de Valois, B. A., Young, T. E., Robinson, N., McCourt, C., & Maher, E. J. (2010). Using traditional acupuncture for breast cancer-related hot flashes and night sweats. Journal of Alternative and Complementary Medicine, 16, 1047–1057.

To determine if traditional acupuncture (TA) could reduce hot flashes and night sweats (HF&NS) frequency, improve physical and emotional well-being, and improve perceptions of HF&NS in women receiving tamoxifen after active breast cancer treatment.

Women with a diagnosis of breast cancer receiving tamoxifen who reported experiencing HF&NS for more than three months underwent eight sessions of TA, delivered once weekly. They were monitored for 30 weeks, during which there were five measurement points. Data were collected using a paper-based hot flash diary. Physical and emotional well-being were measured using two questionnaires:  the Women’s Health Questionnaire (WHQ) and the Hot Flashes and Night Sweats Questionnaire (HFNSQ).

• The sample was comprised of 47 female patients.  
• Mean age was 54.3 years (range 37–68). 
• Patients
  • Were women taking tamoxifen as adjuvant treatment for early breast cancer
  • Were six or more months postsurgery, chemotherapy, or radiotherapy
  • Were taking tamoxifen for at least six months
  • Reported HF&NS for at least 3 months.
  • Had no recurrent or metastatic disease
  • Could be receiving concomitant preparations for relieving HF&NS, whether prescription or over the counter, if they had been taking them at least three months and would continue them through the trial period.

• Single site   
• Outpatient 
• Mount Vernon Hospital, Middlesex, United Kingdom

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for late effects and survivorship.

This was a prospective, single-arm, observational study using before and after measurements.

• Hot Flash Diaries    
• WHQ
• HFNSQ

HF&NS mean frequency was reduced by 49.8% (95% confidence interval [40.5, 56.5]; p < 0.0001; n = 48) at end of treatment (EOT) over baseline. Trends indicated longer-term effects of TA at 4 and 18 weeks after EOT. At EOT, seven WHQ domains showed significant statistical and clinical improvements, including Anxiety/Fears, Memory/Concentration, Menstrual Problems, Sexual Behavior, Sleep Problems, Somatic Symptoms, and Vasomotor Symptoms. Perceptions of HF&NS as a problem were reduced by 2.2 points (standard deviation = 2.15 points; n = 48; t = 7.16; p < 0.0001).

The study supports using TA to manage HF&NS in women receiving tamoxifen as a breast cancer treatment. In addition, it suggests that the women received the added benefit of improved emotional and physical well-being with few side effects.

• The study lacked an appropriate control group.
• The study lacked control over the therapeutic relationship that was established between the practitioner and the patient, which could have contributed to the placebo effect.
• Concomitant medication was used for managing hot flashes.

Nurses should recognize that tamoxifen continues to pose distressing side effects in women with breast cancer, even after prolonged use. This study suggests that, through the use of TA, women receiving tamoxifen may be able to control some of these distressing side effects. Randomized, controlled trials using larger samples are warranted to validate TA as a tool for reducing these common side effects. Future studies, if including concomitant medications for hot flash symptoms, may want to control the types of concomitant medication usage for further analysis of results or have a randomized group to TA alone to TA plus a specific concomitant medication to note if hot flash symptoms are further controlled.