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Hot Flash Management: Update of the Evidence for Patients With Cancer

Marcelle Kaplan
Suzanne Mahon
CJON 2014, 18(6), 59-67 DOI: 10.1188/14.CJON.S3.59-67

Hot flashes are a distressing symptom frequently experienced by survivors of breast cancer or prostate cancer who are receiving estrogen or androgen-deprivation therapies. The frequency and intensity of hot flashes can lead to diminished quality of life and decreased adherence with prescribed antineoplastic therapies. This evidence-based review synthesizes and updates the findings of the highest quality evidence-based studies of interventions to manage hot flashes resulting from cancer therapies in patients with breast or prostate cancer since the initial Putting Evidence Into Practice review of hot flashes in 2011. Recent studies involving a variety of pharmacologic and nonpharmacologic interventions were evaluated and, as reported in 2011, the drugs gabapentin and venlafaxine were the only therapies rated as likely to be effective. In addition, a strong placebo effect was noted in several studies that included a placebo intervention and should be considered when reviewing interventions for hot flashes.


Agarwal, P., & Oefelein, M. (2005). Testosterone replacement therapy after primary treatment for prostate cancer. <i>Journal of Urology, 173</i>, 533-536. doi:10.1097/01.ju.0000143942.55896.64

Ashamalla, H., Jiang, M. L., Guirguis, A., Peluso, F., & Ashamalla, M. (2011). Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. <i>International Journal of Radiation Oncology, Biology, and Physics, 79</i>, 1358-1363. doi:10.1016/j.ijrobp.2010.01.025

Baber, R., Hickey, M., & Kwik, M. (2005). Therapy for menopausal symptoms during and after treatment for breast cancer: Safety considerations. <i>Drug Safety, 28</i>, 1085-1100.

Barton, D. L., LaVasseur, B. I., Sloan, J. A., Stawis, A. N., Flynn, K. A., Dyar, M., … Loprinzi, C. L. (2010). Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG Trial N05C9. <i>Journal of Clinical Oncology, 28</i>, 3278-3283. doi:10.1200/JCO.2009.26.6379

Barton, D. L., Loprinzi, C. L., Quella, S. K., Sloan, J. A., Veeder, M. H., Egner, J. R., … Novotny, P. (1998). Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. <i>Journal of Clinical Oncology, 16</i>, 495-500.

Batur, P., Blixen, C. E., Moore, H. C., Thacker, H. L., & Xu, M. (2006). Menopausal hormone therapy (HT) in patients with breast cancer. <i>Maturitas, 53</i>, 123-132. doi:10.1016/j.maturitas.2005.03.004

Beer, T. M., Benavides, M., Emmons, S. L., Hayes, M., Liu, G., Garzotto, M., … Eilers, K. (2010). Acupuncture for hot flashes in patients with prostate cancer. <i>Urology, 76</i>, 1182-1188. doi:10.1016/j.urology.2010.03.033

Bertelli, G., Venturini, M., Del Mastro, L., Bergaglio, M., Sismondi, P., Biglia, N., … Rosso, R. (2002). Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: A randomized study. <i>Annals of Oncology, 13</i>, 883-888. doi:10.1093/annonc/mdf151

Biglia, N., Kubatzki, F., Sgandurra, P., Ponzone, R., Marenco, D., Peano, E., & Sismondi, P. (2007). Mirtazapine for the treatment of hot flushes in breast cancer survivors: A prospective pilot trial. <i>Breast Journal, 13</i>, 490-495.

Biglia, N., Sgandurra, P., Peano, E., Marenco, D., Moggio, G., Bounous, V., … Sismondi, P. (2009). Non-hormonal treatment of hot flushes in breast cancer survivors: Gabapentin vs. vitamin E. <i>Climacteric, 12</i>, 310-318. doi:10.1080/13697130902736921

Boekhout, A. H., Beijnen, J. H., & Schellens, J. H. (2006). Symptoms and treatment in cancer therapy-induced early menopause. <i>Oncologist, 11</i>, 641-654. doi:10.1634/theoncologist.11-6-641

Boekhout, A. H., Vincent, A. D., Dalesio, O. B., van den Bosch, J., Foekema-Töns, J. H., Adriaansz, S., … Schellens, J. H. (2011). Management of hot flashes in patients who have breast cancer with venlafaxine and clonidine: A randomized, double-blind, placebo-controlled trial. <i>Journal of Clinical Oncology, 29</i>, 3862-3868. doi:10.1200/JCO.2010.33.1298

Bokmand, S., & Flyger, H. (2012). Acupuncture relieves menopausal discomfort in breast cancer patients: A prospective, double blinded, randomized study. <i>Breast, 22</i>, 320-323. doi:10.1016/j.breast.2012.07.015

Bordeleau, L., Pritchard, K. I., Loprinzi, C. L., Ennis, M., Jugovic, O., Warr, D., … Goodwin, P. J. (2010). Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. <i>Journal of Clinical Oncology, 28</i>, 5147-5152. doi:10.1200/JCO.2010.29.9230

Buijs, C., Mom, C. H., Willemse, P. H., Marike Boezen, H., Maurer, J. M., Wymenga, A. N., … Mourits, M. J. (2009). Venlafaxine versus clonidine for the treatment of hot flashes in breast cancer patients: A double-blind, randomized cross-over study. <i>Breast Cancer Research and Treatment, 115</i>, 573-580. doi:10.1007/s10549-008-0138-7

Carpenter, J. S. (2001). The Hot Flash-Related Daily Interference Scale: A tool for assessing the impact of hot flashes on quality of life following breast cancer. <i>Journal of Pain and Symptom Management, 22</i>, 979-989. doi:10.1016/S0885-3924(01)00353-0

Carpenter, J. S. (2005). State of the science: Hot flashes and cancer. Part 1: Definition, scope, impact, physiology, and measurement. <i>Oncology Nursing Forum, 32</i>, 959-968. doi:10.1188/05.ONF.959-968

Carpenter, J. S., Wu, J., Burns, D. S., & Yu, M. (2012). Perceived control and hot flashes in treatment-seeking breast cancer survivors and menopausal women. <i>Cancer Nursing, 35</i>, 195-202. doi:10.1097/NCC.0b013e31822e78eb

Carson, J. W., Carson, K. M., Porter, L. S., Keefe, F. J., & Seewaldt, V. L. (2009). Yoga of Awareness program for menopausal symptoms in breast cancer survivors: Results from a randomized trial. <i>Supportive Care in Cancer, 17</i>, 1301-1309. doi:10.1007/s00520-009-0587-5

Clover, A., & Ratsey, D. (2002). Homeopathic treatment of hot flushes: A pilot study. <i>Homeopathy, 91</i>, 75-79. doi:10.1054/homp.2002.0004

Dalal, S., & Zhukovsky, D. S. (2006). Pathophysiology and management of hot flashes. <i>Journal of Supportive Oncology, 4</i>, 315-320, 325.

Deng, G., Vickers, A., Yeung, S., D'Andrea, G. M., Xiao, H., Heerdt, A. S., … Cassileth, B. (2007). Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. <i>Journal of Clinical Oncology, 25</i>, 5584-5590. doi:10.1200/JCO.2007.12.0774

de Valois, B. A., Young, T. E., Robinson, N., McCourt, C., & Maher, E. J. (2010). Using traditional acupuncture for breast cancer-related hot flashes and night sweats. <i>Journal of Alternative and Complementary Medicine, 16</i>, 1047-1057. doi:10.1089/acm.2009.0472

Dodin, S., Blanchet, C., Marc, I., Ernst, E., Wu, T., Vaillancourt, C., … Maunsell, E. (2013). Acupuncture for menopausal hot flushes. <i>Cochrane Database of Systematic Reviews, 7</i>, CD007410. doi:10.1002/14651858.CD007410.pub2

Duijts, S. F., van Beurden, M., Oldenburg, H. S., Hunter, M. S., Kieffer, J. M., Stuiver, M. M., … Aaronson, N. K. (2012). Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: Results of a randomized, controlled, multicenter trial. <i>Journal of Clinical Oncology, 30</i>, 4124-4133. doi:10.1200/JCO.2012.41.8525

Elkins, G., Marcus, J., Stearns, V., Perfect, M., Rajab, M. H., Ruud, C., … Keith, T. (2008). Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. <i>Journal of Clinical Oncology, 26</i>, 5022-5026. doi:10.1200/JCO.2008.16.6389

Elkins, G., Marcus, J., Stearns, V., & Rajab, M. H. (2007). Pilot evaluation of hypnosis for the treatment of hot flashes in breast cancer survivors. <i>Psycho-Oncology, 16</i>, 487-492. doi:10.1002/pon.1096

Engstrom, C. A. (2008). Hot flashes in prostate cancer: State of the science. <i>American Journal of Men's Health, 2</i>, 122-132. doi:10.1177/1557988306298802

Fagerlin, A., Zikmund-Fisher, B. J., Nair, V., Derry, H. A., McClure, J. B., Greene, S., … Ubel, P. A. (2010). Women's decisions regarding tamoxifen for breast cancer prevention: Responses to a tailored decision aid. <i>Breast Cancer Research and Treatment, 119</i>, 613-620. doi:10.1007/s10549-009-0618-4

Fenlon, D. R., Corner, J. L., & Haviland, J. S. (2008). A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer. <i>Journal of Pain and Symptom Management, 35</i>, 397-405. doi:10.1016/j.jpainsymman.2007.05.014

Filshie, J., Bolton, T., Browne, D., & Ashley, S. (2005). Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients—Audit and treatment algorithm. <i>Acupuncture in Medicine, 23</i>, 171-180. doi:10.1136/aim.23.4.171

Frisk, J. (2010). Managing hot flushes in men after prostate cancer. A systematic review. <i>Maturitas, 65</i>, 15-22. doi:10.1016/j.maturitas.2009.10.017

Frisk, J., Carlhäll, S., Källström, A. C., Lindh-Astrand, L., Malmström, A., & Hammar, M. (2008). Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: A prospective, randomized, controlled multicenter trial. <i>Climacteric, 11</i>, 166-174. doi:10.1080/13697130801958709

Frisk, J., Källström, A. C., Wall, N., Fredrikson, M., & Hammar, M. (2012). Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes. <i>Supportive Care in Cancer, 20</i>, 715-724. doi:10.1007/s00520-011-1134-8

Ganz, P. A., Greendale, G. A., Petersen, L., Zibecchi, L., Kahn, B., & Belin, T. R. (2000). Managing menopausal symptoms in breast cancer survivors: Results of a randomized controlled trial. <i>Journal of the National Cancer Institute, 92</i>, 1054-1064. doi:10.1093/jnci/92.13.1054

Garcia, M. K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., … Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. <i>Journal of Clinical Oncology, 31</i>, 952-960. doi:10.1200/JCO.2012.43.5818

Gerber, G. S., Zagaja, G. P., Ray, P. S., & Rukstalis, D. B. (2000). Transdermal estrogen in the treatment of hot flushes in men with prostate cancer. <i>Urology, 55</i>, 97-101. doi:10.1016/S0090-4295(99)00370-2

Goodwin, J. W., Green, S. J., Moinpour, C. M., Bearden, J. D., III, Giguere, J. K., Jiang, C. S., … Albain, K. S. (2008). Phase III randomized placebo-controlled trial of two doses of megestrol acetate as treatment for menopausal symptoms in women with breast cancer: Southwest Oncology Group Study 9626. <i>Journal of Clinical Oncology, 26</i>, 1650-1656.

Haest, K., Kumar, A., Van Calster, B., Leunen, K., Smeets, A., Amant, F., … Neven, P. (2012). Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: An uncontrolled experimental study with 24 weeks of follow-up. <i>Annals of Oncology, 23</i>, 1449-1454. doi:10.1093/annonc/mdr478

Hanisch, L. J., Palmer, S. C., Marcus, S. C., Hantsoo, L., Vaughn, D. J., & Coyne, J. C. (2009). Comparison of objective and patient-reported hot flash measures in men with prostate cancer. <i>Journal of Supportive Oncology, 7</i>, 131-135.

Hernández Muñoz, G., & Pluchino, S. (2003). Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. <i>Maturitas, 44</i>(Suppl. 1), S59-S65. doi:10.1016/S0378-5122(02)00349-3

Hervik, J., & Mjåland, J. (2009). Acupuncture for the treatment of hot flashes in breast cancer patients: A randomized, controlled trial. <i>Breast Cancer Research and Treatment, 116</i>, 311-316. doi:10.1007/s10549-008-0210-3

Howell, A., Cuzick, J., Baum, M., Buzdar, A., Dowsett, M., Forbes, J. F., … Tobias, J. S. (2005). Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. <i>Lancet, 365</i>, 60-62. doi:10.1016/S0140-6736(04)17666-6

Hunter, M. S., Coventry, S., Hamed, H., Fentiman, I., & Grunfeld, E. A. (2009). Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment. <i>Psycho-Oncology, 18</i>, 560-563. doi:10.1002/pon.1414

Irani, J., Salomon, L., Oba, R., Bouchard, P., & Mottet, N. (2010). Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: A double-blind, randomised trial. <i>Lancet Oncology, 11</i>, 147-154. doi:10.1016/S1470-2045(09)70338-9

Jacobs, J., Herman, P., Heron, K., Olsen, S., & Vaughters, L. (2005). Homeopathy for menopausal symptoms in breast cancer survivors: A preliminary randomized controlled trial. <i>Journal of Alternative and Complementary Medicine, 11</i>, 21-27. doi:10.1089/acm.2005.11.21

Jacobson, J. S., Troxel, A. B., Evans, J., Klaus, L., Vahdat, L., Kinne, D., … Grann, V. R. (2001). Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. <i>Journal of Clinical Oncology, 19</i>, 2739-2745.

Joffe, H., Partridge, A., Giobbie-Hurder, A., Li, X., Habin, K., Goss, P., … Garber, J. (2010). Augmentation of venlafaxine and selective serotonin reuptake inhibitors with zolpidem improves sleep and quality of life in breast cancer patients with hot flashes: A randomized, double-blind, placebo-controlled trial. <i>Menopause, 17</i>, 908-916. doi:10.1097/gme.0b013e3181dbee1b

Johnson. L. A. (2014). Putting Evidence Into Practice: The process for evidence-based research. <i>Clinical Journal of Oncology Nursing, 18</i>(Suppl. 3), 5-7.

Jones, J. M., Kohli, M., & Loprinzi, C. L. (2012). Androgen deprivation therapy-associated vasomotor symptoms. <i>Asian Journal of Andrology, 14</i>, 193-197. doi:10.1038/aja.2011.101

Kadakia, K. C., Loprinzi, C. L., & Barton, D. L. (2012). Hot flashes: The ongoing search for effective interventions. <i>Menopause, 19</i>, 719-721. doi:10.1097/gme.0b013e3182578d31

Kaplan, M., Mahon, S., Cope, D., Keating, E., Hill, S., & Jacobson, M. (2011). Putting Evidence Into Practice: Evidence-based interventions for hot flashes resulting from cancer therapies. <i>Clinical Journal of Oncology Nursing, 15</i>, 149-157.

Kaplan, M., & Mahon, S. M. (2013). Tamoxifen benefits and <i>CYP2D6</i> testing in women with hormone receptor-positive breast cancer. <i>Clinical Journal of Oncology Nursing, 17</i>, 174-179. doi:10.1188/13.CJON.174-179

Kelly, C. M., Juurlink, D. N., Gomes, T., Duong-Hua, M., Pritchard, K. I., Austin, P. C., & Paszat, L. F. (2010). Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population-based cohort study. <i>BMJ, 340</i>, c693. doi:10.1136/bmj.c693

Kenemans, P., Bundred, N. J., Foidart, J., Kubista, E., von Schoultz, B., Sismondi, P., … Beckmann, M. W. (2009). Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: A double-blind, randomised, non-inferiority trial. <i>Lancet Oncology, 10</i>, 135-146. doi:10.1016/S1470-2045(08)70341-3

Kimmick, G. G., Lovato, J., McQuellon, R., Robinson, E., & Muss, H. B. (2006). Randomized double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen. <i>Breast Journal, 12</i>, 114-122. doi:10.1111/j.1075-122X.2006 .00218.x

Kontos, M., Agbaje, O. F., Rymer, J., & Fentiman, I. S. (2010). What can be done about hot flashes after treatment for breast cancer? <i>Climacteric, 13</i>, 4-21. doi:10.3109/13697130903291058

Kouriefs, C., Georgiou, M., & Ravi, R. (2002). Hot flushes and prostate cancer: Pathogenesis and treatment. <i>BJU International, 89</i>, 379-383. doi:10.1046/j.1464-4096.2001.01761.x

Kroiss, R., Fentiman, I. S., Helmond, F. A., Rymer, J., Foidart, J. M., Bundred, N., … Kubista, E. (2005). The effect of tibolone in postmenopausal women receiving tamoxifen after surgery for breast cancer: A randomised, double-blind, placebo-controlled trial. <i>BJOG: An International Journal of Obstetrics and Gynaecology 112</i>, 228-233. doi:10.1111/j.1471-0528.2004.00309.x

Liljegren, A., Gunnarsson, P., Landgren, B. M., Robéus, N., Johansson, H., & Rotstein, S. (2012). Reducing vasomotor symptoms with acupuncture in breast cancer patients treated with adjuvant tamoxifen: A randomized controlled trial. <i>Breast Cancer Research and Treatment, 135</i>, 791-798. doi:10.1007/s10549-010-1283-3

Lipov, E. G., Joshi, J. R., Sanders, S., Wilcox, K., Lipov, S., Xie, H., … Slavin, K. (2008). Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: A pilot study. <i>Lancet Oncology, 9</i>, 523-532. doi:10.1016/S1470-2045(08)70131-1

Loibl, S., Schwedler, K., von Minckwitz, G., Strohmeier, R., Mehta, K. M., & Kaufmann, M. (2007). Venlafaxine is superior to clonidine as treatment of hot flashes in breast cancer patients—A double-blind, randomized study. <i>Annals of Oncology, 18</i>, 689-693. doi:10.1093/annonc/mdl478

Loprinzi, C. L., & Barton, D. L. (2009). Gadgets for measuring hot flashes: Have they become the gold standard? <i>Journal of Supportive Oncology, 7</i>, 136-137.

Loprinzi, C. L., Barton, D. L., & Qin, R. (2011). Nonestrogenic management of hot flashes. <i>Journal of Clinical Oncology, 29</i>, 3842-3846. doi:10.1200/JCO.2011.37.5865

Loprinzi, C. L., Goldberg, R. M., O'Fallon, J. R., Quella, S. K., Miser, A. W., Mynderse, L. A., … Dose, M. (1994). Transdermal clonidine for ameliorating post-orchiectomy hot flashes. <i>Journal of Urology, 151</i>, 634-636.

Loprinzi, C. L., Michalak, J. C., Quella, S. K., O'Fallon, J. R., Hatfield, A. K., Nelimark, R. A., … Oesterling, J. E. (1994). Megestrol acetate for the prevention of hot flashes. <i>New England Journal of Medicine, 331</i>, 347-352. doi:10.1056/NEJM199408113310602

Loprinzi, C. L., Sloan, J. A., Perez, E. A., Quella, S. K., Stella, P. J., Mailliard, J. A., … Rummans, T. A. (2002). Phase III evaluation of fluoxetine for treatment of hot flashes. <i>Journal of Clinical Oncology, 20</i>, 1578-1583. doi:10.1200/JCO.20.6.1578

MacGregor, C. A., Canney, P. A., Patterson, G., McDonald, R., & Paul, J. (2005). A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. <i>European Journal of Cancer, 41</i>, 708-714. doi:10.1016/j.ejca.2005.01.005

Mann, E., Smith, M. J., Hellier, J., Balabanovic, J. A., Hamed, H., Grunfeld, E. A., & Hunter, M. S. (2012). Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): A randomised controlled trial. <i>Lancet Oncology, 13</i>, 309-318. doi:10.1016/S1470-2045(11)70364-3

Moraska, A. R., Atherton, P. J., Szydlo, D. W., Barton, D. L., Stella, P. J., Rowland, K. M., Jr., … Loprinzi, C. L. (2010). Gabapentin for the management of hot flashes in prostate cancer survivors: A longitudinal continuation study—NCCTG Trial N00CB. <i>Journal of Supportive Oncology, 8</i>, 128-132.

Morrow, P. K., Mattair, D. N., & Hortobagyi, G. N. (2011). Hot flashes: A review of pathophysiology and treatment modalities. <i>Oncologist, 16</i>, 1658-1664. doi:10.1634/theoncologist.2011-0174

National Comprehensive Cancer Network. (2013). <i>NCCN Clinical Practice Guidelines in Oncology: Invasive breast cancer</i> [v.3.2013]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf'>http://w...

Nedstrand, E., Wijma, K., Wyon, Y., & Hammar, M. (2005). Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: A preliminary study. <i>Climacteric, 8</i>, 243-250. doi:10.1080/13697130500118050

Nikander, E., Metsa-Heikkilä, M., Ylikorkala, O., & Tiitinen, A. (2004). Effects of phytoestrogens on bone turnover in postmenopausal women with a history of breast cancer. <i>Journal of Clinical Endocrinology and Metabolism, 89</i>, 1207-1212. doi:10.1016/j.ejca.2005.01.005

Nuñez, G. R., Pinczowski, H., Zanellato, R., Tateyama, L., Schindler, F., Fonseca, F., & Del Giglio, A. (2013). Bupropion for control of hot flashes in breast cancer survivors: A prospective, double-blind, randomized, crossover, pilot phase II trial. <i>Journal of Pain and Symptom Management, 45</i>, 969-979. doi:10.1016/j.jpainsymman.2012.06.011

Otte, J. L., Carpenter, J. S., Zhong, X., & Johnstone, P. A. (2011). Feasibility study of acupuncture for reducing sleep disturbances and hot flashes in postmenopausal breast cancer survivors. <i>Clinical Nurse Specialist, 25</i>(5), 228-236. doi:10.1097/NUR.0b013e318229950b

Pandya, K. J., Raubertas, R. F., Flynn, P. J., Hynes, H. E., Rosenbluth, R. J., Kirshner, J. J., … Morrow, G. R. (2000). Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: A University of Rochester Cancer Center community clinical oncology program study. <i>Annals of Internal Medicine, 132</i>, 788-793. doi:10.7326/0003-4819-132-10-200005160-00004

Park, H., Parker, G. L., Boardman, C. H., Morris, M. M., & Smith, T. J. (2011). A pilot phase II trial of magnesium supplements to reduce menopausal hot flashes in breast cancer patients. <i>Supportive Care in Cancer, 19</i>, 859-863. doi:10.1007/s00520-011-1099-7

Pockaj, B. A., Gallagher, J. G., Loprinzi, C. L., Stella, P. J., Barton, D. L., Sloan, J. A., … Fauq, A. H. (2006). Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG trial N01CC1. <i>Journal of Clinical Oncology, 24</i>, 2836-2841. doi:10.1200/JCO.2005.05.4296

Quella, S. K., Loprinzi, C. L., Barton, D. L., Knost, J. A., Sloan, J. A., LaVasseur, B. I., … Novotny, P. J. (2000). Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group trial. <i>Journal of Clinical Oncology, 18</i>, 1068-1074.

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. <i>Cochrane Database of Systematic Reviews, 9</i>, CD004923. doi:10.1002/14651858.CD004923.pub2

Richardson, M. K. (2013). Alternatives to hormone therapy for hot flashes: Many choices but science is lacking. <i>Menopause, 20</i>, 980-982. doi:10.1097/GME.0b013e3182982436

Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., & Bartsch, H. H. (2011). Black cohosh (<i>Cimicifuga racemosa</i>) in tamoxifen-treated breast cancer patients with climacteric complaints—A prospective observational study. <i>Gynecological Endocrinology, 27</i>, 844-848. doi:10.3109/09513590.2010.538097

Schover, L. R., Jenkins, R., Sui, D., Adams, J. H., Marion, M. S., & Jackson, K. E. (2006). Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. <i>Journal of Clinical Oncology, 24</i>, 1620-1626. doi:10.1200/JCO.2005.04.7159

Shanafelt, T. D., Barton, D. L., Adjei, A. A., & Loprinzi, C. L. (2002). Pathology and treatment of hot flashes. <i>Mayo Clinic Proceedings, 77</i>, 1207-1218.

Sharma, P., Wisniewski, A., Braga-Basaria, M., Xu, X., Yep, M., Denmeade, S., … Basaria, S. (2009). Lack of an effect of high dose isoflavones in men with prostate cancer undergoing androgen deprivation therapy. <i>Journal of Urology, 182</i>, 2265-2272. doi:10.1016/j.juro.2009.07.030

Sismondi, P., Kimmig, R., Kubista, E., Biglia, N., Egberts, J., Mulder, R., … Kenemans, P. (2011). Effects of tibolone on climacteric symptoms and quality of life in breast cancer patients—Data from LIBERATE trial. <i>Maturitas, 70</i>, 365-372. doi:10.1016/j.maturitas.2011.09.003

Sloan, J. A., Loprinzi, C. L., Novotny, P. J., Barton, D. L., LaVasseur, B. I., & Windschitl, H. (2001). Methodologic lessons learned from hot flash studies. <i>Journal of Clinical Oncology, 19</i>, 4280-4290.

Stearns, V., Slack, R., Greep, N., Henry-Tilman, R., Osborne, M., Bunnell, C., … Isaacs, C. (2005). Paroxetine is an effective treatment for hot flashes: Results from a prospective randomized clinical trial. <i>Journal of Clinical Oncology, 23</i>, 6919-6930. doi:10.1200/JCO.2005.10.081

Thompson, E. A., & Reilly, D. (2003). The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients: A prospective observational study. <i>Homeopathy, 92</i>, 131-134. doi:10.1016/S1475-4916(03)00035-3

U. S. Food and Drug Administration. (2013). FDA approves the first non-hormonal treatment for hot flashes associated with menopause. Retrieved from <a target="_blank" href='http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm359030.htm'...

Vandecasteele, K., Ost, P., Oosterlinck, W., Fonteyne, V., Neve, W. D., & Meerleer, G. D. (2012). Evaluation of the efficacy and safety of Salvia officinalis in controlling hot flashes in prostate cancer patients treated with androgen deprivation. <i>Phytotherapy Research, 26</i>, 208-213. doi:10.1002/ptr.3528

Van Patten, C. L., Olivotto, I. A., Chambers, G. K., Gelmon, K. A., Hislop, T. G., Templeton, E., … Prior, J. C. (2002). Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: A randomized, controlled clinical trial. <i>Journal of Clinical Oncology, 20</i>, 1449-1455. doi:10.1200/JCO.20.6.1449

Vitolins, M. Z., Griffin, L., Tomlinson, W. V., Vuky, J., Adams, P. T., Moose, D., … Shaw, E. G. (2013). Randomized trial to assess the impact of venlafaxine and soy protein on hot flashes and quality of life in men with prostate cancer. <i>Journal of Clinical Oncology, 31</i>, 4092-4098. doi:10.1200/JCO.2012.48.1432

Walker, E. M., Rodriguez, A. I., Kohn, B., Ball, R. M., Pegg, J., Pocock, J. R., … Levine, R. A. (2010). Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: A randomized controlled trial. <i>Journal of Clinical Oncology, 28</i>, 634-640. doi:10.1200/JCO.2009.23.5150

Wu, M. F., Hilsenbeck, S. G., Tham, Y. L., Kramer, R., Elledge, R. M., Chang, J. C., & Friedman, L. C. (2009). The efficacy of sertraline for controlling hot flashes in women with or at high risk of developing breast cancer. <i>Breast Cancer Research and Treatment, 118</i>, 369-375. doi:10.1007/s10549-009-0425-y

Younus, J., Simpson, I., Collins, A., & Wang, X. (2003). Mind control of menopause. <i>Women's Health Issues, 13</i>, 74-78. doi:10.1016/S1049-3867(02)00196-2