Can Hypnosis Reduce Hot Flashes in Breast Cancer Survivors? A Literature Review

American Journal of Clinical Hypnosis,  Jul 2004  by Elkins, Gary,  Marcus, Joel,  Palamara, Lynne,  Stearns, Vered

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Hot flashes can significantly decrease quality of life, alter daily activities, and negatively affect sleep (Carpenter, 2001 ; Lamb, 1995) in breast cancer survivors. Further, hot flashes are a very common result of breast cancer treatment with cytotoxic chemotherapy drugs or with tamoxifen. It has been demonstrated that up to 78% of female chemotherapy recipients and 72% of tamoxifen recipients experience hot flashes (Carpenter et al., 1998). Hot flashes that are chemically induced (such as from cancer therapy) can be of a more profound nature compared to hot flashes as a consequence of natural menopause (McKeon, 1993; Knobf, 1997).

Women's Health Initiative

The standard treatment of ovarian failure and hot flashes has been hormone replacement therapy. Hot flashes and associated symptoms respond quickly and dramatically to estrogen hormone replacement therapy. However a recent Women's Health Initiative study (Rossouw et al., 2002) found that estrogens are associated with increased risk of breast cancer.

The Women's Health Initiative study (Rossouw, et al., 2002) involved over 16,000 women with an intact uterus who were randomly assigned to receive either estrogen and progesterone or placebo. The study was halted early because of an increased risk of breast cancer in the group receiving hormone replacement therapy. In the Women's Health Initiative trial, the incidence of breast cancer increased by 26% for women in the hormone replacement therapy group. Furthermore, increased risks of heart disease, stroke, and blood clots were associated with hormone replacement therapy. The risk of breast cancer began to increase after two years of hormone replacement therapy and the risk of cardiovascular disease increased shortly after hormones were started. The benefits of hormone replacement therapy were found to be reductions in hip fractures and colon cancer. The conclusion reached by the Women's Health Initiative was that the long-term use of hormone replacement therapy was associated with more risks than benefits. Of note, in a more recent publication of the Women's Health Initiative trial of women with a prior hysterectomy who were randomized to estrogen or placebo, an increase in breast cancer risk was not observed. Due to a significant increase in stroke and no improvement in cardiovascular events, results of this latter study were also prematurely reported (Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women's Health Initiative randomized controlled trial, Anderson et al., 2004).

In another large study, designated the "Million Women Study," current users of hormone replacement therapy were more likely to develop breast cancer (adjusted relative risk 1.66 and 1.22 respectively). Risk was seen with almost all estrogen preparations, but the magnitude was significantly greater for estrogen combined with progesterone (Beral, 2003).

Therefore hormone replacement therapy is often avoided for breast cancer survivors (Loprinzi et al., 1994), many women reject estrogens (Chlebowski & McTiernan, 1999), and health care providers are reluctant to prescribe it. Indeed, the HABITS trial (Hormonal replacement therapy after breast cancer-is it safe?), in which women were randomized to hormone replacement therapy or best treatment without hormones, was recently terminated due to an increase in new breast cancer events in the hormone-treated group (Holmberg & Anderson, 2004). Because of this, alternatives to hormone replacement therapy are needed.