Nerve block useful for hot flushes and sleep trouble in breast cancer survivors

Last Updated: 2008-05-14 18:30:07 -0400 (Reuters Health)

NEW YORK (Reuters Health) – A stellate-ganglion block can safely reduce hot flushes and improve nighttime sleep in survivors of breast cancer, according to results of a small pilot study reported in the May 15th online issue of The Lancet Oncology.

With the block, the average number of hot flushes per week fell from about 80 to just 8. Very severe hot flushes were almost totally abolished and a marked drop in nighttime awakenings was also seen, the report indicates.

Hot flushes and sleep dysfunction are common in breast cancer survivors, particularly those who use anti-estrogen agents, Dr. Eugene G. Lipov, from Advanced Pain Centers in Hoffman Estates, Illinois, and colleagues explain. Conventional treatments, such as hormone therapy or herbal remedies, have proven either ineffective or have been linked to important side effects.

Stellate-ganglion blocks, which have been used to treat various conditions for more than 60 years, disrupt parts of the sympathetic nervous system that regulate body temperature. The researchers hypothesized that this treatment may provide a safe and effective alternative to current therapies used to treat hot flushes and sleep dysfunction in breast cancer survivors.

The new study involved 13 survivors of breast cancer with severe hot flushes and night awakenings who underwent stellate-ganglion block at the C6 vertebra under fluoroscopic guidance. Patients were given one block, but during the course of the study they were permitted to have another if they thought that the beneficial effects were waning.

Hot flushes were rated by the subjects using the Hot-Flash Score and night awakening were rated using the Pittsburgh Sleep Quality Index. Assessments were made 1 week before treatment and then every week after treatment for 12 weeks.

Following treatment, the patients displayed a transient Horner’s syndrome, indicating that the stellate ganglion had, in fact, been successfully blocked. No other adverse effects were noted.

Five patients had one block and eight had two blocks, the authors report.

With treatment, the average number of hot flushes per week fell from 79.4 to 8.1 (p < 0.0001) and severe hot flushes virtually disappeared. Night awakenings dropped from 19.5 per week prior to treatment to just 1.4 per week.

"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-estrogen medications for breast cancer," the authors state.

Lancet Oncology 2008.