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.
PHASE OF CARE: Transition phase after active treatment
APPLICATIONS: Elder care, palliative care
Venlafaxine is superior compared to placebo or other nonhormonal therapies in the management of hot flashes. Clonidine also demonstrated benefits.
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.
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.
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.