Evidence-based, clinical practice guidelines from the Oncology Nursing Society (ONS) on the management of hot flashes associated with surgery or drug-related therapy in women with breast cancer and men with prostate cancer were published in the Oncology Nursing Forum.

It has been estimated that over half of women undergoing breast cancer treatment and approximately 80% of men receiving androgen-deprivation therapy (ADT) for prostate cancer will experience hot flashes. Hot flashes can negatively affect patient quality of life, and potentially interfere with a patient’s adherence to their cancer treatment.

The interprofessional panel that developed the ONS guidelines emphasized that “nurses and other healthcare professionals need to know which patients are at risk for hot flashes and assess if hot flashes are present as well as their degree of frequency, severity, and level of interference with quality of life.”  

Other motivations for development of these guidelines, which were based on findings from a systematic review and meta-analysis of the relevant medical literature, were to evaluate the evidence associated with different interventions (including associated benefits, harms, and burdens), provide recommendations based on these evaluations, identify knowledge gaps in order to demonstrate the need for research in specific areas, and promote policy and advocacy related to the management of hot flashes in these patients.


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For women with breast cancer who experience hot flashes, the guideline panel suggested the use of an antidepressant over no treatment. Specifically, venlafaxine and paroxetine were mentioned as an initial approach, with clonidine suggested for use in those not responding to the former agents, and sertraline, fluoxetine, escitalopram, or duloxetine suggested for those not responding to venlafaxine, paroxetine, or clonidine.

For men with prostate cancer experiencing cancer treatment–related hot flashes, the guideline panel suggested the use of paroxetine or clonidine over no treatment, and the use of sertraline, fluoxetine, escitalopram, or duloxetine in those not responding to paroxetine or clonidine.

Furthermore, they suggested that women with breast cancer and men with prostate cancer experiencing hot flashes may benefit from physical activity, such as exercise or yoga, compared with no intervention.