Debra L. Barton

Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial

BACKGROUNDnHot flashes can be troublesome, especially when hormonal therapy is contraindicated. Preliminary data have suggested that newer antidepressants, such as venlafaxine, can diminish hot flashes. We undertook a double-blind, placebo-controlled, randomised trial to assess the efficacy of venlafaxine in women with a history of breast cancer or reluctance to take hormonal treatment because of fear of breast cancer.nnnMETHODSnParticipants were assigned placebo (n=56) or venlafaxine 37.5 mg daily (n=56), 75 mg daily (n=55), or 150 mg daily (n=54). After a baseline assessment week, patients took the study medication for 4 weeks. All venlafaxine treatment started at 37.5 mg daily and gradually increased in the 75 mg and 150 mg groups. Patients completed daily hot-flash questionnaire diaries. The primary endpoint was average daily hot-flash activity (number of flashes and a score combining number and severity). Analyses were based on the women who provided data throughout the baseline and study weeks.nnnFINDINGSn191 patients had evaluable data for the whole study period (50 placebo, 49 venlafaxine 37.5 mg, 43 venlafaxine 75 mg, 49 venlafaxine 150 mg). After week 4 of treatment, median hot flash scores were reduced from baseline by 27% (95% CI 11-34), 37% (26-54), 61% (50-68), and 61% (48-75) in the four groups. Frequencies of some side-effects (mouth dryness, decreased appetite, nausea, and constipation) were significantly higher in the venlafaxine 75 mg and 150 mg groups than in the placebo group.nnnINTERPRETATIONnVenlafaxine is an effective non-hormonal treatment for hot flashes, though the efficacy must be balanced against the drugs side-effects. Confirmation of the results of this 4-week study awaits the completion of three ongoing randomised studies to assess the effects of other related antidepressants for the treatment of hot flashes.

A randomized, crossover evaluation of methylphenidate in cancer patients receiving strong narcotics

Sedation may be a doselimiting side-effect of opioid therapy in some cancer patients. This study was designed to evaluate further the use of the psychostimulant, methylphenidate, an agent that has been reported to counteract opioid-induced sedation, in patients with cancer-related pain. Patients receiving a stable dose of an opioid for cancer-related pain were recruited for this randomized, double-blind, crossover clinical trial. In addition to their regular dose of narcotics, they received 5 days of methylphenidate followed by 5 days of placebo, or vice versa. Our data did not definitively demonstrate any statistically significant benefit for methylphenidate, but did suggest that this drug could mildly decrease narcotic-induced drowsiness and could increase night-time sleep. These data, in conjunction with other published data, suggest that methylphenidate can counteract narcotic-induced daytime sedation to a limited degree.

Definitions of hot flashes in breast cancer survivors.

Menopause is an expected event in a womans life. Treatment for breast cancer can impact the onset of menopause and precipitate symptoms such as hot flashes. Yet this sequelae of events is not well measured, defined or assimilated into quality of life assessments for cancer survivors. Though not life threatening, hot flashes can greatly impact a womans quality of life or functional ability. It is important for health care professionals to more fully understand the nature of the experience of hot flashes so as not to underestimate their disruptive potential. As part of a larger clinical trial to look at the effectiveness of vitamin E for hot flashes, breast cancer survivors kept a log of both the frequency and intensity of their hot flashes. These women then wrote descriptions to define the severity of those hot flashes. The purpose of this paper is to provide insight into the experience of hot flashes in breast cancer survivors and to describe the severity of hot flashes with narratives given by the women experiencing them.

Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention

PurposenPreliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN.nnnMethodsnSixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement.nnnResultsnNone of the hypothesized mediators had a statistically significant effect on worst pain (n=38).nnnImplicationsnFurther research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.

Médiateurs potentiels d’amélioration de la neuropathie périphérique chimio-induite douloureuse par une intervention cognitivocomportementale en ligne

Objetxa0: Des donnees preliminaires ont revele qu’une intervention autoguidee cognitivocomportementale de gestion de la douleur (PROSPECT) etait efficace contre la neuropathie peripherique chronique douloureuse induite par chimiotherapiexa0(NPCI), mais le mecanisme d’action demeure inconnu. L’objectif de cette analyse secondaire a consiste a determiner si les changements par rapport a l’anxiete, a la depression, aux troubles du sommeil ou a la fatigue diminuaient la douleur apres l’utilisation de PROSPECT chez les patients atteints dexa0NPCI. Methodologiexa0: En tout, 60xa0participants ont ete selectionnes au hasard pour recevoir soit l’intervention autoguidee cognitivocomportementale contre la douleur (acces pendant huit semaines), soit le traitement habituel. Un journal sur sept jours de suivi de la douleur due a laxa0NPCI et le systeme PROMIS (Patient Reported Outcomes Measurement Information System) de mesure de l’anxiete, de la depression, de la fatigue et des troubles du sommeil ont ete utilises avant et apres l’etude (huit semaines). L’analyse de la mediation causale a ete utilisee pour quantifier les mediateurs d’amelioration quant aux douleurs les plus intenses. Resultatsxa0: Aucun des mediateurs hypothetiques n’a eu un effet statistiquement important sur les douleurs les plus fortes (nxa0=xa038). Implicationsxa0: D’autres recherches sont necessaires pour determiner les mediateurs potentiels d’intensite de la douleur qui peuvent etre cibles par des strategies cognitivocomportementales specifiques afin d’ameliorer la gravite de la douleur de laxa0CIPN. Mots clesxa0: Douleur chronique, neuropathie peripherique chimio-induite, intervention cognitivocomportementale, maladie du systeme nerveux peripherique/chimio-induite