Non-hormonal treatments for hot flashes in breast cancer patients: a narrative review

Abstract Background Hot flashes represent a major and clinically significant global health challenge, affecting a large proportion of women in midlife, with a higher burden observed in African regions and low-income settings compared with high-income countries. These vasomotor symptoms are also common after menopause and are particularly prevalent among breast cancer patients receiving endocrine therapy, where they can substantially impair quality of life and adherence to treatment. Although hormone replacement therapy is effective in relieving vasomotor symptoms, its contraindication in hormone receptor–positive breast cancer creates a clear therapeutic gap and highlights the urgent clinical need for well-validated, safe, and effective non-hormonal treatment strategies that can be integrated into routine breast cancer care. Main body. Hot flashes, a common and distressing symptom in cancer patients, result from estrogen withdrawal and involve hypothalamic thermoregulatory changes as well as altered serotonergic and noradrenergic signaling. Although many interventions are being explored, relatively few have demonstrated clear, safe, and effective clinical benefits. Non-hormonal management strategies include lifestyle modifications, complementary therapies, and pharmacological treatments. Behavioral approaches such as relaxation, yoga, and paced breathing may offer modest and variable relief, while complementary interventions like acupuncture, vitamin E, soy, and phytoestrogens have shown mixed results. Pharmacological options, including SSRIs (e.g., paroxetine, escitalopram), SNRIs (e.g., venlafaxine, desvenlafaxine), and gabapentin, have shown more consistent reductions in hot flash frequency and severity (25–69%) in clinical studies, though potential interactions with tamoxifen should be carefully considered. This review aims to critically evaluate current non-hormonal treatments options for hot flashes, focusing on key endpoints reported in recent clinical trials, and to propose prospective future directions. The review specifically addresses women receiving hormonal therapy for breast cancer. Conclusion Pharmacological non-hormonal treatments currently provide the most reliable relief from hot flashes, supporting adherence to therapy and improving quality of life in breast cancer patients. Behavioral and complementary interventions may supplement care, but further research is needed to refine long-term strategies, ensure safety, and enhance patient adherence.