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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Alternative Interventions for Hot Flashes

At the present time there are few effective alternatives for treatment of hot flashes. Megestrol acetate has been found to decrease hot flashes (Loprinzi, et al, 1994); however there is a concern by many about placing breast cancer patients on any hormonal agent (Quella et al., 2000). Further, it does not effectively alleviate hot flashes in all patients with whom it is used and may be associated with untoward side effects in some patients (Quella et al., 1998). Therefore this intervention is not widely used with breast cancer survivors.

Because of these concerns about hormonal interventions, efforts have been made to identify non-hormonal agents for hot flashes. Studies have been conducted to investigate the use of: soy supplementation (Quella et al., 2000), vitamin E (Barton et al., 1998), and clonidine (Pandya et al., 2002; Goldberrg et al., 1994). Soy does not seem to be much more effective, or only modestly more effective than placebo (Stearns & Hayes, 2002). Other alternative non-conventional remedies that have been studied in randomized clinical trials were not more effective than placebo (Kronenberg & Fugh-Berman, 2002). Other non-hormonal agents have not been found to be very efficacious and can be associated with a high toxicity profile (Stearns et al., 2002; Shanafelt, Barton, Adjei, & Loprinzi, 2002).

Based on anecdotal reports, two studies have investigated the use of antidepressant medication for hot flashes. Stearns et al. (2000) reported on the use of paroxetine hydrochloride (Paxil) and found a mean reduction of hot flashes of 67% in a pilot study with breast cancer survivors. However, adverse reactions to the treatment included somnolence and anxiety in 16% of the participants resulting in discontinuation or reduction in medication. Loprinzi et al. (1998) conducted a pilot study to investigate the use of venlafaxine hydrochloride for hot flashes in cancer survivors. Of those patients who completed the study, 58% reported a reduction in hot flashes. However, negative effects were found in some participants and included symptoms of depression, dry mouth, fatigue, sleepiness, and difficulty with concentration.

More recently, prospective randomized clinical trials have confirmed these findings. Venlafaxine reduced hot flashes by 60% compared to a 20% reduction with placebo (Loprinzi et al., 2000). Fluoxetine decreased hot flash frequency by 50% compared to 36% in placebo (Loprinzi et al., 2002). Paroxetine was studied in postmenopausal women and reduced hot flashes by up to 65% compared to a 38% reduction in a placebo group (Stearns, Beebe, Lyengar, & Dube, 2003). Kimmick suggested that sertraline was no more effective than placebo in decreasing hot flashes (Kimmick, Lovato, McQuellon, Robinson, & Muss, 2001). Given these facts it is imperative that effective new interventions be developed to help breast cancer survivors who experience hot flashes. Because most hot flashes will resolve with time, and due to the risks associated with hormonal and non-hormonal pharmacological intervention, a well-tolerated, non-hormonal treatment for hot flashes would be of great value. Based upon our clinical experience with breast cancer survivors we have identified that hypnosis may be of significant benefit in reducing the frequency and severity of hot flashes in breast cancer survivors who are receiving chemotherapy and/or tamoxifen.