Breast Cancer Research and Treatment

, Volume 152, Issue 2, pp 231–237 | Cite as

Venlafaxine in management of hot flashes in women with breast cancer: a systematic review and meta-analysis

  • Ramya Ramaswami
  • Marcos Daniel Villarreal
  • Dina Marie Pitta
  • Janet S. Carpenter
  • Justin Stebbing
  • Bindu Kalesan


Toxicity due to treatment causes a negative impact on quality of life in breast cancer survivors. Hot flash symptoms, described as intense sensations of heat, sweating and flushing occur in more than 50 % of breast cancer patients taking tamoxifen. We hypothesized that venlafaxine, a selective-norepinephrine reuptake inhibitor drug, was effective for reducing patient-reported hot flash scores among women treated for breast cancer compared to other non-hormonal treatments. We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials from inception till May 2015 for venlafaxine (75 mg once daily or greater) with non-hormonal comparators for the treatment of hot flashes in female breast cancer patients. The primary outcome was hot flash score (derived from patient-reported hot flash severity and frequency) in randomized controlled trials. Standardized mean differences (SMD) were calculated for each study due to variation in the outcome measures. Heterogeneity was determined using I 2 statistics, and publication bias was assessed using a contour funnel plot and Egger’s tests. Pooled analyses demonstrated that venlafaxine significantly reduced hot flash scores compared to the trial comparators (overall SMD 2.06; 95 % confidence interval (CI) [0.40, 3.72]). There was significant heterogeneity among these studies (I 2 = 98.7 %, P < 0.001). Asymmetry in the contour funnel plot suggests the presence of publication bias and a trend towards small study effects (Egger’s test, P = 0.096). Venlafaxine is efficacious in managing hot flashes among women with breast cancer. This review highlights methodological issues that arise from eligible trials and recommends a collaborative approach in survivorship studies.


Breast cancer Venlafaxine Hot flash Symptoms Meta-analysis Review 


Conflict of interest

Dr. Kalesan is employed by PPD (Contract research organization) after this study was completed. This study was not done at PPD. This does not pose a conflict of interest.

Supplementary material

10549_2015_3465_MOESM1_ESM.docx (187 kb)
Supplementary material 1 (DOCX 187 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ramya Ramaswami
    • 1
    • 3
  • Marcos Daniel Villarreal
    • 1
  • Dina Marie Pitta
    • 1
  • Janet S. Carpenter
    • 2
  • Justin Stebbing
    • 3
  • Bindu Kalesan
    • 1
  1. 1.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.School of NursingIndiana UniversityIndianapolisUSA
  3. 3.Medical OncologyImperial College LondonLondonUK

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