A local anesthetic administered into the neck appears to significantly reduce severe menopausal-like side effects among women who have been treated for breast cancer. These results were recently published in the Lancet Oncology.

Women undergoing treatment for breast cancer often suffer side effects such as hot flushes or sleep disturbances. These side effects are particularly prominent among women who are on therapy to suppress or reduce estrogen levels in the body, and often continue even after therapy has been completed. In addition, chemotherapy agents often suppress ovarian function, also resulting in reduced levels of estrogen in the body. These side effects often mimic those of menopause, and are commonly described as “intolerable.” In fact, up to half of breast cancer patients who are on therapy to suppress estrogen levels will discontinue therapy due to these side effects. Therefore, the reduction of menopausal-like side effects among these women not only improves quality of life, but may also allow patients to continue therapy and achieve optimal outcomes.

A stellate-ganglion block refers to a local anesthetic that is placed in the neck. The stellate are a group of nerves in the neck that provide sensory input to the top region of the body. In addition, it appears that there is interplay with the sympathetic nervous system, the biologic system responsible for such things as temperature regulation and possibly, sleep patterns. As such, researchers speculated that a stellate-ganglion block could help relieve side effects like hot flushes and sleep disturbances among breast cancer survivors.

Researchers from Illinois recently conducted a small clinical trial to explore the potential association between a stellate-ganglion block and side effects such as hot flushes and sleep-disturbances among 13 breast cancer survivors. All patients were suffering from severe hot flushes and sleep disturbances and provided self-reported questionnaires following a stellate-ganglion block.

• The total number of hot flushes was reduced from nearly 80 per week prior to the stellate-ganglion block to 50 per week within the first two weeks following the block; the number continued to decrease and stabilized at approximately eight per week.

• The 12th week following the block, the number of severe hot flushes was nearly zero.

• Night awakenings decreased from nearly 20 per week prior to the procedure to 1.4 per week at 12 weeks following the procedure.

• There were no few side effects reported from the procedure.

The researchers concluded: “The findings of this study suggest that stellate-ganglion block can provide survivors of breast cancer with relief from hot flushes and sleep dysfunction with few or no side-effects. Long-term relief of symptoms has the potential to improve overall quality of life and increase compliance with anti-oestrogen medications for breast cancer.”

Follow-up trials of the effectiveness of a stellate-ganglion block among breast cancer survivors suffering from hot flushes or sleep disturbances are planned.

Patients with breast cancer who are suffering from hot flushes or sleep disturbances may wish to speak with their physician regarding their individual risks and benefits of participation in a clinical trial further evaluating this procedure or other novel procedures. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.eCancerTrials.com.

Reference: Lipov E, Joshi J, Sanders S, et al. Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncology [early online publication]. May 15, 2008. DOI:10.1016/S1470-2045(08)70131-1.

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