Breast and prostate cancers are the most commonly diagnosed non-dermatologic malignancies in Canada. Agents including endocrine therapies (e.g., aromatase inhibitors, gonadotrophin-releasing hormone analogs, anti-androgens, tamoxifen) and chemotherapy have improved survival for both conditions.
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As endocrine manipulation is a mainstay of treatment, it is not surprising that hot flashes are a common and troublesome adverse effect. Hot flashes can cause chills, night sweats, anxiety, and insomnia, lessening patients' quality of life. These symptoms impact treatment adherence, worsening prognosis. While short-term estrogen replacement therapy is frequently used to manage hot flashes in healthy menopausal women, its use is contraindicated in breast cancer. Similarly, testosterone replacement therapy is contraindicated in prostate cancer. It is therefore not surprising that non-hormonal pharmacological treatments (anti-depressants, anti-epilectics, anti-hypertensives), physical/behavioral treatments (e g , acupuncture, yoga/exercise, relaxation techniques, cognitive behavioral therapy), and natural health products (e g , black cohosh, flax, vitamin E, ginseng) have been studied for control of hot flashes. There is a need to identify which interventions minimize the frequency and severity of hot flashes and their impact on quality of life. This systematic review and network meta-analysis of randomized studies will synthesize available evidence addressing this knowledge gap.
An electronic search of Medline, Embase, AMED, PsycINFO, and the Cochrane Register of Controlled Trials has been designed by an information specialist and peer reviewed by a second information specialist. Study selection and data collection will be performed by two reviewers independently. Risk of bias assessments will be completed using the Cochrane Risk of Bias Scale Outcomes of interest will include validated measures of hot flash severity, hot flash frequency, quality of life, and harms. Bayesian network meta-analyses will be performed where judged appropriate based on review of clinical and methodologic features of included studies.
Our review will include a broad range of interventions that patients with breast and prostate cancer have attempted to use to manage hot flashes. Our work will establish the extent of evidence underlying these interventions and will employ an inclusive approach to analysis to inform comparisons between them. Our findings will be shared with Cancer Care Ontario for consideration in the development of guidance related to supportive care in these patients.
Systematic reviews 2015 Aug 27*** epublish ***
Brian Hutton, Fatemeh Yazdi, Louise Bordeleau, Scott Morgan, Chris Cameron, Salmaan Kanji, Dean Fergusson, Andrea Tricco, Sharon Straus, Becky Skidmore, Mona Hersi, Misty Pratt, Sasha Mazzarello, Melissa Brouwers, David Moher, Mark Clemons
Ottawa Hospital Research Institute, Ottawa, Canada bhutton@Ohri ca , Ottawa Hospital Research Institute, Ottawa, Canada fayazdi@Ohri ca , Department of Oncology, McMaster University, Hamilton, Ontario, Canada bordeleaul@hhsc ca , Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Canada smorgan@toh on ca , Cornerstone Research Group, Toronto, Canada cgcamero@gmail com , Ottawa Hospital Research Institute, Ottawa, Canada skanji@ottawahospital on ca , Ottawa Hospital Research Institute, Ottawa, Canada dafergusson@Ohri ca , Li Ka Shing Knowledge Institute, St Mike's Hospital, Toronto, Canada triccoa@smh ca , Li Ka Shing Knowledge Institute, St Mike's Hospital, Toronto, Canada, Ottawa Hospital Research Institute, Ottawa, Canada bskidmore@rogers com , Ottawa Hospital Research Institute, Ottawa, Canada mhersi@ohri ca , Ottawa Hospital Research Institute, Ottawa, Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, Ottawa, Canada smazarello@toh on ca , Department of Oncology, McMaster University, Hamilton, Ontario, Canada , Ottawa Hospital Research Institute, Ottawa, Canada dmoher@ohri ca , Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, Ottawa, Canada