Homeopathy for hot flashes in breast cancer survivors

Hot flashes, and other symptoms of estrogen withdrawal, are common in both pre- and postmenopausal breast cancer survivors. The standard treatment for these symptoms, hormone replacement therapy, is contraindicated in breast cancer survivors. Homeopathic medicines have been used to treat hot flashes and other menopausal symptoms for more than 100 years. Our goal was to determine whether homeopathy is an effective treatment to improve the quality of life in breast cancer survivors who are experiencing hot flashes and other menopausal-type symptoms. We carried out a pilot study to demonstrates our ability to successfully conduct a full-scale trial. A group of 83 breast cancer survivors with hot flashes and other menopausal symptoms were randomized to one of three treatment arms: classical homeopathy, a combination homeopathic remedy, or placebo. The number of hot flashes, menopausal index scores, general health status, patient satisfaction, and the use of health care services were measured over a period of 12 months. Recruitment was slower and more difficult than anticipated. We expanded recruitment to another medical center and extended the recruitment period for an additional seven months, to obtain a total of 83 patients in the study, 79% of our projected goal of 105. Withdrawals were higher than anticipated, with a total of 28 withdrawals from the study (33.7% of the total cohort). Of these, 12 (44%), reported no relief from hot flashes, 7 (25%) had a cancer recurrence or were advised to withdraw by their physicians, 5 (18.5%) said the study was too inconvenient, and 4 (15%) were lost to follow-up. However, 66 of the 83 originally enrolled completed at least six months of the study (80%). We plan to look at the withdrawal rate by study arm to see whether those receiving placebo had a higher withdrawal rate. In future studies, recruitment should be more aggressive, with a larger budget for advertisements in the local media and gift incentives for subjects. We also recommend that the study period be shortened to six months, as it is unreasonable to expect women who are not receiving relief from hot flashes to continue for one year. The public health importance of a natural treatment for hot flashes in breast cancer survivors would be great.