Web Exclusive: Hot Flashes: Q & A with Debra Barton, PhD

To learn more about managing cancer treatment-related hot flashes in men and women, CURE talked with Debra Barton, PhD, associate professor of oncology at the Mayo Clinic in Rochester, Minnesota.

How would you describe hot flashes and its symptoms?

It’s an intense, physiologic experience that happens because of a change in hormones that affects one’s ability to regulate their own temperature. And it’s associated with, or can be connected with, anxiety, panic, nausea, dizziness, heart palpitations—a wide range of emotional and physical symptoms.

What percentage of women and men with cancer experience hot flashes?

Some published papers cite percentages of 60 to 75 percent. This is in women; there is less published information on the prevalence in men, but what I have seen published related to surgery or anti-androgen therapy in men is about the same, 70 percent, although fewer men report hot flashes as distressing or bothersome.

Why is it important to treat hot flashes in men and women with cancer?

Because they very negatively impact somebody’s quality of life; and specifically, they can disrupt one’s sleep, which affects how well you can think, and how well you can do what you have to do during the day, as well as mood.

Are there ways to manage hot flashes without medication?

There are several behavioral things people can do, such as wearing clothes that are loosely woven and layered so they can take clothes off and on as they need to as they get hot, or having air moving to try to help keep themselves cool. For women with mild to moderate hot flashes that only last a couple years, they can do these behavioral things and tolerate it.

When should a person see a doctor about hot flashes?

For women whose hot flashes go on for longer than that (a couple of years) or whose hot flashes are more severe, and the behavioral things aren’t making them tolerable—women who aren’t sleeping at night because of their hot flashes or who can’t get through an hour without having to put cold water under their armpits and wipe off their face—those people are the ones who could benefit from seeing a health care provider about their options for hot flashes.

Do the same treatments for hot flashes that work for women also work for men?

Almost everything we have found that works for women with hot flashes also works for men, except for clonidine (Catapres). Clonidine is a treatment used for hot flashes in women, and it doesn’t seem to help men. But everything else that has been tried—venlafaxine (Effexor), gabapentin (Neurontin)—seems to work as well for men.

Out of the antidepressants and hormonal therapies out there, which ones work best for hot flashes in men and women so far?

I think of the antidepressants, venlafaxine (Effexor) and paroxetine (Paxil) are the two leaders, with hot flash reduction of about 55 percent. Paroxetine, though, can’t be used with tamoxifen because of the interaction with the metabolites.

Gabapentin, which is an anti-seizure medicine, also works well with a 55 to 60 percent reduction in hot flashes. The downside of gabapentin is that it has a few more side effects and has to be taken three times a day. A recent study looked at pregabalin—the newer type of gabapentin—and that looked like it was about equally as effective as gabapentin, with about 55 percent reduction in hot flashes, but it also can have a few side effects.

Next is the antidepressant citalopram (Celexa). We finished a study with that and it had very good reduction of hot flashes—a little over 50 percent—with few side effects.

There is a non-estrogen, hormone therapy, megestrol acetate (Megace), which can relieve hot flashes. There are also estrogen-based therapies to alleviate symptoms, but there is some controversy about the safety of this in cancer survivors.

Are there any natural or alternative therapies used to treat hot flashes?

Vitamin E has now been studied in two fairly large, well-designed studies and the impact on hot flashes was pretty mild, about a 30 to 35 percent reduction, which is not much better than a placebo in controlled studies.

Acupuncture is still being studied, and there has been mixed effects in how much it’s benefited people and for how long.

There are several herbs and plant-based products that people use for hot flashes (such as black cohosh). There have been several studies that clearly tell us that black cohosh is not helpful for hot flashes. There have been a gazillion studies with soy and hot flashes and the bulk of them have been negative.

There’s a lot of stuff you can go into a health food store and get over the counter that promises to be helpful for hot flashes, but you have to be very careful about those kinds of products because a lot of plants have estrogenic properties.

What are some treatments that are currently being researched for hot flashes?

We did a pilot trial that wasn’t placebo-controlled and it looked like flaxseed was promising, and we’re going to open a study with flaxseed in the next month or two. We are also doing a study right now with paced breathing to see how much that helps. And we’re getting ready to start a study with hypnosis. My goal in really understanding how to treat hot flashes going forward is to see how much these behavioral things can impact hot flashes and then combining them with a very low-dose antidepressant like venlafaxine. That’s really my goal—to find things that can help, can work together to reduce hot flashes 80 to 90 percent, and yet not have side effects.