[Management of hot flushes for breast cancer survivors]

Hot flushes experienced by breast cancer survivors present specific issues due to their frequency, severity and difficulty to treat. After an evaluation of her symptoms and expression of her expectations and requests, each patient will be provided a clear, synthetic, comprehensible, supported and prioritized view of all treatment options. Any prescribed treatment will be a shared medical decision making. An algorithm of treatment propositions, documented by evidence-based medicine, is proposed. As randomized trials show that placebo-induced reduction of hot flushes frequency represents to 25 to 75%, non-pharmacological approaches selected by the patient should be preferred at first, to the exception however of phytoestrogens. The first-line treatment for severe hot flushes should be, depending on each specific context, venlafaxine, paroxetine or gabapentine. In case of inefficiency, treatments of second- and third-line will be proposed. Prescription of progestin or of a menopausal hormone therapy should remain exceptional and limited to cases where all other treatments failed, after obtaining the patient's informed consent following exhaustive information. Indications of stellate ganglion block remain to be defined.