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Recommendation
Menopausal symptom management – Sleep disturbance
In breast cancer patients experiencing sleep disturbance due to vasomotor symptoms and that is impacting on their quality of life, consider the second-line use of non-endocrine systemic therapies (desvenlafaxine, paroxetine, gabapentin) at doses shown to be effective in the management of sleep disturbance due to vasomotor symptoms. Be aware that paroxetine should be avoided in women treated with tamoxifen.
Desvenlafaxine (100 - 150 mg/d) can be considered for the management of sleep disturbance in women with a history of breast cancer, based on evidence from a general population of menopausal women. Note: Desvenlafaxine may alter the serum concentration of tamoxifen and metabolites. There is little evidence for clinical concern resulting from their concomitant use
Paroxetine (10 - 20 mg/day) can be considered for the management of moderate to severe vasomotor symptoms in women with a history of breast cancer who are not receiving tamoxifen. This recommendation is not generalisable to other SSRIs as there is insufficient evidence in women with a history of breast cancer that they have comparable effects on vasomotor symptoms. Note: Paroxetine interacts with tamoxifen and reduces the serum concentration of tamoxifen and metabolites
Gabapentin (300 - 900mg/d) can be considered for the management of sleep disturbance in women with a history of breast cancer
Body of evidence can be trusted to guide practice in most situations
Body of evidence provides some support for recommendation(s) but care should be taken in its application
How this guidance was developed
This recommendation was adapted from the CA 2016 guidelines for the management of menopausal symptoms in women with a history of breast cancer (Australia). Three source recommendations (one for each pharmaceutical treatment) were merged and simplified by removing unnecessary details. All three source recommendations were based on a systematic review conducted to 2015: the Desvenlafaxine source recommendation was graded ‘B’ (using NHMRC methods) and the paroxetine and gabapentin source recommendations were graded ‘C’ (using NHMRC methods) by the source guideline authors.
Menopausal symptom management – Sleep disturbance
Recommendation
In breast cancer patients experiencing sleep disturbance due to vasomotor symptoms and that is impacting on their quality of life, consider the second-line use of non-endocrine systemic therapies (desvenlafaxine, paroxetine, gabapentin) at doses shown to be effective in the management of sleep disturbance due to vasomotor symptoms. Be aware that paroxetine should be avoided in women treated with tamoxifen.
Principles in action
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Supportive care
This recommendation was adapted from the CA 2016 guidelines for the management of menopausal symptoms in women with a history of breast cancer (Australia). Three source recommendations (one for each pharmaceutical treatment) were merged and simplified by removing unnecessary details. All three source recommendations were based on a systematic review conducted to 2015: the Desvenlafaxine source recommendation was graded ‘B’ (using NHMRC methods) and the paroxetine and gabapentin source recommendations were graded ‘C’ (using NHMRC methods) by the source guideline authors.