Source: National Cancer Institute Research, www.cancer.gov
Sweating is the body's way of lowering body temperature by causing heat loss through the skin. In patients with cancer, sweating may be caused by fever, a tumor, or cancer treatment.
Hot flashes can also cause too much sweating. They may occur in natural menopause or in patients who have been treated for breast cancer or prostate cancer.
Hot flashes combined with sweats that happen while sleeping are often called
A treatment plan to help manage hot flashes and night sweats is based on the patient's condition and goals of care. For some patients, relieving symptoms and improving quality of life is the most important goal.
This summary describes the causes and treatment of hot flashes and night sweats in cancer patients.
Sweating happens with disease conditions such as fever and may occur without disease in warm climates, during exercise, and during hot flashes in menopause. Sweating helps balance body temperature by allowing heat to evaporate through the skin.
Hot flashes and night sweats are common in patients with cancer and in cancer survivors. They are more common in women but can also occur in men.
Menopause in women can have natural, surgical, or chemical causes. Chemical menopause in women with cancer is caused by certain types of chemotherapy, radiation, or hormone therapy with androgen (a male hormone).
"Male menopause" in men with cancer can be caused by orchiectomy (surgery to remove one or both testicles) or hormone therapy with gonadotropin-releasing hormone or estrogen.
Treatment for breast cancer and prostate cancer can cause menopause or menopause-like effects, including severe hot flashes.
Drugs that may cause night sweats include the following:
Sweats caused by fever are controlled by treating the cause of the fever. Sweats caused by a tumor are usually controlled by treatment of the tumor.
Hot flashes during natural or treatment-related menopause can be controlled with estrogen replacement therapy. However, many women are not able to take estrogen replacement (for example, women who have or had breast cancer). Hormone replacement therapy that combines estrogen with progestin may increase the risk of breast cancer or breast cancer recurrence.
Treatment of hot flashes in men who have been treated for prostate cancer may include estrogens, progestin, antidepressants, and anticonvulsants. Certain hormones (such as estrogen) can make some cancers grow.
Studies of non-estrogen drugs to treat hot flashes in women with a history of breast cancer have reported that many of them do not work as well as estrogen replacement or have side effects. Megestrol (a drug like progesterone), certain antidepressants, anticonvulsants, and clonidine (a drug used to treat high blood pressure) are non-estrogen drugs used to control hot flashes. Some antidepressants may change how other drugs, such as tamoxifen, work in the body. Side effects of drug therapy may include the following:
Patients may respond in different ways to drug therapy. It is important that the patient's health care providers know about all medicines, dietary supplements, and herbs the patient is taking.
Drugs that may relieve nighttime hot flashes or night sweats and improve sleep at the same time are being studied in clinical trials.
If one medicine does not improve symptoms, switching to another medicine may help.
Treatments that change how patients deal with stress, anxiety, and negative emotions may help manage hot flashes. These are called psychologicalinterventions. Psychological interventions help patients gain a sense of control and develop coping skills to manage symptoms. Staying calm and managing stress may lower levels of a hormone called serotonin that can trigger hot flashes.
Psychological interventions may help hot flashes and related problems when used together with drug treatment.
Hypnosis is a trance-like state that allows a person to be more aware, focused, and open to suggestion. Under hypnosis, the person can concentrate more clearly on a specific thought, feeling, or sensation without becoming distracted.
Hypnosis is a newer treatment for hot flashes that has been shown to be helpful. In hypnosis, a therapist helps the patient to deeply relax and focus on cooling thoughts. This may lower stress levels, balance body temperature, and calm the heart rate and breathing rate.
Comfort measures may be used to treat night sweats related to cancer. Since body temperature goes up before a hot flash, doing the following may control body temperature and help control symptoms:
Studies of vitamin E for the relief of hot flashes show that it is only slightly better than a placebo (pill that has no effect). Most studies of soy and black cohosh show they are no better than a placebo in reducing hot flashes. Soy contains estrogen-like substances; the effect of soy on the risk of breast cancer growth or recurrence is not clear. Studies of ground flaxseed to treat hot flashes have shown mixed results.
Claims are made about several other plant-based and natural products as remedies for hot flashes. These include dong quai, milk thistle, red clover, licorice root extract, and chaste tree berry. Since little is known about how these products work or whether they affect the risk of breast cancer, women should be cautious about using them.
Pilot studies of acupuncture and randomized clinical trials that compare true acupuncture and sham (inactive) treatment have been done in patients with hot flashes. Results are not clear and more studies are needed. (See the Vasomotor symptoms section in the PDQ health professional summary on Acupuncture for more information.)
Check NCI’s list of cancer clinical trials for U.S. supportive and palliative care trials about fever, sweats, and hot flashes, neutropenia, hot flashes and hot flashes attenuation that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.