Hot flash treatment for breast cancer survivors

Imagine a wave of intense heat suddenly enveloping your body, flushing your skin red and leaving your clothes drenched with sweat.

Your heartbeat accelerates to a gallop as you choke for air.

Minutes pass before the crippling heat begins to subside.

Now, think about experiencing this up to 25 times a day, sometimes six time in one hour, and you can picture what life was like for Bianca Kennedy of Chicago.

Kennedy was one of the many breast cancer survivors in America afflicted by debilitating hot flashes.

"I would sweat from every part of my body, from head to toe." said Kennedy, who was diagnosed with breast cancer seven years ago at the age of 35. "I would turn beet-red and feel like I was going to explode."

Over the next two years, Kennedy endured a double mastectomy, breast reconstruction and several rounds of chemotherapy to battle her breast cancer. But hot flashes, a common side effect of breast cancer treatments, continued to plague the Streeterville resident, forcing her to keep her air conditioner on full blast, even during the winter.

After trying a number of failed medications to mollify her attacks, Kennedy finally found relief with an injection into the neck-a painless procedure that took about five minutes. One Band-aid and several days later, her hot flashes stopped.

Kennedy received a numbing injection called a stellate ganglion block, which has been shown to reduce the severity and frequency of hot flashes in breast cancer survivors, according to a study published Wednesday in The Lancet Oncology's online issue.

A previous study showed that the treatment benefits women suffering from hot flashes due to menopause as well.

"In breast cancer survivors, the body's thermostat doesn't work," said Dr. Eugene Lipov, the study's author and medical director of Advanced Pain Centers in Hoffman Estates. "Numbing up the stellate resets the body's thermostat and makes it work like it's supposed to."

The stellate ganglion, a star-shaped cluster of nerves in the neck, sends signals to the brain's hypothalamus, the body's temperature control center. But the hypothalamus becomes confused when the body has a diminished level of estrogen.

This is common in breast cancer survivors who take anti-estrogen medication to fight their cancer. In its confused state, the hypothalamus tries to rid the body of heat by dilating blood vessels and opening sweat glands. The result is a hot flash.

In his study, Lipov administered a stellate ganglion block to 13 breast cancer survivors, who recorded the severity and frequency of their hot flashes one week before the procedure and on a weekly basis 12 weeks after the procedure.

Two weeks after the treatment, the average number of hot flashes decreased from nearly 80 to about 50 per week. The number of hot flashes per week stabilized at approximately eight over the next nine weeks. By the end of the treatment period, the number of very severe hot flashes dropped to almost zero.

"I came home and within hours, I was feeling cooler," said Kennedy. "Within the next few days, I wasn't having the hot flashes. I was in shock-a happy shock this time."

Kennedy's hot flashes returned four weeks later, but after a second injection, she was completely free of symptoms for six months. After a third and final treatment, she has not had a hot flash in three years.

"I'm very comfortable in my own skin again and the difference is night and day," said Kennedy, who now works at a breast cancer hotline.

But like any procedure, the stellate ganglion block does have its risks, Lipov said. There is a rare chance the patient could have a seizure if the anesthesiologist hits a blood vessel, but this can be avoided by guiding the needle by X-ray.

There are alternative options for treating hot flashes, but they pose more dangerous risks, according to Lipov. Menopausal patients can take estrogen hormonal therapy but the therapy is linked to an increased risk of cancer. Breast cancer survivors cannot even consider such therapy because estrogen increases their risk of cancer recurrence.

For Kennedy, receiving the stellate ganglion block was worth the risk.

"The day-to-day hot flashes, the misery of living with that day-in and day-out, all that is thankfully behind me," she said. "It has allowed me to focus on my goals in life and enjoy my life immensely."

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