Grant: Knowledge Synthesis Grant

<html> <body> <span style="font-family: Verdana; font-size: 80%"><strong><u>Background.</u></strong>Breast and prostate cancers are the most commonly diagnosed non-dermatologic malignancies in Canada, with over 23,000 women and 23,000 men diagnosed annually.^1,2 Drugs including aromatase inhibitors, gonadotrophin-releasing hormone analogues, antiandrogens and tamoxifen have improved survival for both conditions. As endocrine manipulation is the mainstay of treatment for both diseases, it is not surprising <strong><em>hot flashes</em></strong> are a troublesome side effect in <strong><em>2 of every 3</em></strong> patients receiving endocrine therapy.³ Hot flashes are a vasomotor symptom which lessens patients&rsquo; quality of life given that they cause chills, night sweats and irregular heartbeat and can cause compromised sleep and insomnia.^4-6 They can be a challenge for years. These symptoms impact adherence to treatment, with non-adherence rates as high as 55%, and thus worsen prognosis.⁴ While estrogen replacement therapy (ERT) is often for hot flashes in healthy menopausal women, its use is contraindicated in breast cancer.⁷ Similarly, testosterone replacement therapy (TRT) is contraindicated in prostate cancer.^8,9 Thus it is not surprising that non-hormonal pharmacological treatments (anti-depressants, anti-epilectics, anti-hypertensives), physical/ behavioral treatments (e.g. acupuncture, yoga/exercise, relaxation techniques, cognitive behavioral therapy) and natural health products (e.g. black cohosh, flax, vitamin E, ginseng) have been studied for control of hot flashes.^10-12 While past reviews have considered treatments&rsquo; in isolation, there is a need for network meta-analyses^13-15 to compare many alternatives in a unified analysis.</span> <br> <br> <span style="font-family: Verdana; font-size: 80%"><strong><u>Questions Addressed.</u></strong> Establishing which non-hormonal treatments can minimize the frequency and severity of hot flashes and their impact on quality of life is vital for prostate and breast cancer survivors. We will perform a systematic review with network meta-analyses to address the following question: <strong><em>In breast cancer and prostate cancer survivors, what are the relative benefits of non-hormonal therapies for (1) minimizing the frequency and severity of hot flashes? (2) minimizing any losses in the measurement of quality of life?</em> <em>(3)</em></strong> <strong><em>minimizing any decrements in quality of life for the specific symptoms of depression and sleep</em></strong><strong><em>quality?</em></strong>Network meta-analysis is a statistical framework for synthesis of evidence from randomized trials allowing the comparison of many interventions based on all &lsquo;direct&rsquo; and &lsquo;indirect&rsquo; information.^13-15 Such analyses are needed to address this knowledge gap. Data regarding harms and treatment adherence will also be collected.</span> <br> <br> <span style="font-family: Verdana; font-size: 80%"><strong><u>Methods.</u></strong>This review will evaluate the benefits and harms of treatments for hot flashes in breast and prostate cancer patients in separate and combined analyses. The review will use established methods for systematic reviews and network meta-analysis described in this proposal.^16-19 We will conduct systematic searches for and data collection from eligible studies and pursue sensitivity analyses to establish the robustness of findings.We will employ an integrated knowledge translation approach and share findings with our knowledge user Cancer Care Ontario for clinical guidance development, as well as clinicians and patients.`</span> <br> <br> <span style="font-family: Verdana; font-size: 80%"><strong><u>Team Expertise.</u></strong>Our team includes researchers and physicians in epidemiology, systematic reviews, network meta-analysis, oncology, pharmacy, and knowledge translation. Our knowledge users and collaborators are oncologists, urologists, guideline developers and patients.</span> <br> </body> </html>