EXCLUSION CRITERIA: Studies with doubts on concealment of allocation, blinding of investigators or not opaque

Literature Evaluated

TOTAL REFERENCES RETRIEVED: n = 47 references
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Each study done by two authors using criteria from the Cochrane Handbook

Sample Characteristics

FINAL NUMBER OF STUDIES INCLUDED = 5 of 15 reports were eligible
 
TOTAL PATIENTS INCLUDED IN REVIEW = 525 participants randomized to venlafaxine or comparators
 
KEY SAMPLE CHARACTERISTICS: Women with breast cancer aged 50–56 years, using 75 mg once daily or more of venlafaxine or clonidine, acupuncture, gabapentin, and placebo agents

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after active treatment
 
APPLICATIONS: Elder care, palliative care

Results

Venlafaxine is superior compared to placebo or other nonhormonal therapies in the management of hot flashes. Clonidine also demonstrated benefits.

Conclusions

Dose of 75 mg venlafaxine is efficacious for hot flashes in women with breast cancer and should be considered as a first-line treatment. Venlafaxine or clonidine is safe and not associated with breast cancer mortality or CYP2D6 activity.

Limitations

There was a high heterogeneity among trials. None was analyzed as intention to treat (ITT) analysis. Concealment of allocation was unclear among three of six. Blinding was not feasible in the study with acupuncture. In five of six studies, blinding of outcome assessment was unclear or absent. Incomplete data or missing was not equal in groups in all studies.

Nursing Implications

This is important for cancer survivors without clear guidelines on symptom management after cancer treatment. North American population, mostly tool validation; expected differences in other populations. An apparent benefit exists in reducing hot flashes, but it needs a multicentered trial to confirm. Nurses should advise further research in standardizing hot flash scoring and need a standardized scoring approach.

Legacy ID

5745