OBJECTIVE: To obtain practical experience with venlafaxine for hot flushes
in breast cancer patients and incorporate this in a treatment protocol.
METHOD: Twenty-two women with a history of breast cancer (mean age 49.2
years, range 35-65) were referred for consideration of treatment with
venlafaxine for hot flushes. Patients received extensive information on
treatment with venlafaxine and were advised to self-monitor the frequency
of their hot flushes. RESULTS: Eight women did not start venlafaxine
because they had no postmenopausal complaints, were lost to follow-up, had
too low a frequency of hot flushes, or refused treatment. Eventually 14
women started venlafaxine. Two of them did not tolerate venlafaxine, four
reported some effect but stopped because of side effects, two women had no
effect whatsoever. Six women observed a clear ( > 50%) reduction in their
hot flush frequency that was maintained at a median follow-up of 13
months. CONCLUSION: The group of patients referred for treatment was more
heterogeneous and more patients dropped out because of side effects than
expected. Extensive patient education, patient selection and evaluation of
the treatment effect (by self-monitoring of hot flush frequency) are
mandatory to avoid useless (continuation of) treatment and to prepare
patients for side effects. Under these conditions, a substantial minority
of patients benefit from venlafaxine