Hot Flash Diary Research Articles

Determination of Factors Associated With Hospitalization in Breast Cancer Survivors

To identify factors associated with hospitalization after diagnosis of breast cancer in working-age women. Descriptive, retrospective survey. Caseload of a single medical oncologist affiliated with an urban, not-for-profit, academic medical center. 123 consecutively evaluated women aged 21-65 years with breast cancer associated with projected survival greater than three years. Data were collected from an electronic clinical file with demographic, diagnostic, and hormone replacement therapy (HRT) information. Four survey forms were mailed to subjects: (a) a form ascertaining personal demographics, health status, and healthcare utilization, (b) menopausal Symptom Rating Scale, (c) a hot flash diary, and (d) the Center for Epidemiologic Studies Depression Scale. Menopausal symptoms, depression symptoms, age, time since diagnosis, and overnight hospitalization. An increasing depression score and increasing menopausal symptoms score were found to be independent predictors of hospitalization controlling for age at diagnosis, disease stage, and time since diagnosis. Demographic variables, HRT use at or prior to diagnosis (a proxy measure of health status), current self-reported health status, and hot flashes were not associated with hospitalization. Psychological factors can be important significant predictors of hospitalization in survivors of breast cancer independent of disease stage. Further study should be undertaken to determine whether support services directed at identifying and treating those at risk for depression or menopausal symptoms may reduce the likelihood of potentially avoidable hospitalization. The identification of those at high risk for hospitalization because of high levels of depressive or menopausal symptoms and prompt intervention offer the opportunity to improve the quality of life of breast cancer survivors and reduce the cost of health care for themselves, their families, and the healthcare system.

Pilot evaluation of paroxetine for alleviation of hot flashes in men

8016 Background: Effective and nontoxic nonhormonal means of alleviating hot flashes are desirable for men with androgen-ablation related hot flashes. Based on positive pilot information suggesting that relatively low doses of paroxetine were able to alleviate hot flashes in women (with subsequent placebo-controlled data in women confirming the efficacy of this agent in women), we developed a phase II trial of paroxetine in men with bothersome hot flashes related to androgen ablation therapy. Methods: Participants kept a daily hot flash diary during a baseline week and then during four treatment weeks while they received paroxetine SR in the following manner: 12.5 mg/d for one week, then 25 mg/d for one week, then 37.5 mg/d for one week, and then either 25 mg/d or 37.5 mg/d for the last week (patient preference). A total of 26 patients were entered on this study between 8/6/2001 and 10/22/2003. Two patients canceled before receiving treatment, 2 patients did not returned any questionnaires, and 4 patients did not complete all 4 weeks of their diaries. Results: Hot flash information on the 18 evaluable study patients are provided in the table, illustrating mean hot flash score (daily frequency times average severity) data compared to the baseline week (where patients had a mean of 14.8 hot flashes per day). For comparison, similarly obtained data from a previous pilot trial, examining venlafaxine in men with hot flashes, is also illustrated. The paroxetine was tolerated well overall, with most patients reporting an improvement, during the weeks they were receiving paroxetine compared to the baseline week, in most of the potential side effects that we followed. Conclusions: These preliminary data support paroxetine as a potentially effective nonhormonal agent for managing hot flashes in men. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Glaxo

Pilot evaluation of paroxetine for alleviation of hot flashes in men

8016 Background: Effective and nontoxic nonhormonal means of alleviating hot flashes are desirable for men with androgen-ablation related hot flashes. Based on positive pilot information suggesting that relatively low doses of paroxetine were able to alleviate hot flashes in women (with subsequent placebo-controlled data in women confirming the efficacy of this agent in women), we developed a phase II trial of paroxetine in men with bothersome hot flashes related to androgen ablation therapy. Methods: Participants kept a daily hot flash diary during a baseline week and then during four treatment weeks while they received paroxetine SR in the following manner: 12.5 mg/d for one week, then 25 mg/d for one week, then 37.5 mg/d for one week, and then either 25 mg/d or 37.5 mg/d for the last week (patient preference). A total of 26 patients were entered on this study between 8/6/2001 and 10/22/2003. Two patients canceled before receiving treatment, 2 patients did not returned any questionnaires, and 4 patients did not complete all 4 weeks of their diaries. Results: Hot flash information on the 18 evaluable study patients are provided in the table, illustrating mean hot flash score (daily frequency times average severity) data compared to the baseline week (where patients had a mean of 14.8 hot flashes per day). For comparison, similarly obtained data from a previous pilot trial, examining venlafaxine in men with hot flashes, is also illustrated. The paroxetine was tolerated well overall, with most patients reporting an improvement, during the weeks they were receiving paroxetine compared to the baseline week, in most of the potential side effects that we followed. Conclusions: These preliminary data support paroxetine as a potentially effective nonhormonal agent for managing hot flashes in men. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Glaxo

Mind control of menopause

The primary objective of this study was to observe the effect of hypnosis on hot flashes (HF) and overall quality of life in symptomatic patients. A secondary objective was to observe the effect of hypnosis on fatigue. Ten healthy volunteers and four breast cancer patients (total 14 patients) with symptoms of HF were treated with four, 1 h/wk sessions of hypnosis. The same physician, with the help of a nurse, conducted every session. All subjects recorded frequency, duration, and severity of HF in a HF diary. The QLQ-C30 and Brief Fatigue Inventory forms were used to assess the impact on quality of life and fatigue, respectively. The statistical evaluations were performed, including analysis of variance and nonparametric procedures. The frequency ( p < 0.0001), duration ( p < 0.0001), and severity ( p < 0.0001) of HF were significantly reduced. The overall quality of life was also improved ( p = 0.05). The subjects enjoyed better sleep and had less insomnia ( p = 0.012). There was a significant improvement on current fatigue level ( p = 0.017), but we did not find a statistically significant reduction in the total fatigue level. We conclude that hypnosis appears to be a feasible and promising intervention for HF, with a potential to improve quality of life and insomnia. Although improvement in current level of fatigue was observed in this pilot study, total fatigue improvement did not reach statistical significance.

Depomedroxyprogesterone Acetate for Hot Flashes

To evaluate the efficacy of a long-acting preparation of medroxyprogesterone acetate for hot flash management, 3 men receiving androgen ablation therapy for prostate cancer and 15 women with a history of breast cancer were treated as part of clinical practice with three biweekly intramuscular injections of 500 mg depomedroxyprogesterone. A review of hot flash diaries and patient charts were completed to evaluate the effectiveness and tolerability of these injections for managing hot flashes. Treatment was associated with an approximate 90% decrease in hot flashes (95% CI 82–97%). Daily hot flash frequency decreased from a mean of 10.9 on the first day of treatment (95% CI 8.0–13.8 hot flashes per day) to a mean of 1.1 hot flashes 6 weeks later (95% CI 0.5–1.8 hot flashes) and to a mean of 0.7 hot flashes 12 weeks following therapy initiation (95% CI 0.1–1.2). Improvement in the hot flashes remained for months after discontinuing the injections in many patients. Reported side effects were minimal. This experience suggests that treatment with depomedroxyprogesterone may be an effective and well-tolerated option for the treatment of hot flashes.

The Hot Flash Related Daily Interference Scale: A Tool for Assessing the Impact of Hot Flashes on Quality of Life Following Breast Cancer

To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.

Tamoxifen-Induced Hot Flashes

Hot flashes are the most prominent side effect of tamoxifen, the most frequently prescribed antitumor agent in the world. Little detailed information is available to predict who will develop hot flashes on tamoxifen, to describe the natural history of these hot flashes, and/or to predict who will request therapy for such a side effect. This current trial was developed to address these items. Women who were about to begin adjuvant tamoxifen for locally treated breast cancer were approached for this trial. Before initiating tamoxifen, patients completed a short questionnaire designed to inquire about potential prognostic factors. Upon starting tamoxifen, women were asked to complete a hot flash diary daily for 3 months, and then daily for 1 week of each of the subsequent 9 months. Fifty patients, aged 51-83 years, provided data for this report. Approximately half of the women reported that they did not have any substantial hot flashes while the other half reported hot flashes of variable intensity. On average, these hot flashes gradually increased over 3 months and then plateaued. Baseline factors that appeared to predict for subsequent hot flash problems included a prior history of moderate to severe hot flashes with menopause and a history of prior estrogen therapy use. Overall, 16% of the women reported the desire for therapy for their hot flashes. Thirty-seven and one-half percent of the women (6/16) had a history of both prior estrogen use and moderate to severe hot flashes with menopause as compared to none (0/14) of the women without either of these factors. The data from this study can be utilized to better identify and educate women as to their probability of developing hot flashes after starting tamoxifen, to describe the average time frame for these hot flashes, and to predict the likelihood of whether resultant hot flashes will be substantial enough to have a woman request therapy for them.