Risk factors, pathophysiology, and treatment of hot flashes in cancer

Fisher, William; Johnson, Aimee K.; Elkins, Gary; Otte, Julie L.; Burns, Debra S.; Yu, Menggang; Carpenter, Janet S.

doi:10.3322/caac.21171

Cited by 43 publications

(33 citation statements)

References 271 publications

(313 reference statements)

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“…Fisher et al found that ~80% of women receiving tamoxifen experienced hot flashes 9. Hot flashes are sudden and transient episodes of heat and sweating with possible palpitations and anxiety 10. Their pathophysiology is unclear and appears to involve thermoregulatory and neurochemical disruptions 9.…”

Section: Introductionmentioning

confidence: 99%

<em>CYP2D6</em> polymorphisms may predict occurrence of adverse effects to tamoxifen: a preliminary retrospective study

Wickramage

Tennekoon

Ariyaratne

et al. 2017

BCTT

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Introduction and aimsTamoxifen is an adjuvant drug effective in treating hormone receptor – positive breast cancer. However, 30%–50% of patients relapse and many develop adverse effects, such as hot flashes and fatty liver. Allelic variations altering the activity of cytochrome P450-2D6 enzyme affect response to tamoxifen by modulating metabolism of tamoxifen into its pharmacologically active metabolite endoxifen. Although association between CYP2D6 polymorphisms and recurrence of breast cancer in patients on tamoxifen had been reported, little evidence exists on association between these polymorphisms and adverse effects to tamoxifen. This study explored the association between CYP2D6 polymorphisms and tamoxifen effects, hitherto not studied in Sri Lanka.MethodsA retrospective preliminary study was carried out on 24 breast cancer patients on tamoxifen for minimally 3 months attending National Cancer Institute, Maharagama, Sri Lanka. They were not on CYP2D6-inhibiting drugs, chemotherapy or other endocrine therapy, and had no conditions that could occur as adverse effects to tamoxifen before starting the therapy. Their blood samples were collected, DNA was extracted and genotyped using SNaPshot Multiplex sequencing based single-nucleotide polymorphism (SNP) assay.ResultsSNP/allele frequencies detected: 1846G>A (confirmatory of *4 null allele)=8.3%; 2549delA (confirmatory of *3 null allele)=50%; 100C>T (suggestive of *10 reduced functional allele, in addition to other alleles)=0%; combination of 2988G>A, −1584C and 2850C>T (strongly suggestive of *41 or other reduced functional allele)=4.8%. Occurrence of heterozygous 2988G>A SNP with −1584C and 2850C>T was significantly higher among those with ultrasound-diagnosed fatty liver following the commencement of tamoxifen therapy (P=0.029). Adverse effects occurred at a significantly higher frequency among postmenopausal women (P=0.041). Three patients who developed recurrence of breast cancer had no association with SNPs tested.ConclusionsCYP2D6 SNP combination 2988G>A, −1584C and 2850C>T, strongly suggestive of *41 reduced functional allele, is likely to be useful in predicting occurrence of adverse effect fatty liver in breast cancer patients on tamoxifen, thereby alternative treatment can be considered and lifestyle modifications implemented. Larger sample studies are recommended with the measurement of tamoxifen and metabolite levels. Alternative therapy should be considered for postmenopausal patients.

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Section: Introductionmentioning

confidence: 99%

<em>CYP2D6</em> polymorphisms may predict occurrence of adverse effects to tamoxifen: a preliminary retrospective study

Wickramage

Tennekoon

Ariyaratne

et al. 2017

BCTT

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“…1–5 Although vasomotor symptoms (VMS) have been the focus of most intervention studies, 6, 7 they do not occur in isolation. VMS frequently co-occur with disturbed sleep and mood, fatigue, trouble remembering or concentrating, and/or sexual difficulties.…”

Section: Introductionmentioning

confidence: 99%

“…1–3, 8–10 These co-occurring symptoms are typically not assessed or are considered secondary outcomes, with few trials specifically targeting more than one symptom. 6, 7, 11, 12 Research shows that symptoms act synergistically and that the impact of co-occurring symptoms on an individual is multiplicative rather than additive. 9, 13 Thus, addressing multiple co-occurring symptoms is vital to improving midlife women’s quality of life.…”

Section: Introductionmentioning

confidence: 99%

MsFLASH participants’ priorities for alleviating menopausal symptoms

et al. 2015

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Objective To describe self-reported menopausal symptom priorities and their association with demographics and other symptoms among participants in an intervention trial for vasomotor symptoms (VMS). Methods Cross-sectional study embedded in the MsFLASH 02 trial, a three by two factorial design of yoga vs. exercise vs. usual activity and omega-3-fatty acid vs. placebo. At baseline, women (n=354) completed hot flash diaries, a card sort task to prioritize symptoms they would most like to alleviate, and standardized questionnaires. Results The most common symptom priorities were: VMS (n=322), sleep (n=191), concentration (n=140), and fatigue (n=116). In multivariate models, (1) women who chose VMS as their top priority symptom (n=210) reported significantly greater VMS severity (p=0.004) and never smoking (p=0.012) and (2) women who chose sleep as their top priority symptom (n=100), were more educated (p≤0.001) and had worse sleep quality (p<0.001). ROC curves identified sleep scale scores that were highly predictive of ranking sleep as a top priority symptom. Conclusions Among women entering an intervention trial for VMS and with relatively low prevalence of depression and anxiety, VMS was the priority symptom for treatment. A card sort may be a valid tool for quickly assessing symptom priorities in clinical practice and research.

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“…Despite missing information on the timing and type of OET and the use of menopausal symptom management strategies (pharmaceutical, nutraceutical, surgical, or alternative/ behavioral), 9 the main point of the large study by Davis et al 2 is that menopausal symptoms were prevalent and severe in long-term breast cancer survivors. This is a special population of women for whom nonhormone interventions are needed.…”

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confidence: 99%