Hot Flashes and Night Sweats in Cancer Patients

• Hot flashes and night sweats may be side effects of cancer or its treatment.
• Hot flashes and night sweats affect quality of life in many patients with cancer.
• In patients with cancer, hot flashes and night sweats may be caused by the tumor, its treatment, or other conditions.
• Many patients treated for breast cancer and prostate cancer have hot flashes.
• Certain types of drugs can cause night sweats.
• Sweats are controlled by treating their cause.
• Hot flashes may be controlled with estrogen replacement therapy.
• Other drugs may be useful in some patients.
• Treatments that help patients cope with stress and anxiety may help manage hot flashes.
• Hypnosis may help relieve hot flashes.
• Comfort measures may help relieve night sweats related to cancer.
• Herbs and dietary supplements should be used with caution.
• Acupuncture has been studied in the treatment of hot flashes.

Treatments that help patients cope with stress and anxiety may help manage hot flashes.

Treatments that change how patients deal with stress, anxiety, and negative emotions may help manage hot flashes. These are called psychological interventions. Psychological interventions help patients gain a sense of control and develop coping skills to manage symptoms. Staying calm and managing stress may lower levels of a hormone called serotonin that can trigger hot flashes. Psychological interventions may help hot flashes and related problems when used together with drug treatment.

Hypnosis may help relieve hot flashes. Hypnosis is a trance-like state that allows a person to be more aware, focused, and open to suggestion. Under hypnosis, the person can concentrate more clearly on a specific thought, feeling, or sensation without becoming distracted.

Hypnosis is a newer treatment for hot flashes that has been shown to be helpful. In hypnosis, a therapist helps the patient to deeply relax and focus on cooling thoughts. This may lower stress levels, balance body temperature, and calm the heart rate and breathing rate.

Comfort measures may be used to treat night sweats related to cancer. Since body temperature goes up before a hot flash, doing the following may control body temperature and help control symptoms:

• Wear loose-fitting clothes made of cotton.
• Use fans and open windows to keep air moving.
• Practice relaxation training and slow, deep breathing.
• Herbs and dietary supplements should be used with caution.

Studies of vitamin E for the relief of hot flashes show that it is only slightly better than a placebo (pill that has no effect). Most studies of soy and black cohosh show they are no better than a placebo in reducing hot flashes. Soy contains estrogen -like substances; the effect of soy on the risk of breast cancer growth or recurrence is not clear. Studies of ground flaxseed to treat hot flashes have shown mixed results.

Claims are made about several other plant-based and natural products as remedies for hot flashes. These include dong quai, milk thistle, red clover, licorice root extract, and chaste tree berry. Since little is known about how these products work or whether they affect the risk of breast cancer, women should be cautious about using them.

Acupuncture has been studied in the treatment of hot flashes. Pilot studies of acupuncture and randomized clinical trials that compare true acupuncture and sham (inactive) treatment have been done in patients with hot flashes and results are mixed. A review of many studies combined showed that acupuncture had slight or no effects in breast cancer patients with hot flashes.

Hot flashes and night sweats may be side effects of cancer or its treatment.

Sweating is the body's way of lowering body temperature by causing heat loss through the skin. In patients with cancer, sweating may be caused by fever, a tumor, or cancer treatment. Hot flashes can also cause too much sweating. They may occur in natural menopause or in patients who have been treated for breast cancer or prostate cancer.

Hot flashes combined with sweats that happen while sleeping are often called night sweats or hot flushes. Hot flashes and night sweats affect quality of life in many patients with cancer. A treatment plan to help manage hot flashes and night sweats is based on the patient's condition and goals of care. For some patients, relieving symptoms and improving quality of life is the most important goal.

This summary describes the causes and treatment of hot flashes and night sweats in cancer patients.

In patients with cancer, hot flashes and night sweats may be caused by the tumor, its treatment, or other conditions. Sweating happens with disease conditions such as fever and may occur without disease in warm climates, during exercise, and during hot flashes in menopause. Sweating helps balance body temperature by allowing heat to evaporate through the skin.

Hot flashes and night sweats are common in patients with cancer and in cancer survivors. They are more common in women but can also occur in men. Many patients treated for breast cancer and prostate cancer have hot flashes.

Menopause in women can have natural, surgical, or chemical causes. Chemical menopause in women with cancer is caused by certain types of chemotherapy, radiation, or hormone therapy with androgen (a male hormone). "Male menopause" in men with cancer can be caused by orchiectomy (surgery to remove one or both testicles) or hormone therapy with gonadotropin-releasing hormone or estrogen.

Treatment for breast cancer and prostate cancer can cause menopause or menopause-like effects, including severe hot flashes.

Certain types of drugs can cause night sweats.

Drugs that may cause night sweats include the following:

• Tamoxifen.
• Aromatase inhibitors.
• Opioids.
• Tricyclic antidepressants.
• Steroids.

Sweats are controlled by treating their cause. Sweats caused by fever are controlled by treating the cause of the fever. Sweats caused by a tumor are usually controlled by treatment of the tumor. Hot flashes may be controlled with estrogen replacement therapy.

Hot flashes during natural or treatment-related menopause can be controlled with estrogen replacement therapy. However, many women are not able to take estrogen replacement (for example, women who have or had breast cancer). Hormone replacement therapy that combines estrogen with progestin may increase the risk of breast cancer or breast cancer recurrence. Treatment of hot flashes in men who have been treated for prostate cancer may include estrogens, progestin, antidepressants, and anticonvulsants. Certain hormones (such as estrogen) can make some cancers grow.

Other drugs may be useful in some patients.

Studies of non-estrogen drugs to treat hot flashes in women with a history of breast cancer have reported that many of them do not work as well as estrogen replacement or have side effects. Megestrol (a drug like progesterone), certain antidepressants, anticonvulsants, and clonidine (a drug used to treat high blood pressure) are non-estrogen drugs used to control hot flashes. Some antidepressants may change how other drugs, such as tamoxifen, work in the body. Side effects of drug therapy may include the following:

• Antidepressants used to treat hot flashes over a short period of time may cause nausea, drowsiness, dry mouth, and changes in appetite.
• Anticonvulsants used to treat hot flashes may cause drowsiness, dizziness, and trouble concentrating.
• Clonidine may cause dry mouth, drowsiness, constipation, and insomnia.

Patients may respond in different ways to drug therapy. It is important that the patient's health care providers know about all medicines, dietary supplements, and herbs the patient is taking.

Drugs that may relieve nighttime hot flashes or night sweats and improve sleep at the same time are being studied in clinical trials.

If one medicine does not improve symptoms, switching to another medicine may help.