Nonhormonal Hot Flash Management for Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis

Jian Liu; Guangning Nie; Yang Li; Zehuai Wen; Liming Lu; Li Xie; Dongdong Cao; Yafang Lai; Hongyan Yang

doi:10.1155/2020/4243175

Nonhormonal Hot Flash Management for Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis

Evid Based Complement Alternat Med. 2020 Apr 28:2020:4243175. doi: 10.1155/2020/4243175. eCollection 2020.

Authors

Jian Liu¹, Guangning Nie¹, Yang Li¹, Zehuai Wen², Liming Lu³, Li Xie⁴, Dongdong Cao⁵, Yafang Lai⁶, Hongyan Yang^{1

7}

Affiliations

¹ Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China.
² Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
³ Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
⁴ The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
⁵ Department of Chinese Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
⁶ Department of Gynecology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
⁷ Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.

Abstract

Materials and methods: We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP up to May 2018. Randomized controlled trials (RCTs) reporting nonhormonal hot flash treatments for breast cancer survivors were included. Primary outcome measurements were hot flash frequency and hot flash score of posttreatment. The methodological quality of each study was assessed with Cochrane's risk of bias tool.

Results: 16 RCTs involving 2,349 participants were included. The nonhormonal therapies used in the included studies were classified as follows: lifestyle changes, mind-body techniques, dietary/supplements, SSRIs/SNRIs, other medications, and other therapies. Pairwise meta-analysis showed that the general effect of nonhormonal management was statistically more effective than no treatment/placebo/sham in reducing hot flash frequency (SMD = -0.60, 95% CI [-1.13, -0.06]; P=0.03)) and hot flash score (SMD = -0.38, 95% CI [-0.68, -0.08]). For hot flash frequency, results from the NMA showed that there was no statistically significant difference between any two of the nonhormonal treatments. Another NMA result indicated that acupuncture (other therapies) was 16.05 points more effective in reducing hot flash scores than no treatment/waitlist (SMD = -16.05, 95% CI [-30.2, -1.99]). These results were statistically significant. Acupuncture was also ranked the optimal nonhormonal therapy for both hot flash frequency and hot flash score. The safety analysis showed that there were few related adverse events during acupuncture and that drug related adverse reactions could have also occurred in studies using drug interventions.

Conclusions: This network meta-analysis comparing nonhormonal treatments suggested that acupuncture might be more effective in improving hot flashes for breast cancer survivors. A pronounced placebo response was found during hot flash treatments. The evidence of safety for nonhormonal therapies was also insufficient. Therefore, at present, we cannot make confirmative recommendations of nonhormonal hot flash management for breast cancer survivors. This study is registered with PROSPERO (CRD42018082008).

Publication types

Review