© Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or otherwise reuse any or all content from this article, e-mail pubpermissions@ons.org. To purchase high-quality reprints, email reprints@ons.org.


December 2014, Supplement to Volume 18, Number 6



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

Marcelle Kaplan, RN, MS, AOCN®, CBCN®, and Suzanne Mahon, RN, DNSc, AOCN®, APNG


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.


Hot flashes are often a lasting and distressing side effect of antineoplastic treatment, particularly for women with breast cancer and men with prostate cancer. Hot flashes have been reported in 65%–80% of breast cancer survivors (Kontos, Agbaje, Rymer, & Fentiman, 2010; Mann et al., 2012) and as many as 80% of men with prostate cancer treated with androgen-deprivation therapy (ADT) (Frisk, 2010). A hot flash has been defined as “a subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and a subsequent drop in core temperature” (Boekhout, Beijnen, & Schellens, 2006, p. 642). Hot flashes generally involve the face and chest and are characterized by their transient and unpredictable nature (Jones, Kohli, & Loprinzi, 2012). The vasomotor symptoms that characterize hot flashes (e.g., feelings of intense heat, profuse sweating, flushing) have a negative effect on sleep, energy, sexuality, and overall quality of life (Kadakia, Loprinzi, & Barton, 2012).


Hot flashes are reported to be significantly more frequent and severe in women treated for breast cancer than in women undergoing natural menopause (Carpenter, 2005; Kadakia et al., 2012). Hot flashes are believed to be precipitated by the abrupt suppression of ovarian function caused by chemotherapy-induced premature menopause and/or the use of estrogen withdrawal therapies, including tamoxifen and aromatase inhibitors (Baber, Hickey, & Kwik, 2005; Howell et al., 2005; Morrow, Mattair, & Hortobagyi, 2011). Tamoxifen has been shown to produce more frequent and severe hot flashes than the aromatase inhibitors anastrozole and letrozole (Howell et al., 2005; Morrow et al., 2011). Men with advanced prostate cancer who receive ADT via surgical or chemical castration also experience distressing hot flashes that may persist for at least eight years following treatment (Frisk, 2010).


The exact physiologic mechanisms of hot flashes are unknown, and what is known comes mainly from studies with menopausal women (Shanafelt, Barton, Adjei, & Loprinzi, 2002). Core body temperature is regulated centrally in the hypothalamus and is maintained within a narrow physiologic set range called the thermoneutral zone. Elevations of core temperature above the set range stimulate the hypothalamus to activate such heat-dissipating mechanisms as profuse sweating and cutaneous vasodilation, manifested as hot flashes (Dalal & Zhukovsky, 2006; Morrow et al., 2011). Plasma sex hormones (estrogen in women, gonadal hormones in men) are involved in regulating the hypothalamic thermoregulatory center through negative feedback mechanisms involving the neurotransmitters serotonin and norepinephrine (Shanafelt et al., 2002). The abrupt withdrawal of sex hormones, which occurs with estrogen therapy or ADT, leads to dysfunction of the thermoregulatory center in the hypothalamus whereby even small, transitory elevations in the core temperature trigger the heat-loss mechanisms characteristic of hot flashes (Boekhout et al., 2006; Kouriefs, Georgiou, & Ravi, 2002; Shanafelt et al., 2002).


Subjective measures of hot flashes include assessing the frequency, severity, intensity, distress, and interference with daily activities (Carpenter, Wu, Burns, & Yu, 2012). Data collected from retrospective self-reported hot flash diaries that have been validated in women with breast cancer and men with prostate cancer (the Loprinzi and Sloan Self-Report Diary) (Sloan et al., 2001), as well as in women with breast cancer (the Hot Flash-Related Daily Interference Scale) (Carpenter, 2001), are deemed sufficient for clinical practice (Hanisch et al., 2009; Loprinzi & Barton, 2009).


For an overview of the methods used in creating the Putting Evidence Into Practice (PEP®) resources, see Johnson (2014). The current article updates and synthesizes the evidence for interventions to manage hot flashes in women with breast cancer and men with prostate cancer since those presented by Kaplan et al. (2011). Search methods are available at www.ons.org/content/hot-flashes-search-strategy. Sources of evidence are divided into pharmacologic and nonpharmacologic interventions.


Pharmacologic Interventions


Likely to Be Effective


Gabapentin: Several randomized, controlled clinical trials demonstrated the efficacy of gabapentin in reducing hot flashes in women with breast cancer, as described in Kaplan et al. (2011) and in a systematic review by Rada et al. (2010). In addition, a randomized crossover study of gabapentin and venlafaxine in women with breast cancer (N = 38) revealed that both agents decreased hot flashes. Gabapentin was associated with more dizziness (p = 0.005) and increased appetite (p < 0.001) (Bordeleau et al., 2010). A self-report study of 117 men with prostate cancer who received gabapentin 600 mg per day showed moderately decreased hot flash scores without substantial toxicities (Moraska et al., 2010).


Venlafaxine: Several randomized, controlled trials have demonstrated the efficacy of venlafaxine, a selective serotonin reuptake inhibitor (SSRI) antidepressant, in reducing hot flashes. A randomized crossover study of 38 women with breast cancer compared gabapentin and venlafaxine, and both agents were found to decrease hot flashes. Venlafaxine was associated with loss of appetite (p = 0.003), nausea (p = 0.02), and constipation (p = 0.05), but fewer negative mood changes (p = 0.01) than gabapentin (Bordeleau et al., 2010). A 12-week, double-blind trial comparing clonidine, venlafaxine, and placebo in 80 women with a history of breast cancer found venlafaxine and clonidine were slightly more effective than placebo in reducing hot flash symptoms. Of note, all study groups showed significant reduction in symptoms at 12 weeks, including the placebo group, which reported a 29% decrease in hot flashes (Boekhout et al., 2011). Venlafaxine was not found to be superior to cyproterone acetate and medroxyprogesterone acetate in a double-blind randomized study of men experiencing significant hot flushes during androgen-suppression therapy (N = 109). However, no placebo control group was included (Irani, Salomon, Oba, Bouchard, & Mottet, 2010).


Effectiveness Not Established


Clonidine: In prior randomized trials, clonidine demonstrated a moderate reduction in tamoxifen-induced hot flashes in women with breast cancer (Buijs et al., 2009), in association with a significant placebo effect (Pandya et al., 2000), and was shown to be less effective than venlafaxine (Loibl et al., 2007). A similar placebo-controlled trial in men treated with orchiectomy for prostate cancer found no significant benefit for clonidine (Loprinzi, Goldberg, et al., 1994). In a systematic review, Rada et al. (2010) reported that clonidine provided benefit in reducing hot flashes in women with breast cancer. A randomized, double-blind, placebo-controlled, 12-week study of 80 women with a history of breast cancer compared clonidine, venlafaxine, and placebo. Hot flash scores were found to be significantly lower in the clonidine group versus placebo (p = 0.03), were not significant for venlafaxine versus placebo (p = 0.07), and were equal in the clonidine and venlafaxine groups (Boekhout et al., 2011). However, Loprinzi, Barton, and Qin (2011) cited methodologic issues related to the study, including an inadequate sample size per study arm, an unbalanced randomization scheme (2:2:1), and an uneven dropout rate among treatment arms.


Progestin therapies: Mixed results were reported in studies examining the efficacy of megestrol and medroxyprogesterone in reducing hot flashes in men with prostate cancer and women with breast cancer (Bertelli et al., 2002; Frisk, 2010; Goodwin et al., 2008; Loprinzi, Michalak, et al., 1994). A systematic literature review of hot flash interventions for men treated for prostate cancer found that some hormone agents were able to decrease hot flashes by at least 75% but produced severe side effects. Cyproterone acetate was associated with fatigue, weight gain, depressed mood, gynecomastia, and hot flushes. Megestrol produced weight gain, edema, and nausea and increased the prostatic-specific antigen in one patient, raising concerns about promoting prostate cancer (Frisk, 2010). All studies were too limited to evaluate safety and long-term risks of treatment. Irani et al. (2010) conducted a 12-week double-blind study of three drugs to manage hot flashes in men receiving ADT for prostate cancer: venlafaxine 75 mg per day (n = 102), medroxyprogesterone acetate 20 mg per day (n = 108), or cyproterone acetate 100 mg per day (n = 101). No comparator placebo control arm was included. All three drugs were found to reduce hot flashes in men, but cyproterone acetate and medroxyprogesterone were most effective (Irani et al., 2010). However, cyproterone acetate is used to treat prostate cancer and could interfere with ADT (Jones et al., 2012). In general, hormone therapies are not recommended for patients with prostate or breast cancer because of concerns about promoting tumor growth (Rada et al., 2010).


Stellate ganglion block: A stellate ganglion block is an injection of local anesthetic into the sympathetic nerve tissue in the anterior neck. A small study (N = 13) that investigated the effectiveness of stellate ganglion block in women with breast cancer and hot flashes found a significant decrease in weekly hot flash episodes during a 12-week period (Lipov et al., 2008). In a prospective single-arm trial, 34 women with breast cancer who were resistant to other therapies were treated with a stellate ganglion block. Although hot flashes were reduced initially, they gradually returned over time (Haest et al., 2012).


Zolpidem: In one study, 53 women with breast cancer were asked whether they were currently using an SSRI or a serotonin-norepinephrine reuptake inhibitor (SNRI) to treat hot flashes. Those taking an SSRI or SNRI were instructed to continue on the medication. Nonusers were started on venlafaxine (an SSRI) at 75 mg per day. All participants were then randomized to receive daily zolpidem 10 mg or placebo for five weeks. Although no change was seen in the number of hot flashes, zolpidem appeared to improve the perception of nighttime hot flashes, perhaps by allowing the patient to sleep through the hot flash (Joffe et al., 2010).


Other Interventions


Buproprion: In a randomized, double-blind, crossover, placebo-controlled pilot study of bupropion 150 mg in breast cancer survivors (N = 55), participants reported a larger reduction in hot flashes with placebo and a preference for placebo (Nuñez et al., 2013).


Citalopram: One randomized, placebo-controlled, double-blind trial evaluated three oral dosages of citalopram (10 mg, 20 mg, and 30 mg per day) versus placebo for six weeks in 254 postmenopausal women experiencing hot flashes. Ninety-one participants had a history of breast cancer, and 69 were receiving concurrent estrogen-deprivation therapy. Hot flash scores decreased from baseline with all dose levels of citalopram compared with placebo (p < 0.002). No significant response to doses of more than 10 mg per day was noted (Barton et al., 2010).


Magnesium: In a small observational study, 25 women with breast cancer experiencing hot flashes completed treatment with magnesium 400 mg per day for four weeks, escalating to 800 mg per day if needed. Reductions in weekly hot flash scores (frequency times severity) ranged from more than 50% to more than 25% (Park, Parker, Boardman, Morris, & Smith, 2011).


Miscellaneous agents: Other pharmacologic agents investigated in small studies that produced mixed results include transdermal estrogen patches in men (Gerber, Zagaja, Ray, & Rukstalis, 2000), fluoxetine (Loprinzi et al., 2002), mirtazapine (Biglia et al., 2007), sertraline (Kimmick, Lovato, McQuellon, Robinson, & Muss, 2006; Wu et al., 2009), testosterone-replacement therapy in men (Agarwal & Oefelein, 2005), and vitamin E (Barton et al., 1998; Biglia et al., 2009), which was also found not effective in a systematic review by Rada et al. (2010).


Benefits Balanced With Harms


Paroxetine: A small randomized, placebo-controlled trial of two dose levels of paroxetine in women with breast cancer showed a significant reduction in hot flashes with both doses (Stearns et al., 2005). However, paroxetine is an SSRI antidepressant that is a strong inhibitor of the CYP2D6 enzyme system that acts to metabolize tamoxifen to its active form, endoxifen (Kaplan & Mahon, 2013). A retrospective study of women with breast cancer taking tamoxifen and paroxetine showed a significantly increased risk of death from breast cancer with overlapping use of both agents (Kelly et al., 2010). Caution is recommended in the use of paroxetine for women experiencing tamoxifen-induced hot flashes (National Comprehensive Cancer Network, 2013).


Not Recommended for Practice


Tibolone: A double-blind placebo-controlled trial comparing tibolone, a synthetic steroid with properties that mimic estrogen, progestins, and androgens, to placebo in women with tamoxifen-induced hot flashes showed no change in hot flash episodes in either arm after three months. Effects of tibolone on recurrence of breast cancer are unknown (Kroiss et al., 2005). A multinational, double-blind, placebo-controlled trial randomized 3,098 women with breast cancer to daily oral tibolone (2.5 mg) or placebo. Mean treatment duration was lengthy at 2.75 years. Tibolone was found to be effective in alleviating menopausal symptoms in breast cancer survivors overall but was less effective in women taking tamoxifen or aromatase inhibitors. A persistent placebo effect was noted (Sismondi et al., 2011). In a randomized, double-blind safety and efficacy trial of tibolone versus placebo in women with breast cancer and vasomotor symptoms, tibolone was found to be effective in relieving symptoms, but the trial was stopped prematurely because of increased recurrence of breast cancer in the tibolone group (Kenemans et al., 2009).


Nonpharmacologic Interventions


Effectiveness Not Established


Acupuncture: Several randomized trials of acupuncture in women with breast cancer and men with prostate cancer that demonstrated a decrease in hot flashes were identified. However, methodologic issues included sample sizes of fewer than 75 participants in all studies combined and limited follow-up that did not exceed six months in any study (Deng et al., 2007; de Valois, Young, Robinson, McCourt, & Maher, 2010; Filshie, Bolton, Browne, & Ashley, 2005; Frisk et al., 2008; Frisk, Källström, Wall, Fredrikson, & Hammar, 2012; Hervik & Mjåland, 2009; Liljegren et al., 2012; Nedstrand, Wijma, Wyon, & Hammar, 2005; Otte, Carpenter, Zhong, & Johnstone, 2011; Walker et al., 2010). A prospective single-arm trial of 14 men with prostate cancer found a short-term decrease in hot flash intensity and frequency (Ashamalla, Jiang, Guirguis, Peluso, & Ashamalla, 2011). Similar findings were reported by Beer et al. (2010) in a study of 22 men with prostate cancer. A prospective, double-blind, randomized study in women with “troublesome” hot flashes related to breast cancer therapies tested the effect of real acupuncture (n = 31) against sham acupuncture (n = 29) and no treatment (n = 34). The researchers reported that significant relief was achieved after the second real acupuncture treatment compared to the sham acupuncture and no-treatment groups (p < 0.05) that lasted for at least 12 weeks. However, some women in all groups concurrently received a variety of other hot flash therapies, including clonidine and/or venlafaxine, mirtazapine with clonidine, and hormone replacement (Bokmand & Flyger, 2012).


In a systematic review of 41 randomized clinical trials, the efficacy of acupuncture for symptoms other than chemotherapy-induced nausea and vomiting could not be determined because of the high risk of bias among the studies (Garcia et al., 2013). A systematic review of 16 studies that compared acupuncture versus sham acupuncture did not provide sufficient evidence to determine whether acupuncture is an effective treatment for vasomotor symptoms. Debate exists about whether sham acupuncture is a placebo intervention or whether it possesses an active effect related to peripheral sensory stimulation (Dodin et al., 2013).


Cognitive-behavioral interventions: In a randomized, controlled trial, Ganz et al. (2000) studied the impact of comprehensive menopausal symptom assessment in 42 breast cancer survivors and found no change in the number of hot flashes. Using similar methodology, an exploratory trial of 17 women with breast cancer showed a decrease in the number of hot flashes (Hunter, Coventry, Hamed, Fentiman, & Grunfeld, 2009). In a study by Mann et al. (2012), 96 symptomatic women seen in a breast cancer clinic were enrolled in a randomized trial in which individualized “usual care” by breast care nurses was compared to usual care plus group cognitive-behavioral therapy (CBT) intervention. Group CBT incorporated group discussions, handouts, and weekly homework with audio instructions for daily relaxation and paced breathing exercises at home. Little difference in hot flash frequency and night sweats was found between the two groups at weeks 9 and 26 (Mann et al., 2012). Members of both groups received individualized attention and may have benefited from the placebo effect. A study of 422 women with breast cancer randomized to CBT, physical exercise, CBT and physical exercise, or a control group found that CBT resulted in a significant decrease in the perceived burden of hot flashes and night sweats using the problem-rating portion of the Hot Flush Rating Scale (p < 0.001, effect size = 0.39–0.56) (Duijts et al., 2012).


Other interventions: Several studies evaluating the effectiveness of black cohosh have provided conflicting evidence (Hernández Muñoz & Pluchino, 2003; Jacobson et al., 2001; Pockaj et al., 2006; Rostock et al., 2011). Other intervention strategies with limited research that demonstrated some decrease in hot flashes include peer counseling (Schover et al., 2006), relaxation therapy (Fenlon, Corner, & Haviland, 2008; Rada et al., 2010), yoga (Carson, Carson, Porter, Keefe, & Seewaldt, 2009), hypnosis (Elkins et al., 2008; Elkins, Marcus, Stearns, & Rajab, 2007; Younus, Simpson, Collins, & Wang, 2003), and Salvia officinalis (i.e., a medicinal herb more commonly known as sage) (Vandecasteele et al., 2012).


Effectiveness Unlikely


Homeopathy: The homeopathy approach to treating hot flashes usually involves a consultation with a homeopathic practitioner who prescribes an individualized homeopathic remedy. The ingredients and doses of the homeopathic remedies reported in several studies were unclear or lacking (Clover & Ratsey, 2002; Jacobs, Herman, Heron, Olsen, & Vaughters, 2005; Thompson & Reilly, 2003) making it impossible to replicate the intervention in clinical practice or truly evaluate the effectiveness of the intervention (Rada et al., 2010).


Soy supplements: Depending on the study, soy supplements were provided in the form of capsules, tablets, powder, or beverage (MacGregor, Canney, Patterson, McDonald, & Paul, 2005; Nikander, Metsa-Heikkilä, Ylikorkala, & Tiitinen, 2004; Quella et al., 2000; Sharma et al., 2009; Van Patten et al., 2002). A 12-week placebo-controlled study randomized 120 androgen-deprived men with prostate cancer and hot flashes to venlafaxine alone, venlafaxine plus soy, soy alone, or placebo. Results indicated that neither venlafaxine nor soy, alone or in combination, had a significant effect on hot flash symptom severity. At week 12, hot flashes decreased 28% in the venlafaxine plus soy arm, 35% in the venlafaxine arm, and 31% in the soy arm. The placebo arm had a 55% decrease in hot flashes (Vitolins et al., 2013).


The Placebo Effect on Hot Flash Interventions


Analysis of numerous hot flash intervention studies has revealed that even participants who received a placebo intervention reported significant reductions in hot flash activity. About 25% of participants who received a placebo reported a reduction of 50% or more in hot flashes and 15% indicated more than a 75% reduction (Boekhout et al., 2006). A review of data from 375 participants in seven randomized, placebo-controlled clinical trials found that those receiving the placebo intervention reported an average decrease of 25% in hot flash frequency and scores at four weeks (Sloan et al., 2001). A study comparing the efficacy of venlafaxine and clonidine versus placebo in reducing hot flash symptoms found that patients receiving placebo reported a 29% decrease in hot flashes (Boekhout et al., 2011). A small, double-blind, crossover study that compared bupropion to placebo reported a larger reduction in hot flashes in the placebo group and a preference for the placebo intervention (Nuñez et al., 2013). Patients randomized to venlafaxine, soy, or placebo reported a reduction in hot flash severity of 55% in the placebo arm compared to reductions ranging from 28%–35% in the treatment arms (Vitolins et al., 2013). Therefore, the beneficial results of placebo therapy should be considered when examining reports of new hot flash interventions that have not been studied in rigorous, randomized, controlled clinical trials.


Conclusion and Implications for Practice


Women and men who experience hot flashes as a result of hormone-deprivation therapies may discontinue treatment prematurely and lose the potential survival benefit conferred by these therapies. Five years of tamoxifen use is associated with a 50% reduction in risk of breast cancer recurrence (Batur, Blixen, Moore, Thacker, & Xu, 2006), but early discontinuation rates for tamoxifen therapy range from 15%–35% (Buijs et al., 2009). Women at high risk for breast cancer who are recommended tamoxifen for chemoprevention often do not adhere because of concerns about side effects, including hormonal symptoms (Fagerlin et al., 2010). The persistence of hot flashes in men has been associated with their decision to discontinue ADT (Engstrom, 2008). Nurses should be aware that, although the U.S. Food and Drug Administration (2013) recently approved paroxetine as a nonhormonal treatment for postmenopausal hot flashes, caution is needed in women with tamoxifen-induced hot flashes because paroxetine is a strong inhibitor of the CYP2D6 enzyme system that metabolizes tamoxifen to its active form. Although the current evidence regarding effective interventions to manage hot flashes is limited, interventions including gabapentin and venlafaxine are emerging as potentially effective therapies. No high-quality evidence was found supporting the efficacy of dietary or lifestyle interventions (e.g., CBT, exercise, yoga) in reducing hot flashes in patients with cancer. Nurses can discuss with patients non–evidence-based behavioral approaches that may help to mitigate hot flashes (see Figure 1).


This article provides an overview and evaluation of the interventions that have been studied to manage hot flashes in cancer survivors, particularly individuals with breast or prostate cancer. Additional randomized clinical trials with long-term follow-up for safety and efficacy are needed for all interventions. Nurses should remember the contributions of the placebo effect when reviewing the results of published studies about hot flash management.


Implications for Practice


Ø  Ask women treated for breast cancer or who experience treatment-related premature menopause and men treated with androgen-deprivation therapy for prostate cancer, whether they have hot flashes. If they do, ask them to describe the frequency, severity, and effect on quality of life.


Ø  Discuss some pharmacologic and nonpharmacologic interventions that have been studied in at-risk patient populations to manage hot flashes.


Ø  Provide information about some behavioral techniques (emphasizing that they are not evidence based) that may help prevent or alleviate hot flashes.


The authors gratefully acknowledge the contributions of  the following Oncology Nursing Society staff: Margaret Irwin, RN, PhD, Lee Ann Johnson, MSN, RN, Kerri A. Moriarty, MLS, and Mark Vrabel, MLS, AHIP, ELS; as well as members of the Putting Evidence Into Practice hot flash team: Elizabeth Abernathy, RN, MSN, APRN, AOCNS®, Dale Grimmer, RN, MS, AOCN®, CCRC, and Paz Fernandez-Ortega, RN.




Agarwal, P., & Oefelein, M. (2005). Testosterone replacement therapy after primary treatment for prostate cancer. Journal of Urology, 173, 533–536. http://dx.doi.org/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. International Journal of Radiation Oncology, Biology, and Physics, 79, 1358–1363. http://dx.doi.org/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. Drug Safety, 28, 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. Journal of Clinical Oncology, 28, 3278–3283. http://dx.doi.org/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. Journal of Clinical Oncology, 16, 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. Maturitas, 53, 123–132. http://dx.doi.org/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. Urology, 76, 1182–1188. http://dx.doi.org/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. Annals of Oncology, 13, 883–888. http://dx.doi.org/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. Breast Journal, 13, 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. Climacteric, 12, 310–318. http://dx.doi.org/10.1080/13697130902736921


Boekhout, A.H., Beijnen, J.H., & Schellens, J.H. (2006). Symptoms and treatment in cancer therapy-induced early menopause. Oncologist, 11, 641–654. http://dx.doi.org/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. Journal of Clinical Oncology, 29, 3862–3868. http://dx.doi.org/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. Breast, 22, 320-323. http://dx.doi.org/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. Journal of Clinical Oncology, 28, 5147–5152. http://dx.doi.org/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. Breast Cancer Research and Treatment, 115, 573–580. http://dx.doi.org/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. Journal of Pain and Symptom Management, 22, 979–989. http://dx.doi.org/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. Oncology Nursing Forum, 32, 959–968. http://dx.doi.org/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. Cancer Nursing, 35, 195–202. http://dx.doi.org/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. Supportive Care in Cancer, 17, 1301–1309. http://dx.doi.org/10.1007/s00520-009-0587-5


Clover, A., & Ratsey, D. (2002). Homeopathic treatment of hot flushes: A pilot study. Homeopathy, 91, 75–79. http://dx.doi.org/10.1054/homp.2002.0004


Dalal, S., & Zhukovsky, D.S. (2006). Pathophysiology and management of hot flashes. Journal of Supportive Oncology, 4, 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. Journal of Clinical Oncology, 25, 5584–5590. http://dx.doi.org/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. Journal of Alternative and Complementary Medicine, 16, 1047–1057. http://dx.doi.org/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. Cochrane Database of Systematic Reviews, 7, CD007410. http://dx.doi.org/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. Journal of Clinical Oncology, 30, 4124–4133. http://dx.doi.org/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. Journal of Clinical Oncology, 26, 5022–5026. http://dx.doi.org/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. Psycho-Oncology, 16, 487–492. http://dx.doi.org/10.1002/pon.1096


Engstrom, C.A. (2008). Hot flashes in prostate cancer: State of the science. American Journal of Men’s Health, 2, 122–132. http://dx.doi.org/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. Breast Cancer Research and Treatment, 119, 613–620. http://dx.doi.org/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. Journal of Pain and Symptom Management, 35, 397–405. http://dx.doi.org/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. Acupuncture in Medicine, 23, 171–180. http://dx.doi.org/10.1136/aim.23.4.171


Frisk, J. (2010). Managing hot flushes in men after prostate cancer. A systematic review. Maturitas, 65, 15–22. http://dx.doi.org/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. Climacteric, 11, 166–174. http://dx.doi.org/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. Supportive Care in Cancer, 20, 715–724. http://dx.doi.org/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. Journal of the National Cancer Institute, 92, 1054–1064. http://dx.doi.org/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. Journal of Clinical Oncology, 31, 952–960. http://dx.doi.org/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. Urology, 55, 97–101. http://dx.doi.org/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. Journal of Clinical Oncology, 26, 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. Annals of Oncology, 23, 1449–1454. http://dx.doi.org/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. Journal of Supportive Oncology, 7, 131–135.


Hernández Muñoz, G., & Pluchino, S. (2003). Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas, 44(Suppl. 1), S59–S65. http://dx.doi.org/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. Breast Cancer Research and Treatment, 116, 311–316. http://dx.doi.org/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. Lancet, 365, 60–62. http://dx.doi.org/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. Psycho-Oncology, 18, 560–563. http://dx.doi.org/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. Lancet Oncology, 11, 147–154. http://dx.doi.org/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. Journal of Alternative and Complementary Medicine, 11, 21–27. http://dx.doi.org/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. Journal of Clinical Oncology, 19, 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. Menopause, 17, 908–916. http://dx.doi.org/10.1097/gme.0b013e3181dbee1b


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


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


Kadakia, K.C., Loprinzi, C.L., & Barton, D.L. (2012). Hot flashes: The ongoing search for effective interventions. Menopause, 19, 719–721. http://dx.doi.org/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. Clinical Journal of Oncology Nursing, 15, 149–157.


Kaplan, M., & Mahon, S.M. (2013). Tamoxifen benefits and CYP2D6 testing in women with hormone receptor-positive breast cancer. Clinical Journal of Oncology Nursing, 17, 174–179. http://dx.doi.org/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. BMJ, 340, c693. http://dx.doi.org/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. Lancet Oncology, 10, 135–146. http://dx.doi.org/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. Breast Journal, 12, 114–122. http://dx.doi.org/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? Climacteric, 13, 4–21. http://dx.doi.org/10.3109/13697130903291058


Kouriefs, C., Georgiou, M., & Ravi, R. (2002). Hot flushes and prostate cancer: Pathogenesis and treatment. BJU International, 89, 379–383. http://dx.doi.org/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. BJOG: An International Journal of Obstetrics and Gynaecology 112, 228–233. http://dx.doi.org/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. Breast Cancer Research and Treatment, 135, 791–798. http://dx.doi.org/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. Lancet Oncology, 9, 523–532. http://dx.doi.org/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. Annals of Oncology, 18, 689–693. http://dx.doi.org/10.1093/annonc/mdl478


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


Loprinzi, C.L., Barton, D.L., & Qin, R. (2011). Nonestrogenic management of hot flashes. Journal of Clinical Oncology, 29, 3842–3846. http://dx.doi.org/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. Journal of Urology, 151, 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. New England Journal of Medicine, 331, 347–352. http://dx.doi.org/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. Journal of Clinical Oncology, 20, 1578–1583. http://dx.doi.org/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. European Journal of Cancer, 41, 708–714. http://dx.doi.org/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. Lancet Oncology, 13, 309–318. http://dx.doi.org/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. Journal of Supportive Oncology, 8, 128–132.


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


National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines in Oncology: Invasive breast cancer [v.3.2013]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf


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. Climacteric, 8, 243–250. http://dx.doi.org/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. Journal of Clinical Endocrinology and Metabolism, 89, 1207–1212. http://dx.doi.org/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. Journal of Pain and Symptom Management, 45, 969–979. http://dx.doi.org/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. Clinical Nurse Specialist, 25(5), 228–236. http://dx.doi.org/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. Annals of Internal Medicine, 132, 788–793. http://dx.doi.org/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. Supportive Care in Cancer, 19, 859–863. http://dx.doi.org/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. Journal of Clinical Oncology, 24, 2836–2841. http://dx.doi.org/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. Journal of Clinical Oncology, 18, 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. Cochrane Database of Systematic Reviews, 9, CD004923. http://dx.doi.org/10.1002/14651858.CD004923.pub2


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


Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., & Bartsch, H.H. (2011). Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints—A prospective observational study. Gynecological Endocrinology, 27, 844–848. http://dx.doi.org/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. Journal of Clinical Oncology, 24, 1620–1626. http://dx.doi.org/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. Mayo Clinic Proceedings, 77, 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. Journal of Urology, 182, 2265–2272. http://dx.doi.org/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. Maturitas, 70, 365–372. http://dx.doi.org/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. Journal of Clinical Oncology, 19, 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. Journal of Clinical Oncology, 23, 6919–6930. http://dx.doi.org/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. Homeopathy, 92, 131–134. http://dx.doi.org/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 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. Phytotherapy Research, 26, 208–213. http://dx.doi.org/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. Journal of Clinical Oncology, 20, 1449–1455. http://dx.doi.org/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. Journal of Clinical Oncology, 31, 4092–4098. http://dx.doi.org/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. Journal of Clinical Oncology, 28, 634–640. http://dx.doi.org/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. Breast Cancer Research and Treatment, 118, 369–375. http://dx.doi.org/10.1007/s10549-009-0425-y


Younus, J., Simpson, I., Collins, A., & Wang, X. (2003). Mind control of menopause. Women’s Health Issues, 13, 74–78. http://dx.doi.org/10.1016/S1049-3867(02)00196-2


Marcelle Kaplan, RN, MS, AOCN®, CBCN®, is a self-employed breast oncology nurse consultant in Merick, NY, and Suzanne Mahon, RN, DNSc, AOCN®, APNG, is a professor in the Department of Internal Medicine in the School of Medicine at Saint Louis University in Missouri. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or editorial staff. Descriptions of products do not indicate or imply endorsement by the Clinical Journal of Oncology Nursing or the Oncology Nursing Society. Kaplan can be reached at marcelle.kaplan@gmail.com, with copy to editor at CJONEditor@ons.org. (Submitted April 2014. Revision submitted June 2014. Accepted for publication June 12, 2014.)


Key words: hot flashes; breast cancer; prostate cancer; symptom management