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Holt J, Salas M, Lee SW. Aromatase Inhibitor-Associated Distal Radioulnar Joint Instability and Tear of the Extensor Digiti Minimi: A Case Report. Am J Phys Med Rehabil 2024; 103:e86-e89. [PMID: 38466152 DOI: 10.1097/phm.0000000000002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors.
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Affiliation(s)
- Jonathan Holt
- From the MountainView Hospital, Sunrise Health Graduate Medical Education Consortium, Las Vegas, Nevada (JH, SWL); and VA Southern Nevada Healthcare System, Las Vegas, Nevada (MS)
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Chang CY, Jones BL, Hincapie-Castillo JM, Park H, Heldermon CD, Diaby V, Wilson DL, Lo-Ciganic WH. Association between trajectories of adherence to endocrine therapy and risk of treated breast cancer recurrence among US nonmetastatic breast cancer survivors. Br J Cancer 2024; 130:1943-1950. [PMID: 38637603 PMCID: PMC11183212 DOI: 10.1038/s41416-024-02680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Endocrine therapy is the mainstay treatment for breast cancer (BC) to reduce BC recurrence risk. During the first year of endocrine therapy use, nearly 30% of BC survivors are nonadherent, which may increase BC recurrence risk. This study is to examine the association between endocrine therapy adherence trajectories and BC recurrence risk in nonmetastatic BC survivors. METHODS This retrospective cohort study included Medicare beneficiaries in the United States (US) with incident nonmetastatic BC followed by endocrine therapy initiation in 2010-2019 US Surveillance, Epidemiology, and End Results linked Medicare data. We calculated monthly fill-based proportion of days covered in the first year of endocrine therapy. We applied group-based trajectory models to identify distinct endocrine therapy adherence patterns. After the end of the first-year endocrine therapy trajectory measurement period, we estimated the risk of time to first treated BC recurrence within 4 years using Cox proportional hazards models. RESULTS We identified 5 trajectories of adherence to endocrine therapy in BC Stages 0-I subgroup (n = 28,042) and in Stages II-III subgroup (n = 7781). A trajectory of discontinuation before 6 months accounted for 7.0% in Stages 0-I and 5.8% in Stages II-III subgroups, and this trajectory was associated with an increased treated BC recurrence risk compared to nearly perfect adherence (Stages 0-I: adjusted hazard [aHR] = 1.84, 95% CI = 1.46-2.33; Stages II-III: aHR = 1.38, 95% CI = 1.07-1.77). CONCLUSIONS Nearly 7% of BC survivors who discontinued before completing 6 months of treatment was associated with an increased treated BC recurrence risk compared to those with nearly perfect adherence among Medicare nonmetastatic BC survivors.
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Affiliation(s)
- Ching-Yuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Bobby L Jones
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | | | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Coy D Heldermon
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Wei-Hsuan Lo-Ciganic
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
- Center for Pharmaceutical Prescribing and Policy, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
- North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, FL, USA.
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Kim S, Chen N, Reid P. Current and future advances in practice: aromatase inhibitor-induced arthralgia. Rheumatol Adv Pract 2024; 8:rkae024. [PMID: 38601139 PMCID: PMC11003819 DOI: 10.1093/rap/rkae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024] Open
Abstract
Aromatase inhibitors (AIs) have shown great success as adjuvant therapy for post-menopausal women with hormone receptor-positive breast cancers. AI-induced arthralgia (AIA) is a frequent AI toxicity contributing to non-adherence and discontinuation. This review aims to understand current knowledge of AIA. The mean incidence of AIA was 39.1% and the mean discontinuation of AI therapy due to AIA was 9.3%. Most of the AIAs were non-inflammatory. A shorter time since the last menstrual period and pre-existing joint pain were risk factors. Vitamin D3 supplementation may be a preventative measure and treatment with duloxetine, acupuncture and/or exercise is supported by large randomized controlled trials. There was consistent improvement in AIAs with switching to an alternate AI, and this could additionally allow continuation of cancer treatment with AI. Further research is needed to identify predictive biomarkers, better characterize AIA subcategories and study more reliable therapeutic options.
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Affiliation(s)
- Sara Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nan Chen
- Division of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Pankti Reid
- Division of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL, USA
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Guo L, Kong D, Liu J, Luo L, Zheng W, Chen C, Sun S. Searching for Essential Genes and Targeted Drugs Common to Breast Cancer and Osteoarthritis. Comb Chem High Throughput Screen 2024; 27:238-255. [PMID: 37157194 DOI: 10.2174/1386207326666230508113036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND It is documented that osteoarthritis can promote the progression of breast cancer (BC). OBJECTIVE This study aims to search for the essential genes associated with breast cancer (BC) and osteoarthritis (OA), explore the relationship between epithelial-mesenchymal transition (EMT)- related genes and the two diseases, and identify the candidate drugs. METHODS The genes related to both BC and OA were determined by text mining. Protein-protein Interaction (PPI) analysis was carried out, and as a result, the exported genes were found to be related to EMT. PPI and the correlation of mRNA of these genes were also analyzed. Different kinds of enrichment analyses were performed on these genes. A prognostic analysis was performed on these genes for examining their expression levels at different pathological stages, in different tissues, and in different immune cells. Drug-gene interaction database was employed for potential drug discovery. RESULTS A total number of 1422 genes were identified as common to BC and OA and 58 genes were found to be related to EMT. We found that HDAC2 and TGFBR1 were significantly poor in overall survival. High expression of HDAC2 plays a vital role in the increase of pathological stages. Four immune cells might play a role in this process. Fifty-seven drugs were identified that could potentially have therapeutic effects. CONCLUSION EMT may be one of the mechanisms by which OA affects BC. Using the drugs can have potential therapeutic effects, which may benefit patients with both diseases and broaden the indications for drug use.
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Affiliation(s)
- Liantao Guo
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Deguang Kong
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Jianhua Liu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Lan Luo
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Weijie Zheng
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, Hubei 430060, People's Republic of China
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Baba O, Kisaoglu H, Kalyoncu M. Letrozole-induced inflammatory arthritis and tendinopathy in pediatric rheumatology setting. Int J Rheum Dis 2023; 26:2314-2316. [PMID: 37218595 DOI: 10.1111/1756-185x.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
Musculoskeletal symptoms associated with the use of aromatase inhibitors are a well-known side effect of these drugs and are more prevalent in postmenopausal women. Aromatase inhibitor-associated symptoms are not overt inflammatory processes so are described as arthralgia syndrome. In contrast, aromatase inhibitor-associated inflammatory conditions such as myopathies, vasculitis, and rheumatoid arthritis were also reported. To our knowledge, inflammatory arthritis or tendinopathy associated with aromatase inhibitors were not reported in children despite their increased off-label use in the pediatric setting. Herein, we report a girl with inflammatory arthritis and tendinopathy associated with letrozole treatment.
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Affiliation(s)
- Ozge Baba
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | - Hakan Kisaoglu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | - Mukaddes Kalyoncu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
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Christensen Holz S. Aromatase Inhibitor Musculoskeletal Syndrome and Bone Loss: a Review of the Current Literature. Curr Oncol Rep 2023; 25:825-831. [PMID: 37052869 DOI: 10.1007/s11912-023-01413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW The study aims to review the literature regarding musculoskeletal complications of aromatase inhibitors and treatment options for these complications. RECENT FINDINGS Aromatase inhibitors are common medications to treat hormone receptor-positive breast cancer in postmenopausal women and have been shown to improve survival and prevent disease recurrence. However, 20-60% patients stop treatment prematurely due to side effects. Side effects include joint stiffness and pain, tendonitis, tendon tears, muscle pain, and carpal tunnel syndrome known as aromatase inhibitor musculoskeletal syndrome (AIMSS) as well as bone loss. Proposed mechanisms of AIMSS include decreased estrogen levels, inflammation, and genetic factors. Switching aromatase inhibitors, exercise, non-steroidal anti-inflammatory medications, duloxetine, acupuncture, prednisone, and bisphosphonates are some treatment options for this syndrome and will be discussed in more detail in this review. Aromatase inhibitors are important in the treatment of hormone receptor-positive breast cancer in postmenopausal women. As we study the incidence of side effects of these medications including bone loss and AIMSS and determine the mechanisms of these symptoms and possible treatment options, we will decrease the incidence of patients discontinuing treatment prematurely and improve symptoms, quality of life, and survival in this patient population.
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Drillon P, Desvergée A, Prevost V, Blaizot X. [Impact of adapted physical activity on joint pain induced under adjuvant hormone therapy for breast cancer: A review of the literature]. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:1-12. [PMID: 35728629 DOI: 10.1016/j.pharma.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
Hormone therapy provides an excellent survival rate after cancer but has many side effects, including joint pain in one out of two women. This leads about 13 % of women to stop their treatment within the first 6 months, impacting on its effectiveness, survival and the risk of recurrence. In order to better manage pain and quality of life, physical activity is highly recommended. In this context, the present review proposes a state of the art on the effects of adapted physical activity, based on the works referenced in PubMed. These studies show that physical activity has proved its worth in the primary prevention of cancer and is being evaluated in secondary prevention, particularly in the reduction of adverse effects. Overall, there is a reduction in joint pain, an improvement in quality of life and fatigue. Physical activity also plays a role in tertiary prevention. Paradoxically, oncologists and educators often note a reduction in the practice of physical activity due to fear of the onset of pain. It seems necessary to reinforce communication with patients and health professionals and to recommend the practice of physical activity in an appropriate setting.
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Affiliation(s)
- P Drillon
- Pharmacie Le Point du Jour, 36, rue de Cerisé, 61000 Alençon, France
| | - A Desvergée
- Service de Médecine Physique et Réadaptation; Maison Sport Santé (MSS) CHU, Caen Normandie, avenue de la Côte de Nacre, CS 30001, 14033 Caen cedex 9, France
| | - V Prevost
- Centre François Baclesse, 3, avenue du Général Harris, 14000 Caen, France; Normandie Univ, UNICAEN, Inserm, ANTICIPE, 14000 Caen, France
| | - X Blaizot
- Réseau régional de cancérologie de Normandie, 28, rue Bailey, 14000 Caen, France.
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Zhu Y, Loggia ML, Edwards RR, Flowers KM, Muñoz-Vergara DW, Partridge AH, Schreiber KL. Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy. Clin J Pain 2022; 38:721-729. [PMID: 36136765 PMCID: PMC9649865 DOI: 10.1097/ajp.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Aromatase inhibitors (AIs), which potently inhibit estrogen biosynthesis, are a standard treatment for hormone sensitive early-stage breast cancer. AIs have been associated with substantial joint pain and muscle stiffness (aromatase inhibitor-associated musculoskeletal syndrome). However, the link between AIs and number of clinical pain locations and pain sensitivity are less well understood. The aim of this study was to compare longitudinal changes in clinical pain and quantitative pain sensitivity between women who did or did not receive AI therapy. METHODS Women with early-stage breast cancer were prospectively enrolled and assessed for clinical pain in surgical and nonsurgical body areas using the Brief Pain Inventory and Breast Cancer Pain Questionnaire, and for pain sensitivity using quantitative sensory testing preoperatively and at 1 year postoperatively. Pain outcomes between participants who did and did not begin adjuvant AI therapy were compared using Wilcoxon Signed-Ranks and generalized estimating equation linear regression analyses. RESULTS Clinical pain and pain sensitivity were comparable between AI (n=49) and no-AI (n=106) groups preoperatively. After adjusting for body mass index, AI therapy was associated with a greater increase in the number of painful nonsurgical body sites (significant time by treatment interaction, P =0.024). Pain location was most frequent in knees (28%), lower back (26%), and ankles/feet (17%). Quantitative sensory testing revealed a significant decrease in pain sensitivity (increased pressure pain threshold) in the no-AI group over time, but not in the AI group. CONCLUSIONS AI therapy was associated with increased diffuse joint-related pain and greater post-treatment pain sensitivity, potentially implicating central sensitization as a contributing pain mechanism of aromatase inhibitor-associated musculoskeletal syndrome worthy of future investigation.
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Affiliation(s)
- Yehui Zhu
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco L. Loggia
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey M. Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis W. Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hertz DL, Douglas JA, Miller RM, Kidwell KM, Gersch CL, Desta Z, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. Genome-wide association study of aromatase inhibitor discontinuation due to musculoskeletal symptoms. Support Care Cancer 2022; 30:8059-8067. [PMID: 35776183 PMCID: PMC9529953 DOI: 10.1007/s00520-022-07243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Aromatase inhibitors (AIs) are commonly used to treat hormone receptor positive (HR +) breast cancer. AI-induced musculoskeletal syndrome (AIMSS) is a common toxicity that causes AI treatment discontinuation. The objective of this genome-wide association study (GWAS) was to identify genetic variants associated with discontinuation of AI therapy due to AIMSS and attempt to replicate previously reported associations. METHODS In the Exemestane and Letrozole Pharmacogenetics (ELPh) study, postmenopausal patients with HR + non-metastatic breast cancer were randomized to letrozole or exemestane. Genome-wide genotyping of germline DNA was conducted followed by imputation. Each imputed variant was tested for association with time-to-treatment discontinuation due to AIMSS using a Cox proportional hazards model assuming additive genetic effects and adjusting for age, baseline pain score, prior taxane treatment, and AI arm. Secondary analyses were conducted within each AI arm and analyses of candidate variants previously reported to be associated with AIMSS risk. RESULTS Four hundred ELPh participants were included in the combined analysis. Two variants surpassed the genome-wide significance level in the primary analysis (p value < 5 × 10-8), an intronic variant (rs79048288) within CCDC148 (HR = 4.42, 95% CI: 2.67-7.33) and an intergenic variant (rs912571) upstream of PPP1R14C (HR = 0.30, 95% CI: 0.20-0.47). In the secondary analysis, rs74418677, which is known to be associated with expression of SUPT20H, was significantly associated with discontinuation of letrozole therapy due to AIMSS (HR = 5.91, 95% CI: 3.16-11.06). We were able to replicate associations for candidate variants previously reported to be associated with AIMSS in this cohort, but were not able to replicate associations for any other variants previously reported in other patient cohorts. CONCLUSIONS Our GWAS findings identify several candidate variants that may be associated with AIMSS risk from AI generally or letrozole specifically. Validation of these associations in independent cohorts is needed before translating these findings into clinical practice to improve treatment outcomes in patients with HR + breast cancer.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St., Room 3054, Ann Arbor, MI, 48109-1065, USA.
| | - Julie A Douglas
- Department of Mathematics and Statistics, Skidmore College, Saratoga Springs, NY, 12866, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert M Miller
- Department of Mathematics and Statistics, Skidmore College, Saratoga Springs, NY, 12866, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Christina L Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Vered Stearns
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel F Hayes
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
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Effects of Acupuncture on Breast Cancer Patients Taking Aromatase Inhibitors. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1164355. [PMID: 36132087 PMCID: PMC9484888 DOI: 10.1155/2022/1164355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
Although acupuncture has been used in clinical practice for thousands of years, it remains a controversial treatment option to help alleviate pain in cancer patients. In this study, we analyzed published material on randomized trials of acupuncture from MEDLINE published up until July 31, 2018, to assess its effects on pain experienced by cancer patients. Revman 5.0 software was used to conduct meta-analysis with pain score as the index. The results of nine randomized controlled trials involving 592 patients were analyzed and showed that acupuncture can relieve the pain caused by aromatase inhibitors. Weighted mean difference of worst pain and pain severity was -3.03, 95% CI (-3.90,-2.16) and -2.69, 95% CI (-4.08,-1.30), respectively (
). This led us to conclude that acupuncture has pain relieving effects against pain caused by aromatase inhibitors.
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Roberts KE, Adsett IT, Rickett K, Conroy SM, Chatfield MD, Woodward NE. Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev 2022; 1:CD013167. [PMID: 35005781 PMCID: PMC8743877 DOI: 10.1002/14651858.cd013167.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adjuvant aromatase inhibitors (AI) improve survival compared to tamoxifen in postmenopausal women with hormone receptor-positive stage I to III breast cancer. In approximately half of these women, AI are associated with aromatase inhibitor-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS may have significant and prolonged impact on women's quality of life. AIMSS reduces adherence to AI therapy in up to a half of women, potentially compromising breast cancer outcomes. Differing systemic therapies have been investigated for the prevention and treatment of AIMSS, but the effectiveness of these therapies remains unclear. OBJECTIVES To assess the effects of systemic therapies on the prevention or management of AIMSS in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, WHO International Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov registries to September 2020 and the Cochrane Breast Cancer Group (CBCG) Specialised Register to March 2021. SELECTION CRITERIA: We included all randomised controlled trials that compared systemic therapies to a comparator arm. Systemic therapy interventions included all pharmacological therapies, dietary supplements, and complementary and alternative medicines (CAM). All comparator arms were allowed including placebo or standard of care (or both) with analgesia alone. Published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, and assessed risk of bias and certainty of the evidence using the GRADE approach. Outcomes assessed were pain, stiffness, grip strength, safety data, discontinuation of AI, health-related quality of life (HRQoL), breast cancer-specific quality of life (BCS-QoL), incidence of AIMSS, breast cancer-specific survival (BCSS) and overall survival (OS). For continuous outcomes, we used vote-counting by reporting how many studies reported a clinically significant benefit within the confidence intervals (CI) of the mean difference (MD) between treatment arms, as determined by the minimal clinically importance difference (MCID) for that outcome scale. For dichotomous outcomes, we reported outcomes as a risk ratio (RR) with 95% CI. MAIN RESULTS We included 17 studies with 2034 randomised participants. Four studies assessed systemic therapies for the prevention of AIMSS and 13 studies investigated treatment of AIMSS. Due to the variation in systemic therapy studies, including pharmacological, and CAM, or unavailable data, meta-analysis was limited, and only two trials were combined for meta-analysis. The certainty of evidence for all outcomes was either low or very low certainty. Prevention studies The evidence is very uncertain about the effect of systemic therapies on pain (from baseline to the end of the intervention; 2 studies, 183 women). The two studies, investigating vitamin D and omega-3 fatty acids, showed a treatment effect with 95% CIs that did not include an MCID for pain. Systemic therapies may have little to no effect on grip strength (RR 1.08, 95% CI 0.37 to 3.17; 1 study, 137 women) or on women continuing to take their AI (RR 0.16, 95% 0.01 to 2.99; 1 study, 147 women). The evidence suggests little to no effect on HRQoL and BCS-QoL from baseline to the end of intervention (the same single study; 44 women, both quality of life outcomes showed a treatment effect with 95% CIs that did include an MCID). The evidence is very uncertain for outcomes assessing incidence of AIMSS (RR 0.82, 95% CI 0.63 to 1.06; 2 studies, 240 women) and the safety of systemic therapies (4 studies, 344 women; very low-certainty evidence). One study had a US Food and Drug Administration alert issued for the intervention (cyclo-oxygenase-2 inhibitor) during the study, but there were no serious adverse events in this or any study. There were no data on stiffness, BCSS or OS. Treatment studies The evidence is very uncertain about the effect of systemic therapies on pain from baseline to the end of intervention in the treatment of AIMSS (10 studies, 1099 women). Four studies showed an MCID in pain scores which fell within the 95% CI of the measured effect (vitamin D, bionic tiger bone, Yi Shen Jian Gu granules, calcitonin). Six studies showed a treatment effect with 95% CI that did not include an MCID (vitamin D, testosterone, omega-3 fatty acids, duloxetine, emu oil, cat's claw). The evidence was very uncertain for the outcomes of change in stiffness (4 studies, 295 women), HRQoL (3 studies, 208 women) and BCS-QoL (2 studies, 147 women) from baseline to the end of intervention. The evidence suggests systemic therapies may have little to no effect on grip strength (1 study, 107 women). The evidence is very uncertain about the safety of systemic therapies (10 studies, 1250 women). There were no grade four/five adverse events reported in any of the studies. The study of duloxetine reported more all-grade adverse events in this treatment group than comparator group. There were no data on the incidence of AIMSS, the number of women continuing to take AI, BCCS or OS from the treatment studies. AUTHORS' CONCLUSIONS AIMSS are chronic and complex symptoms with a significant impact on women with early breast cancer taking AI. To date, evidence for safe and effective systemic therapies for prevention or treatment of AIMSS has been minimal. Although this review identified 17 studies with 2034 randomised participants, the review was challenging due to the heterogeneous systemic therapy interventions and study methodologies, and the unavailability of certain trial data. Meta-analysis was thus limited and findings of the review were inconclusive. Further research is recommended into systemic therapy for AIMSS, including high-quality adequately powered RCT, comprehensive descriptions of the intervention/placebo, and robust definitions of the condition and the outcomes being studied.
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Affiliation(s)
- Kate E Roberts
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Australia
- School of Clinical Medicine, Mater Clinical Unit, Mater Hospital, University of Queensland, South Brisbane, Australia
| | | | - Kirsty Rickett
- The University of Queensland Library, UQ/Mater McAuley Library, Brisbane, Australia
| | | | - Mark D Chatfield
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Australia
| | - Natasha E Woodward
- School of Clinical Medicine, Mater Clinical Unit, Mater Hospital, University of Queensland, South Brisbane, Australia
- Department of Medical Oncology, Mater Misericordiae Ltd, South Brisbane, Australia
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12
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Kim JY, Kim MJ, Lee EB, Kim TY, Lee KH, Im SA, Park JK. Musculoskeletal Pain and the Prevalence of Rheumatoid Arthritis in Breast Cancer Patients During Cancer Treatment: A Retrospective Study. J Breast Cancer 2022; 25:404-414. [DOI: 10.4048/jbc.2022.25.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Division of Rheumatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Hun Lee
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
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13
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Kahn AM, Blenman KR, Sonis ST, Lustberg MB. Strategies to mitigate the toxicity of cancer therapeutics. Adv Cancer Res 2022; 155:215-244. [DOI: 10.1016/bs.acr.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Myers SA, Weller S, Schwartz S, Van Patten C, LeVasseur N, Faulkner G, Campbell KL. Feasibility of a Supervised Virtual Exercise Program for Women on Hormone Therapy for Breast Cancer. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Liu XL, Huang YY, Wang T, Molassiotis A, Yao LQ, Huang HQ, Zheng SL, Tan JY(B. Psychometric assessment of the Chinese version of the Oxford Knee Score in breast cancer survivors experiencing hormone treatment-related knee dysfunction. Asia Pac J Oncol Nurs 2022; 9:135-142. [PMID: 35494097 PMCID: PMC9052842 DOI: 10.1016/j.apjon.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To test the validity, reliability, and acceptability of the Oxford Knee Score (OKS) Mandarin Chinese version for measuring knee pain and function among Chinese breast cancer survivors. Methods This validation study was a secondary analysis of a cross-sectional survey that was conducted at the Affiliated Hospital of Southwest Medical University, Sichuan, China. Recruited from a larger arthralgia-related survey cohort, those who experienced knee arthralgia and completed the OKS Chinese version were selected for the current analysis. The Cronbach’s alpha coefficient was calculated to identify the internal consistency reliability of the OKS. Spearman’s correlations were adopted to identify the concurrent validity of the OKS. The discriminate performance of the OKS via subgroup analysis of breast cancer survivors with or without arthritis, as well as different exercise levels, cancer stages, chemotherapy protocols, and occupations, was also conducted. Results One hundred and fifty-nine breast cancer survivors were included. There were significant correlations between the OKS and the FACT-B, the SF-36, and the BPI in measuring knee pain symptoms and their impact on daily living activities. The Cronbach’s alpha for the OKS total scores was 0.90. The participants with arthritis reported significantly lower OKS scores than those without arthritis (P = 0.040). The difference in OKS total scores between the participants with different exercise levels (P < 0.001) and the participants with different occupations (P = 0.006) was statistically significant. Considerable ceiling effects (>15%) of the OKS Chinese version were found in 11 of 12 items. Conclusions The OKS Mandarin Chinese version is a short, valid, reliable, and sensitive tool for knee pain and function assessment among breast cancer survivors.
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Affiliation(s)
- Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Yu-Yan Huang
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Li-Qun Yao
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Hou-Qiang Huang
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Si-Lin Zheng
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing-Yu (Benjamin) Tan
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
- Corresponding author.
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16
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Henry NL, Kim S, Hays RD, Diniz MA, Luu M, Cecchini RS, Yothers G, Rogatko A, Ganz PA. Toxicity Index, Patient-Reported Outcomes, and Early Discontinuation of Endocrine Therapy for Breast Cancer Risk Reduction in NRG Oncology/NSABP B-35. J Clin Oncol 2021; 39:3800-3812. [PMID: 34554865 PMCID: PMC8629339 DOI: 10.1200/jco.21.00910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The US National Cancer Institute Moonshot initiative calls for improving analysis and reporting of toxicity to inform treatment tolerability. We used existing clinician-reported adverse event (AE) and patient-reported outcome (PRO) questionnaire data from the randomized, double-blind NSABP B-35 clinical trial to explore reasons for anastrozole and tamoxifen discontinuation. METHODS Postmenopausal women with ductal carcinoma in situ treated with breast-conserving therapy were randomly assigned to anastrozole or tamoxifen for 5 years. The primary outcome for this analysis was time to treatment discontinuation. AEs were collected every 6 months post-random assignment from all 3,104 participants and summarized using the Toxicity Index (TI). PRO data were collected at baseline and every 6 months from 1,194 participants. Univariate and multivariable analyses of time to treatment discontinuation were performed using Cox regression models with TIs and PROs as time-dependent covariates. RESULTS Of 3,046 analyzed participants, 869 (28.5%) discontinued treatment prematurely. In multivariable analysis, when both baseline PROs and on-treatment AEs were considered, thrombosis and arthralgia AEs were associated with discontinuation of both tamoxifen and anastrozole; additional AEs associated with discontinuation varied by drug. In addition, baseline pain interference, hot flashes, and unhappiness were associated with tamoxifen discontinuation (n = 589; overall Harrell's C-statistic 0.686 [95% CI, 0.640 to 0.732]); no baseline PROs were associated with anastrozole discontinuation (n = 589; overall Harrell's C-statistic 0.656 [95% CI, 0.630 to 0.681]). When only baseline PROs were examined, pain interference, hot flashes, and unhappiness were associated with shorter time to discontinuation of tamoxifen; only hot flashes were associated with discontinuation of anastrozole. CONCLUSION Analysis of AEs using the TI yielded important insights into reasons for discontinuation of endocrine therapy that was enhanced by the addition of PRO baseline and treatment-emergent symptoms.
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Affiliation(s)
- N. Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Sungjin Kim
- Cedars Sinai Medical Center, Los Angeles, CA
| | - Ron D. Hays
- University of California Los Angeles, Los Angeles, CA
| | | | - Michael Luu
- Cedars Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Patricia A. Ganz
- University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
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17
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Abstract
Recent decades have demonstrated significant strides in cancer screening, diagnostics and therapeutics. As such there have been dramatic changes in survival following a diagnosis of cancer.
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Affiliation(s)
- Matthew R D Brown
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - David J Magee
- The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
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18
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Shenouda M, Copley R, Pacioles T, Lebowicz Y, Jamil M, Akpanudo S, Tirona MT. Effect of Tart Cherry on Aromatase Inhibitor-Induced Arthralgia (AIA) in Nonmetastatic Hormone-Positive Breast Cancer Patients: A Randomized Double-Blind Placebo-Controlled Trial. Clin Breast Cancer 2021; 22:e30-e36. [PMID: 34275765 DOI: 10.1016/j.clbc.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aromatase Inhibitor induced Arthralgia (AIA) can cause noncompliance leading to decreased breast-cancer survival. Effective interventions for AIA are limited. Tart cherry (TC) showed beneficial effect on musculoskeletal pain. 48 patients (Pts) randomized to TC versus placebo over 6 weeks, TC (23pts) had 34.7% mean pain decrease versus 1.4% in Placebo (25pts). TC can improve AIA in nonmetastatic breast-cancer patients. METHODS Randomized, placebo-controlled, double-blind trial. Eligible patients with NMHPBC on AI for at least 4 weeks were randomized to TC concentrate [50 tart cherries] vs. placebo (P) [syrup] in 1:1 model. Patients instructed to consume 1 Oz of concentrate in 8 Oz water daily for 6 weeks, and document their pain intensity at baseline, weekly and at study completion in a diary using Visual Analog Scale (VAS), with 0 mm indicating no pain, and 100 mm indicating highest pain. RESULTS Sixty patients were enrolled. Two patients did not complete the study due to diarrhea, and 10 patients were noncompliant. Forty-eight patients were included in the final analysis. TC group (23 pts) had 34.7% mean decrease in pain compared to 1.4% in P group (25 pts). This difference was statistically significant (Mann-Whitney U Test, P = .034). CONCLUSIONS Tart cherry can significantly improve AIA in nonmetastatic breast cancer patient.
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Affiliation(s)
- Mina Shenouda
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV.
| | - Renee Copley
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Toni Pacioles
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Yehuda Lebowicz
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV; Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | - Muhammad Jamil
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Sutoidem Akpanudo
- Internal Medicine Department, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV; Internal Medicine Department, Duke University, Durham, NC
| | - Maria Tria Tirona
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
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19
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Hertz DL, Smith KL, Zong Y, Gersch CL, Pesch AM, Lehman J, Blackford AL, Henry NL, Kidwell KM, Rae JM, Stearns V. Further Evidence That OPG rs2073618 Is Associated With Increased Risk of Musculoskeletal Symptoms in Patients Receiving Aromatase Inhibitors for Early Breast Cancer. Front Genet 2021; 12:662734. [PMID: 34211496 PMCID: PMC8239354 DOI: 10.3389/fgene.2021.662734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Aromatase inhibitors (AI) reduce recurrence and death in patients with early-stage hormone receptor-positive (HR +) breast cancer. Treatment-related toxicities, including AI-induced musculoskeletal symptoms (AIMSS), are common and may lead to early AI discontinuation. The objective of this study was to replicate previously reported associations for candidate germline genetic polymorphisms with AIMSS. Methods Women with stage 0-III HR + breast cancer initiating adjuvant AI were enrolled in a prospective clinic-based observational cohort. AIMSS were assessed by patient-reported outcomes (PRO) including the PROMIS pain interference and physical function measures plus the FACT-ES joint pain question at baseline and after 3 and 6 months. For the primary analysis, AIMSS were defined as ≥ 4-point increase in the pain interference T-score from baseline. Secondary AIMSS endpoints were defined as ≥ 4-point decrease in the physical function T-score from baseline and as ≥ 1-point increase on the FACT-ES joint pain question from baseline. The primary hypothesis was that TCL1A rs11849538 would be associated with AIMSS. Twelve other germline variants in CYP19A1, VDR, PIRC66, OPG, ESR1, CYP27B1, CYP17A1, and RANKL were also analyzed assuming a dominant genetic effect and prespecified direction of effect on AIMSS using univariate logistic regression with an unadjusted α = 0.05. Significant univariate associations in the expected direction were adjusted for age, race, body mass index (BMI), prior taxane, and the type of AI using multivariable logistic regression. Results A total of 143 participants with PRO and genetic data were included in this analysis, most of whom were treated with anastrozole (78%) or letrozole (20%). On primary analysis, participants carrying TCL1A rs11849538 were not more likely to develop AIMSS (odds ratio = 1.29, 95% confidence interval: 0.55-3.07, p = 0.56). In the statistically uncorrected secondary analysis, OPG rs2073618 was associated with AIMSS defined by worsening on the FACT-ES joint pain question (OR = 3.33, p = 0.004), and this association maintained significance after covariate adjustment (OR = 3.98, p = 0.003). Conclusion Carriers of OPG rs2073618 may be at increased risk of AIMSS. If confirmed in other cohorts, OPG genotyping can be used to identify individuals with HR + early breast cancer in whom alternate endocrine therapy or interventions to enhance symptom detection and implement strategies to reduce musculoskeletal symptoms may be needed.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, United States
| | - Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yuhua Zong
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Christina L Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Andrea M Pesch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jennifer Lehman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
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20
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Abstract
Sleep disturbances and insomnia are common among breast cancer survivors, and can have a significant effect on quality of life and numerous other significant outcomes. Among risks for sleep disturbance is the introduction of anti-estrogen endocrine therapies. The possible contributing factors to sleep disturbance in endocrine therapy are complex, and include pre-existing sleep disorders, the effects of chemotherapy and other treatments, and concurrent symptoms such as hot flashes. In addition, sleep disturbance in menopause, the natural downregulation of reproductive hormones in older age, is a common occurrence, and can offer a model for understanding the high prevalence of sleep problems in breast cancer survivors on endocrine therapy, as well as suggesting possible treatments such as behavioral interventions and pharmaceuticals. Altogether, significantly more research is needed to better understand and address sleep disturbance in breast cancer survivors on endocrine therapy in order to support quality of life and treatment adherence.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, UCLA Jonsson Comprehensive Cancer Center
| | - Hadine Joffe
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital; Department of Psychiatry, Brigham and Women's Hospital, Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School
| | - Judith E Carroll
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Cousins Center for Psychoneuroimmunology
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21
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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22
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Chang PJ. Aromatase Inhibitor-Associated Musculoskeletal Symptoms #402. J Palliat Med 2020; 23:1542-1543. [DOI: 10.1089/jpm.2020.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Bell SG, Dalton L, McNeish BL, Fang F, Henry NL, Kidwell KM, McLean K. Aromatase inhibitor use, side effects and discontinuation rates in gynecologic oncology patients. Gynecol Oncol 2020; 159:509-514. [PMID: 32847676 PMCID: PMC8036903 DOI: 10.1016/j.ygyno.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 01/29/2023]
Abstract
Objective. Aromatase inhibitors (AI) are frequently prescribed in gynecologic oncology. We sought to define the frequency and duration of AI use, characterize AI side effects and determine the reasons for discontinuation in these patients. Methods. Uterine and ovarian cancer patients with AI use for gynecologic cancer therapy were identified retrospectively. Data were abstracted from the electronic medical record, including cancer type, stage, prior cancer treatments, body mass index, concurrent medications, prevalence of AI side effects before and during AI therapy, length of AI treatment and reason for AI discontinuation. Results. 146 women received AI therapy, with 68 for ovarian cancer (46.6%) and 78 for uterine cancer (53.4%). The majority (71.9%) had advanced stage disease at diagnosis. 54.1% noted AI-associated side effects within the first three visits after starting AI therapy. The most common side effects were arthralgias (29.5%), hot flashes (25.3%), new/worsening fatigue (16.4%), muscle or joint stiffness (8.2%) and myalgias (6.8%). The mean duration of therapy was 14.7 months. Gabapentin or selective serotonin reuptake inhibitor (SSRI) use was associated with decreased musculoskeletal side effects (gabapentin: p < .001, OR 0.88, 95% CI 0.83–0.94; SSRI: p < .001, OR 0.82, 95% CI 0.77–0.89). The most common reason for AI discontinuation was disease progression (87.9%), with 5.0% discontinuing due to side effects and 7.1% for other reasons. Conclusion. AI therapy for gynecologic cancers is frequently associated with musculoskeletal side effects, but rarely leads to treatment discontinuation. Thus, AI side effects should be assessed in gynecologic cancer patients to allow potential mitigation of symptoms through adjunct therapies.
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Affiliation(s)
- Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Liam Dalton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Fang Fang
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - N Lynn Henry
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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24
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Gupta A, Henry NL, Loprinzi CL. Management of Aromatase Inhibitor-Induced Musculoskeletal Symptoms. JCO Oncol Pract 2020; 16:733-739. [PMID: 32780640 DOI: 10.1200/op.20.00113] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) were first recognized as a distinct entity in 2001, 5 years after the approval of the first aromatase inhibitor, anastrozole. Musculoskeletal symptoms can severely affect patients' quality of life and also lead to premature discontinuation of aromatase inhibitor therapy. Several interventions for managing AIMSS have been investigated in the last decade, with some demonstrating promise. This article provides an evidence-based summary to guide practicing oncologists in regard to the epidemiology, prevention, and treatment of AIMSS.
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Affiliation(s)
- Arjun Gupta
- Department of Medical Oncology, Johns Hopkins University, Baltimore, MD
| | - N Lynn Henry
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
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25
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Borrie AE, Rose FA, Choi YH, Perera FE, Read N, Sexton T, Lock M, Vandenberg TA, Hahn K, Younus J, Logan D, Potvin K, Yaremko B, Yu E, Lenehan J, Welch S, Teft WA, Kim RB. Genetic and clinical predictors of arthralgia during letrozole or anastrozole therapy in breast cancer patients. Breast Cancer Res Treat 2020; 183:365-372. [PMID: 32632513 DOI: 10.1007/s10549-020-05777-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Female patients with breast cancer frequently develop arthralgia when treated with aromatase inhibitors (AI). Although the mechanism of AI-induced arthralgia is unknown, potential biomarkers have been identified. The purpose of this study was to investigate the clinical and genetic predictors of AI-induced arthralgia in a prospective cohort of patients with estrogen receptor-positive breast cancer. METHODS One hundred and ninety-six patients were enrolled at initiation of AI therapy with either letrozole or anastrozole. Patients completed two validated self-report questionnaires assessing pain, stiffness, and physical function at baseline, and repeated the questionnaires at two and at six months after the initiation of treatment with an AI. Germline DNA of all patients was genotyped for seven single-nucleotide polymorphisms (SNPs) previously identified by genetic screens and genome-wide association studies as associated with AI-induced arthralgia. RESULTS More than 50% of the study group experienced arthralgia symptoms. Genetic analysis revealed that four SNPs, in CYP19A1 (rs4775936) and ESR1 (rs9322336, rs2234693, rs9340799), were associated with the development of arthralgia (adjusted P = 0.016, 0.018, 0.017, 0.047). High body mass index (BMI) was also associated with the development of arthralgia symptoms (adjusted P = 0.001). Patients prescribed letrozole were significantly more likely to develop arthralgia than patients on anastrozole (P = 0.018), and also more likely to discontinue AI therapy due to arthralgia. The CYP19A1 (rs4775936) SNP was significantly associated with discontinuation of therapy due to intolerable arthralgia. CONCLUSIONS Our results suggested that BMI and AI drug (letrozole versus anastrozole) were clinical predictors of arthralgia, while genetic variants rs4775936, rs9322336, rs2234693, and rs9340799 were genetic predictors of AI-induced arthralgia. Significantly, rs4775936 was also a predictor of discontinuation of therapy.
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Affiliation(s)
- Adrienne E Borrie
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Finnley A Rose
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | - Tracy Sexton
- Department of Oncology, Western University, London, ON, Canada
| | - Michael Lock
- Department of Oncology, Western University, London, ON, Canada
| | | | - Karin Hahn
- Department of Oncology, Western University, London, ON, Canada
| | - Jawaid Younus
- Department of Oncology, Western University, London, ON, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, ON, Canada
| | - Kylea Potvin
- Department of Oncology, Western University, London, ON, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, ON, Canada
| | - Edward Yu
- Department of Oncology, Western University, London, ON, Canada
| | - John Lenehan
- Department of Oncology, Western University, London, ON, Canada
| | - Stephen Welch
- Department of Oncology, Western University, London, ON, Canada
| | - Wendy A Teft
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Richard B Kim
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada.
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada.
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Sheng JY, Visvanathan K, Thorner E, Wolff AC. Breast cancer survivorship care beyond local and systemic therapy. Breast 2020; 48 Suppl 1:S103-S109. [PMID: 31839149 DOI: 10.1016/s0960-9776(19)31135-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite persistent inequities in access to care and treatments, advances in combined modality care have led to a steady improvement in outcomes for breast cancer patients across the globe. When estimating the magnitude of clinical benefit of therapies, providers and patients must contend with a multitude of factors that impact treatment decisions and can have long-term effects on quality of life and survival. These include commonly described early toxicities, like aromatase inhibitor-associated musculoskeletal syndrome and neuropathy. But longer-term comorbidities often observed among cancer survivors including weight gain, obesity, infertility, psychological distress, sexual dysfunction, second cancers, bone loss, and body image issues can have lasting effects on quality of life. Equally important, system-level factors such as access to care and resource allocation can have a systemic impact on survival and on the quality of survivorship. Financial toxicity including underemployment can have a lasting impact on patients and caregivers. The resulting disparities in access to treatment can help explain much of the observed variability in outcomes, even within high-income countries like the US. This article revisits some of secondary effects from therapies discussed in a prior 2015 review article, along with other impediments to the optimal delivery of breast cancer care that can affect patients anywhere.
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Affiliation(s)
- Jennifer Y Sheng
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Kala Visvanathan
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
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Umamaheswaran G, Kadambari D, Muthuvel SK, Kalaivani S, Devi J, Damodaran SE, Pradhan SC, Dubashi B, Dkhar SA, Adithan C. Association of CYP19A1 gene variations with adjuvant letrozole-induced adverse events in South Indian postmenopausal breast cancer cohort expressing hormone-receptor positivity. Breast Cancer Res Treat 2020; 182:147-158. [PMID: 32385792 DOI: 10.1007/s10549-020-05656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Musculoskeletal adverse events (MS-AEs) and vasomotor symptoms (VMSs) are the major side-effects of newer generation non-steroidal aromatase inhibitor (AI), letrozole. Single-nucleotide polymorphisms (SNPs) in CYP19A1 gene coding for the enzyme aromatase are related to AI treatment-associated adverse drug reactions. Therefore, we aimed to determine whether SNPs in the CYP19A1 gene are associated with adjuvant letrozole-induced 'specific' AEs in postmenopausal hormone receptor-positive (HR+) breast cancer patients. METHODS Genomic DNA was isolated from 198 HR+ breast cancer patients by the phenol-chloroform method, and eleven SNPs in the CYP19A1 gene were genotyped by TaqMan genotyping assays on the qRT-PCR system. Toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, and the data were analyzed using SPSS v19.0 and Haploview v4.2 statistical software. RESULTS Subjects carrying the genetic variants of CYP19A1 gene SNP rs700519 had significantly higher odds (OR 2.33; 95% CI [1.29-4.20], P = 0.0057) of MS-AEs under dominant statistical effect. The frequency of the two distinct haplotypes that include the variant allele 'T' at rs700519 locus, H5-GCTATCTGGCG (P = 0.042) and H11-GCTATTGCACG (P = 0.013) were significantly higher in patients with musculoskeletal toxicity than in those without MS-AEs and thus predisposing to MS-AEs. Similarly, H6-GCCAGCTGGCG (P = 0.037) haplotype exhibited higher frequencies in patients presented with VMSs. However, no such association was observed between CYP19A1 genotypes and VMSs. CONCLUSIONS To the best of our knowledge, this is the first study assessing the impact of CYP19A1 genetic variations with adjuvant letrozole treatment-associated AEs in Indian women. Genetic variations in the CYP19A1 gene is associated with letrozole-induced AEs and warrants further investigation in larger cohorts to validate this finding.
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Affiliation(s)
- Gurusamy Umamaheswaran
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. .,Department of Oncology, Institute of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.
| | - Dharanipragada Kadambari
- Departments of Surgery and Medical Education, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Suresh Kumar Muthuvel
- School of Life Sciences, Centre for Bioinformatics, Pondicherry University, Puducherry, India
| | - Sekar Kalaivani
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jaganathan Devi
- Department of Animal Sciences, University of Connecticut, Storrs, USA
| | - Solai Elango Damodaran
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Suresh Chandra Pradhan
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Regional Cancer Center, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Steven Aibor Dkhar
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chandrasekaran Adithan
- Department of Pharmacology, Centre for Advanced Research in Pharmacogenomics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Central Inter-Disciplinary Research Facility, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
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Bae K, Song SY. Comparison of the clinical effectiveness of treatments for aromatase inhibitor-induced arthralgia in breast cancer patients: a protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e033461. [PMID: 32371507 PMCID: PMC7223021 DOI: 10.1136/bmjopen-2019-033461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Aromatase inhibitor-induced arthralgia (AIA) is a major adverse event of aromatase inhibitors (AIs) and leads to premature discontinuation of AI therapy in breast cancer patients. The objective of this protocol for a systematic review and network meta-analysis (NMA) is to provide the methodology to compare the change in pain intensity between different AIA treatments and demonstrate the rank probabilities for different treatments by combining all available direct and indirect evidence. METHODS AND ANALYSIS PubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE, Web of Science and ClinicalTrials.gov will be searched to identify publications in English from inception to November 2019. We will include randomised controlled trials (RCTs) assessing the effects of different treatments for AIA in postmenopausal women with stage 0-III hormone receptor-positive breast cancer. The primary endpoints will be the change in patient-reported pain intensity from baseline to post-treatment. The number of adverse events will be presented as a secondary outcome.Both pairwise meta-analysis and NMA with the Frequentist approach will be conducted. We will demonstrate summary estimates with forest plots in meta-analysis and direct and mixed evidence with a ranking of the treatments as the P-score in NMA. The revised Cochrane risk-of-bias tool for randomised trials will be used to assess the methodological quality within individual RCTs. The quality of evidence will be assessed. ETHICS AND DISSEMINATION As this review does not involve individual patients, ethical approval is not required. The results of this systematic review and NMA will be published in a peer-reviewed journal. This review will provide valuable information on AIA therapeutic options for clinicians, health practitioners and breast cancer survivors. PROSPERO REGISTRATION NUMBER CRD42019136967.
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Affiliation(s)
- Kyeore Bae
- Department of Integrative Medicine, Center for Immunity and Pain, Kwanghye Hospital, Seoul, Republic of Korea
| | - Si Yeon Song
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
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Zhu Y, Cohen SM, Rosenzweig MQ, Bender CM. Symptom Map of Endocrine Therapy for Breast Cancer: A Scoping Review. Cancer Nurs 2020; 42:E19-E30. [PMID: 30138143 PMCID: PMC6935534 DOI: 10.1097/ncc.0000000000000632] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple symptoms associated with endocrine therapy have a detrimental impact on medication adherence and quality of life. OBJECTIVE The purpose of this scoping review is to map the symptoms during endocrine therapy for breast cancer to provide implications for current practice and suggestions for future research. METHODS The PubMed, CINAHL, and China Science Periodical Databases were searched to identify related studies published in English and Chinese languages. References of included articles were reviewed for additional eligible studies. Of the 2551 articles identified, 57 articles met inclusion criteria and were included in this scoping review. RESULTS Evidence for the 16 most studied symptoms and 15 most prevalent symptoms were synthesized. Five key symptoms associated with endocrine therapy were identified, including joint/muscle pain, hot flashes, low sexual interest/desire, joint/muscle stiffness, and fatigue/lack of energy. Rarely studied but highly prevalent symptoms and other gaps in the symptom science during endocrine therapy for breast cancer were identified. CONCLUSION Nurses caring for women receiving endocrine therapy for breast cancer should assess the 5 key symptoms identified. There remain substantial gaps in the science related to the symptom experience during endocrine therapy for breast cancer. Future studies should focus on the domains of symptom intensity and distress, specific understudied symptoms, symptom clusters, and development of symptom assessment instruments specific to symptoms associated with endocrine therapy. IMPLICATIONS FOR PRACTICE This scoping review identified 5 well-studied and highly prevalent symptoms that should be assessed in women with breast cancer receiving endocrine therapy.
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Affiliation(s)
- Yehui Zhu
- Author Affiliations: School of Nursing, University of Pittsburgh, Pennsylvania
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30
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Chien HC, Kao Yang YH, Kwoh CK, Chalasani P, Wilson DL, Lo-Ciganic WH. Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis. J Clin Med 2020; 9:jcm9020566. [PMID: 32092973 PMCID: PMC7074454 DOI: 10.3390/jcm9020566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
Tamoxifen or aromatase inhibitor (AI) therapy may prevent breast cancer recurrence, however, adverse effects may lead to treatment discontinuation. Evidence regarding the occurrence of AI-associated musculoskeletal problems among Asians is scarce. We identified women with breast cancer-initiating tamoxifen or AIs from the Taiwan National Health Insurance Research Database (2007-2012). Using multivariable cause-specific hazard models, we examined the association between endocrine therapy and the risk of any arthritis and carpal tunnel syndrome, adjusting for age, prior cancer treatment, and other health status factors. Among 32,055 eligible women with breast cancer (mean age = 52.6 ± 11.5 years), 87.4% initiated tamoxifen, 3.9% initiated anastrozole, 8.0% initiated letrozole, and 0.7% initiated exemestane. AI users had a higher 1-year cumulative incidence for any arthritis (13.0% vs. 8.2%, p < 0.0001) and carpal tunnel syndrome (1.4% vs. 0.8%, p = 0.008). Compared to tamoxifen users, AI users had a higher risk of any arthritis [adjusted hazard ratio (aHR) = 1.21, 95%CI = 1.09-1.34] and carpal tunnel syndrome (aHR = 1.68, 95%CI = 1.22-2.32). No significant difference was observed in the risks of any arthritis and carpal tunnel syndrome across different AIs. Taxane use was not associated with any arthritis (aHR = 0.92, 95%CI = 0.81-1.05) or carpal tunnel syndrome (aHR = 0.97, 95%CI = 0.67-1.40) compared to other chemotherapies. Taiwanese women with breast cancer-initiating AIs had an increased risk of arthritis and carpal tunnel syndrome compared to those who initiated tamoxifen.
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Affiliation(s)
- Hsu-Chih Chien
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Health Outcome Research Center, National Cheng Kung University, Tainan 701, Taiwan;
- School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Division of Rheumatology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Health Outcome Research Center, National Cheng Kung University, Tainan 701, Taiwan;
- School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Correspondence: (Y.-H.K.Y.); (W.-H.L.-C.)
| | - C. Kent Kwoh
- Division of Rheumatology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Pavani Chalasani
- Division of Hematology and Oncology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA;
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA;
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: (Y.-H.K.Y.); (W.-H.L.-C.)
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Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev 2020; 1:CD012988. [PMID: 31994181 PMCID: PMC6987034 DOI: 10.1002/14651858.cd012988.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Survival for stage I to III, hormone receptor-positive, breast cancer has substantially improved over time due to advances in screening, surgery and adjuvant therapy. However many adjuvant therapies have significant treatment-related toxicities, which worsen quality of life for breast cancer survivors. Postmenopausal women with hormone receptor-positive breast cancer are now prescribed aromatase inhibitors (AI) as standard, with longer durations of therapy, up to 10 years, being considered for certain women. AI treatment is associated with a high incidence of AI-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS reduces compliance with AI therapy in up to one half of women undergoing adjuvant AI therapy, potentially compromising breast cancer outcomes. Exercise has been investigated for the prevention and treatment of AIMSS but the effect of this intervention remains unclear. OBJECTIVES To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases up to 13 December 2018. We also searched two conference proceedings portals and two clinical trials registries for ongoing studies or unpublished trials, or both, in August 2019. We also reviewed reference lists of the included studies. SELECTION CRITERIA We included randomised controlled trials that compared exercise versus a comparator arm. We did not impose any restriction on the comparator arm, which could include an alternative type of exercise, no exercise or a waiting list control. Both published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed risk of bias and certainty of the evidence using the GRADE approach. The outcomes investigated were pain, joint stiffness, grip strength, health-related quality of life, cancer-specific quality of life, adherence to AI therapy, adverse events, incidence of AIMSS, breast cancer-specific survival and overall survival. For continuous outcomes that were assessed with the same instrument, we used the mean difference (MD); for those outcomes that used different instruments, we used the standardised mean difference (SMD) for the analysis. For dichotomous outcomes, we reported outcomes as an odds ratio (OR). MAIN RESULTS We included seven studies with 400 randomised participants; one study assessed exercise for preventing AIMSS and six studies assessed treating AIMSS. For preventing AIMSS, the single study reported no difference in pain scores, grip strength or compliance to taking AI medication between groups. Data values were not provided in the study and no other outcomes were reported. For managing AIMSS, we found that the evidence for the effect of exercise therapies on overall change in worst pain scores was very uncertain (SMD -0.23, 95% confidence interval (CI) -0.78 to 0.32; 4 studies, 284 women; very low-certainty evidence). The evidence suggested that exercise therapies result in little to no difference in overall change in stiffness scores (Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) stiffness score MD -0.76, 95% CI -1.67 to 0.15 and Visual Analogues Scale (VAS) stiffness score MD -0.42, 95% CI -2.10 to 1.26; 1 study, 53 women; low-certainty evidence). The evidence was very uncertain for the outcomes of overall change in grip strength (MD 0.30, 95% CI -0.55 to 1.15; 1 study, 83 women; very low-certainty evidence); overall change in health-related quality of life (subscales of SF-36 tool ranged from least benefit of MD 1.88, 95% CI -2.69 to 6.45 to most benefit of MD 9.70, 95% CI 1.67 to 17.73; 2 studies, 123 women, very low-certainty evidence); overall change in cancer-specific quality of life (MD 4.58, 95% CI -0.61 to 9.78; 2 studies, 136 women; very low-certainty evidence); and adherence to aromatase inhibitors (OR 2.43, 95% CI 0.41 to 14.63; 2 studies, 224 women; very low-certainty evidence). There were no adverse events identified across four studies in either arm (0 events reported; 4 studies; 331 participants; low-certainty evidence). There were no data reported on incidence of AIMSS, breast cancer-specific survival or overall survival. AUTHORS' CONCLUSIONS Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-ranging benefits. Future research in this area would be enhanced with further understanding of the mechanism of AIMSS, a single clear definition of the condition, and phase III randomised controlled trials that are adequately powered to test targeted exercise interventions on the key clinical outcomes in this condition.
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Affiliation(s)
- Kate E Roberts
- Princess Alexandra HospitalDepartment of Medical OncologyIpswich RoadWoolloongabbaQueenslandAustralia
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
| | - Kirsty Rickett
- UQ/Mater McAuley LibraryThe University of Queensland LibraryRaymond TerraceBrisbaneQueenslandAustralia4101
| | - Sophie Feng
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
| | - Dimitrios Vagenas
- Queensland University of TechnologyInstitute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Natasha E Woodward
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
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Zhu Y, Koleck TA, Bender CM, Conley YP. Genetic Underpinnings of Musculoskeletal Pain During Treatment With Aromatase Inhibitors for Breast Cancer: A Biological Pathway Analysis. Biol Res Nurs 2019; 22:263-276. [PMID: 31847542 DOI: 10.1177/1099800419895114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Musculoskeletal pain (MSKP) is the most reported symptom during treatment with aromatase inhibitors (AIs) for breast cancer. The mechanisms underlying MSKP are multidimensional and not well understood. The goals of this biological pathway analysis were to (1) gain an understanding of the genetic variation and biological mechanisms underlying MSKP with AI therapy and (2) identify plausible biological pathways and candidate genes for future investigation. METHOD Genes associated with MSKP during AI therapy or genes involved in drug metabolism of and response to AIs were identified from the literature. Studies published through February 2019 were queried in PubMed®. The genes identified from the literature were entered into QIAGEN's Ingenuity® Pathway Analysis (IPA) software to generate canonical pathways, upstream regulators, and networks through a core analysis. RESULTS The 17 genes identified were ABCB1, ABCG1, CYP17A1, CYP19A1, CYP27B1, CYP2A6, CYP3A4, CYP3A5, ESR1, OATP1B1, OPG, RANKL, SLCO3A1, TCL1A, UGT2A1, UGT2B17, and VDR. These genes are involved in encoding bone-remodeling regulators, drug-metabolizing enzymes (cytochrome P450 family, UDP-glucuronosyltransferases family), or drug transporters (ATP-binding cassette transporters, organic anion transporters). Multiple plausible biological pathways (e.g., nicotine degradation, melatonin degradation) and candidate genes (e.g., NFKB, HSP90, AKT, ERK1/2, FOXA2) are proposed for future investigation based on the IPA results. CONCLUSION Multiple genes and molecular-level etiologies may contribute to MSKP with AI therapy in women with breast cancer. Our innovative combination of gene identification from the literature plus biological pathway analysis allowed for the emergence of novel candidate genes and biological pathways for future investigations.
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Affiliation(s)
- Yehui Zhu
- School of Nursing, University of Pittsburgh, PA, USA
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Galantino ML, Tiger R, Brooks J, Jang S, Wilson K. Impact of Somatic Yoga and Meditation on Fall Risk, Function, and Quality of Life for Chemotherapy-Induced Peripheral Neuropathy Syndrome in Cancer Survivors. Integr Cancer Ther 2019; 18:1534735419850627. [PMID: 31131640 PMCID: PMC6537287 DOI: 10.1177/1534735419850627] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective. Chemotherapy-induced peripheral neuropathy (CIPN)
syndrome causes significant pain as an adverse effect of treatment, with few
nonpharmacological interventions tested. A somatic yoga and meditation (SYM)
intervention on functional outcomes and quality of life (QOL) was investigated.
Design and methods. Individuals diagnosed with CIPN were
enrolled in an open-label, single-arm, mixed-methods feasibility trial.
Participants and Setting. In an outpatient rehabilitation
center, ten participants with median age 64.4 years (47-81) attended 61% of the
sessions with no adverse events. Intervention. SYM twice a week
for 8 weeks for 1.5 hours, with home program and journaling. Main
outcome measures. Primary functional outcomes included Sit and
Reach (SR), Functional Reach (FR), and Timed Up and Go (TUG). Self-reported
Patient Neurotoxicity Questionnaire (PNQ) and Functional Assessment of Cancer
Therapy—Neurotoxicity (FACT-GOG-NTX) were secondary CIPN outcomes. Biomarkers
included salivary cortisol (stress) and bioesthesiometer (vibration).
Results: Quantitative findings. Significant improvements
were found in flexibility (SR; P = .006); balance (FR;
P = .001) and fall risk (TUG; P = .004).
PNQ improved significantly (P = .003) with other measures
improving non-significantly. Qualitative findings. Five themes
emerged: (1) vacillation of CIPN pain perception over time; (2) transferability
of skills to daily activities; (3) improvement in physical function; (4)
perceived relaxation as an effect of SYM; and (5) group engagement provided a
social context for not feeling isolated with CIPN. Conclusion.
Preliminary data suggest SYM may improve QOL, flexibility, and balance in cancer
survivors with CIPN, with a fully powered randomized controlled trial
indicated. Trial registration: NCT03786055
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Affiliation(s)
- Mary Lou Galantino
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA.,2 University of Pennsylvania, Philadelphia, PA, USA.,3 University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Shera Jang
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA
| | - Kim Wilson
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA
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Romero SAD, Su HI, Satagopan J, Li QS, Seluzicki CM, Dries A, DeMichele AM, Mao JJ. Clinical and genetic risk factors for aromatase inhibitor-associated arthralgia in breast cancer survivors. Breast 2019; 49:48-54. [PMID: 31678641 PMCID: PMC7375589 DOI: 10.1016/j.breast.2019.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Arthralgia is a common and debilitating toxicity of aromatase inhibitors (AI) that leads to premature drug discontinuation. We sought to evaluate the clinical and genetic risk factors associated with AI-associated arthralgia (AIAA). METHODS We performed a cross-sectional study among postmenopausal women with stage 0-III breast cancer who were prescribed a third-generation AI for adjuvant therapy. The primary outcome was patient-reported AIAA occurrence. We extracted and assayed germline DNA for single nucleotide polymorphisms (SNPs) of genes implicated in estrogen and inflammation pathways. Multivariable logistic regression models examined the association between demographic, clinical, and genetic factors and AIAA. Analyses were restricted to White participants. RESULTS Among 1049 White participants, 543 (52%) reported AIAA. In multivariable analyses, women who had a college education [Adjusted Odds Ratio (AOR) 1.49, 95% Confidence Interval (CI) 1.00-2.20], had a more recent transition into menopause (<10 years) (5-10 years AOR 1.55, 95% CI 1.09-2.22; <5 years AOR 1.78, 95% CI 1.18-2.67), were within one year of starting AIs (AOR 1.61, 95% CI 1.08-2.40), and those who received chemotherapy (AOR 1.38, 95% CI 1.02-1.88) were significantly more likely to report AIAA. Additionally, SNP rs11648233 (HSD17B2) was significantly associated with higher odds of AIAA (AOR 2.21, 95% CI 1.55-3.16). CONCLUSIONS Time since menopause and start of AIs, prior chemotherapy, and SNP rs11648233 within the HSD17B2 gene in the estrogen pathway were significantly associated with patient-reported AIAA. These findings suggest that clinical and genetic factors involved in estrogen withdrawal increase the risk of AIAA in postmenopausal breast cancer survivors.
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Affiliation(s)
- Sally A D Romero
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - H Irene Su
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA.
| | - Jaya Satagopan
- Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Q Susan Li
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - Christina M Seluzicki
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - Annika Dries
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Angela M DeMichele
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
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Mao H, Mao JJ, Chen J, Li Q, Chen X, Shen X, Zhao L, Wei J, Shen X. Effects of infrared laser moxibustion on cancer-related fatigue in breast cancer survivors: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2019; 98:e16882. [PMID: 31441863 PMCID: PMC6716733 DOI: 10.1097/md.0000000000016882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is the most common and distressing symptom associated with cancer treatment that breast cancer survivors (BCS) experience. We previously found that laser moxibustion may be efficacious for CRF. The primary aim of this study is to determine the specific efficacy of 10.6 μm infrared laser moxibustion on CRF. The secondary aim is to evaluate the effect of infrared laser moxibustion on co-existing symptoms that BCS experience. METHODS We will conduct a randomized, sham-controlled, three-arm trial of infrared laser moxibustion (ILM) against sham ILM (SILM) and waitlist control (WLC) among BCS with moderate to severe fatigue. The two intervention groups will receive either real or sham infrared laser moxibustion on four acupoints (i.e., ST36 [bilateral], CV4, and CV6) for 20 minutes each session for 6 weeks (twice per week). The primary endpoint is the change in fatigue score from Baseline to Week 6 as measured by the Chinese version of the Brief Fatigue Inventory (BFI-C). Our secondary aim is to compare the severity of co-morbidities (e.g., depression, insomnia, and pain) among the 3 groups. DISCUSSION The results of our trial will establish evidence for the efficacy of infrared laser moxibustion for CRF, a very common and challenging symptom. TRIAL REGISTRATION NUMBER NCT03553355.
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Affiliation(s)
- Huijuan Mao
- Shanghai University of Traditional Chinese Medicine, School of Acupuncture-Moxibustion and Tuina, Shanghai, China
| | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York, NY
| | - Junchao Chen
- Shanghai University of Traditional Chinese Medicine, Institute of Disciplinary Science
| | - Qing Li
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York, NY
| | - Xuefen Chen
- Shanghai University of Traditional Chinese Medicine, School of Public Health
| | - Xubo Shen
- Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine
| | - Ling Zhao
- Shanghai University of Traditional Chinese Medicine, School of Acupuncture-Moxibustion and Tuina, Shanghai, China
| | - Jianzi Wei
- Shanghai University of Traditional Chinese Medicine, School of Acupuncture-Moxibustion and Tuina, Shanghai, China
| | - Xueyong Shen
- Shanghai University of Traditional Chinese Medicine, School of Acupuncture-Moxibustion and Tuina, Shanghai, China
- Shanghai Research Center of Acupuncture and Meridian, Shanghai, China
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36
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Sheng JY, Blackford AL, Bardia A, Venkat R, Rosson G, Giles J, Hayes DF, Jeter SC, Zhang Z, Hayden J, Nguyen A, Storniolo AM, Tarpinian K, Henry NL, Stearns V. Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy. Breast Cancer Res Treat 2019; 176:617-624. [PMID: 31079282 DOI: 10.1007/s10549-019-05270-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. METHODS Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. RESULTS Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. CONCLUSION For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
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Affiliation(s)
- Jennifer Y Sheng
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Amanda L Blackford
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Aditya Bardia
- Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Raghunandan Venkat
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gedge Rosson
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jon Giles
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Stacie C Jeter
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Zhe Zhang
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.,Pfizer, San Diego, CA, USA
| | - Jill Hayden
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Anne Nguyen
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | | | - Karineh Tarpinian
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.,The Emmes Corporation, Rockville, MD, USA
| | - Norah Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Vered Stearns
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA. .,Johns Hopkins School of Medicine, Breast Cancer Research Chair in Oncology, Sidney Kimmel Comprehensive Cancer Center, Under Armour Breast Health Innovation Center, Skip Viragh Building, 10-291, 201 North Broadway, Baltimore, MD, 21287, USA.
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Alhanafy AM, Labeeb A, Khalil A. The Role of Diuretics in Treatment of Aromatase Inhibitors Induced Musculoskeletal Symptoms in Women with Non Metastatic Breast Cancer. Asian Pac J Cancer Prev 2018; 19:3525-3531. [PMID: 30583679 PMCID: PMC6428535 DOI: 10.31557/apjcp.2018.19.12.3525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Around 50% of women receiving Aromatase Inhibitors (AIs) develop musculoskeletal symptoms which may become severe causing interruption of treatment. Patients with AI-induced arthralgia had higher rates of joint effusions and fluid in the tendons, so use of diuretics may be helpful. Methods: This prospective phase II study was conducted in department of clinical oncology and nuclear medicine, Menoufia University Hospital, Egypt, between Jan. to Dec. 2015. Fifty Women with stage I,II and III breast cancer receiving AIs as adjuvant hormonal treatment complaining of AIs related musculoskeletal symptoms received Lasilactone® 50 mg tablet; (an oral combination of Frusemide 20mg/Spironolactone 50 mg), every other day for 4 weeks. Patients were assessed by modified Western Ontario and McMaster Universities osteoarthritis (WOMAC) index for lower limb and the quick Disabilities of the Arm, Shoulder and Hand Score (DASH) scoring system for upper limbs, Arabic versions, at baseline and after 4 weeks of treatment. Results: The mean WOMAC pain score improved significantly (6.0 v 10; P < 0.001), the mean WOMAC stiffness score improved (2.3 v 3.9; P = 0.002), the mean WOMAC functional score improved (8.7 v 15; P < 0.001), the total WOMAC score improved (17 v 29; P < 0.001), also a significant difference was noticed for the quick DASH score; total score (16 v 25; P = 0.02) After use of diuretics for 4 weeks of treatment compared with baseline scores. Conclusions: The use of diuretics effectively reduces AI related musculoskeletal symptoms with good tolerance.
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Affiliation(s)
- Alshimaa Mahmoud Alhanafy
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El kom, Egypt.
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38
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Choo SB, Saifulbahri A, Zullkifli SN, Fadzil ML, Redzuan AM, Abdullah N, Bustamam RSA, Ahmad HZ, Shah NM. Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia. Climacteric 2018; 22:175-181. [PMID: 30556740 DOI: 10.1080/13697137.2018.1540563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study was conducted to determine the prevalence and severity of menopausal symptoms and their associated risk factors among postmenopausal breast cancer patients receiving adjuvant endocrine therapy. METHODS Postmenopausal breast cancer patients on endocrine therapy were recruited at three hospitals in Malaysia. Presence and severity of menopausal symptoms were determined using the Menopause Rating Scale. Sociodemographic and clinical data were collected from medical records. RESULTS A total of 192 patients participated in this study. Commonly reported symptoms were musculoskeletal pain (59.9%), physical and mental exhaustion (59.4%), and hot flushes (41.1%). Multivariate analyses indicated that increasing number of years after menopause until the start of endocrine therapy was significantly associated with less likelihood of reporting menopausal symptoms and musculoskeletal pain. Patients with primary or secondary education levels reported significantly less menopausal urogenital symptoms compared to patients with a tertiary education level. Patients using aromatase inhibitors were twice as likely to experience musculoskeletal pain compared to patients using tamoxifen (odds ratio, 2.18; 95% confidence interval, 1.06-4.50; p < 0.05). CONCLUSION Menopausal symptoms and musculoskeletal pain are common problems encountered by postmenopausal breast cancer patients receiving adjuvant endocrine therapy and should be closely monitored for successful treatment.
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Affiliation(s)
- S B Choo
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - A Saifulbahri
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - S N Zullkifli
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - M L Fadzil
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - A Md Redzuan
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - N Abdullah
- b Department of Surgery , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - R S Ahmad Bustamam
- c Department of Radiotherapy and Oncology , Hospital Kuala Lumpur , Kuala Lumpur , Malaysia
| | - H Z Ahmad
- d Department of Radiotherapy and Oncology , National Cancer Institute , Putrajaya , Malaysia
| | - N Mohamed Shah
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
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39
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Roberts KE, Rickett K, Chatfield MD, Woodward NE. Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Hippokratia 2018. [DOI: 10.1002/14651858.cd013167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kate E Roberts
- Princess Alexandra Hospital; Department of Medical Oncology; Ipswich Road Woolloongabba Queensland Australia
- Mater Hospital, University of Queensland; School of Clinical Medicine, Mater Clinical Unit; South Brisbane Australia 4101
| | - Kirsty Rickett
- UQ/Mater McAuley Library; The University of Queensland Library; Raymond Terrace Brisbane Queensland Australia 4101
| | - Mark D Chatfield
- The University of Queensland; Centre for Health Services Research; Woolloongabba Queensland Australia 4006
| | - Natasha E Woodward
- Mater Hospital, University of Queensland; School of Clinical Medicine, Mater Clinical Unit; South Brisbane Australia 4101
- Mater Health Services; Department of Medical Oncology; Raymond Terrace South Brisbane Queensland Australia 4101
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40
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Shen S, Unger JM, Crew KD, Till C, Greenlee H, Gralow J, Dakhil SR, Minasian LM, Wade JL, Fisch MJ, Henry NL, Hershman DL. Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927). Breast Cancer Res Treat 2018; 172:603-610. [PMID: 30159789 DOI: 10.1007/s10549-018-4946-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Although aromatase inhibitors (AIs) prolong survival in post-menopausal breast cancer (BC) patients, AI-associated arthralgia can lead to discontinuation. Obese patients have higher rates of AI arthralgia than non-obese patients, but treatment options are limited. Omega-3 fatty acid (O3-FA) treatment for AI arthralgia has produced mixed results. METHODS We performed an exploratory analysis of SWOG S0927, a multicenter randomized placebo-controlled trial of O3-FA use for AI arthralgia. Post-menopausal women with stage I-III BC taking an AI were randomized to 24 weeks of O3-FAs or placebo. Brief Pain Inventory (BPI) questionnaires and fasting serum were collected at baseline, 12, and 24 weeks. The BPI assessment included worst pain, average pain, and pain interference scores (range 0-10). RESULTS Among the 249 participants, 139 had BMI < 30 kg/m2 (56%) and 110 had BMI ≥ 30 kg/m2 (44%). Among obese patients, O3-FA use was associated with significantly lower BPI worst pain scores at 24 weeks compared with placebo (4.36 vs. 5.70, p = 0.02), whereas among non-obese patients, there was no significant difference in scores between treatment arms (5.27 vs. 4.58, p = 0.28; interaction p = 0.05). Similarly, O3-FA use was associated with lower BPI average pain and pain interference scores at 24 weeks compared with placebo among obese patients, but no significant difference between treatment arms in non-obese patients (interaction p = 0.005 and p = 0.01, respectively). CONCLUSIONS In obese BC patients, O3-FA use was associated with significantly reduced AI arthralgia compared to placebo.
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Affiliation(s)
- Sherry Shen
- Columbia University Medical Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA
| | - Joseph M Unger
- SWOG Statistical Center, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Katherine D Crew
- Columbia University Medical Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA
| | | | - Heather Greenlee
- Columbia University Medical Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA
| | | | | | - Lori M Minasian
- Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - James L Wade
- Central Illinois CCOP/Cancer Care Specialists of Central Illinois, Decatur, IL, USA
| | | | - N Lynn Henry
- Hunstman Cancer Institute, Salt Lake City, UT, USA
| | - Dawn L Hershman
- Columbia University Medical Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA.
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41
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Borrie AE, Rose RV, Choi YH, Perera FE, Read N, Sexton T, Lock M, Vandenberg TA, Hahn K, Dinniwell R, Younus J, Logan D, Potvin K, Yaremko B, Yu E, Lenehan J, Welch S, Tyndale RF, Teft WA, Kim RB. Letrozole concentration is associated with CYP2A6 variation but not with arthralgia in patients with breast cancer. Breast Cancer Res Treat 2018; 172:371-379. [PMID: 30094551 DOI: 10.1007/s10549-018-4910-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE The aromatase inhibitor (AI) letrozole is a first-line drug in the adjuvant treatment of breast cancer in postmenopausal women. Adherence to AI therapy, including letrozole, remains problematic due to the development of debilitating AI-induced arthralgia. Letrozole is metabolized in the liver by CYP2A6. It remains unknown if plasma letrozole levels or CYP2A6 genetic variation is associated with the development of arthralgia. METHODS We enrolled 126 female breast cancer patients initiated on letrozole therapy and prospectively collected blood samples at baseline and two follow-up time points to determine letrozole plasma concentrations and CYP2A6 genotype. At each visit, participants completed two validated questionnaires to assess the severity of arthralgia symptoms. RESULTS More than half (55%) of patients experienced a significant increase in their arthralgia symptoms after initiation of treatment. The clinical variables of body mass index (P = 0.0003) and age (P = 0.0430) were negatively and positively associated with plasma letrozole concentrations, respectively. CYP2A6 genotype was significantly associated with letrozole levels (P < 0.0001), and increased plasma letrozole levels were observed in patients with CYP2A6 reduced-function genotypes. Plasma levels of letrozole and CYP2A6 genotype were not significantly associated with a change in pain score from baseline. CONCLUSIONS CYP2A6 genotype was a significant predictor of letrozole plasma levels, but was not associated with the development of arthralgia.
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Affiliation(s)
- Adrienne E Borrie
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Rhiannon V Rose
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | - Tracy Sexton
- Department of Oncology, Western University, London, ON, Canada
| | - Michael Lock
- Department of Oncology, Western University, London, ON, Canada
| | | | - Karin Hahn
- Department of Oncology, Western University, London, ON, Canada
| | | | - Jawaid Younus
- Department of Oncology, Western University, London, ON, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, ON, Canada
| | - Kylea Potvin
- Department of Oncology, Western University, London, ON, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, ON, Canada
| | - Edward Yu
- Department of Oncology, Western University, London, ON, Canada
| | - John Lenehan
- Department of Oncology, Western University, London, ON, Canada
| | - Stephen Welch
- Department of Oncology, Western University, London, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, and Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Wendy A Teft
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Richard B Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada. .,Department of Physiology and Pharmacology, Western University, London, ON, Canada. .,LHSC - University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada.
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42
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Mao H, Bao T, Shen X, Li Q, Seluzicki C, Im EO, Mao JJ. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors. Eur J Cancer 2018; 101:47-54. [PMID: 30014974 DOI: 10.1016/j.ejca.2018.06.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is the most common and distressing symptom experienced by cancer survivors. This study sought to determine the prevalence and risk factors for fatigue among breast cancer (BC) survivors receiving aromatase inhibitors (AIs). MATERIAL AND METHODS We conducted a cross-sectional survey study among postmenopausal women with stage 0 to III BC receiving adjuvant AI therapy at the outpatient breast oncology clinic of a large university hospital. Participants with a score ≥4 on the 'worst fatigue' item of the Brief Fatigue Inventory were classified as having moderate or severe fatigue. Multivariate logistic regression analyses were performed to evaluate risk factors. RESULTS Among 1103 participants, 616 (55.8%) had moderate or severe fatigue. In the multivariate logistic regression model, women younger than 55 years were significantly more likely to report moderate to severe fatigue than women older than 65 years (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI] = 1.07-2.35; p = 0.023). Compared to women with high school or less education, women with college or more education were significantly more likely to report moderate to severe fatigue (AOR = 1.40, 95% CI = 1.02-1.91; p = 0.037). Increasing body mass index (BMI) was significantly associated with increased risk of experiencing moderate to severe fatigue (overweight: AOR = 1.37, 95% CI = 1.01-1.84, p = 0.042; obesity: AOR = 2.08, 95% CI = 1.53-2.81, p < 0.001). Fatigue was significantly correlated with pain severity (r = 0.48, p < 0.001) and insomnia (r = 0.62, p < 0.001). CONCLUSION Moderate to severe fatigue complaints exceed 50% among AI users. Fatigue is highly related to younger age, higher education level, higher BMI, pain severity and insomnia.
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Affiliation(s)
- Huijuan Mao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021 USA; School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203 China.
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021 USA.
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203 China.
| | - Qing Li
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021 USA.
| | - Christina Seluzicki
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021 USA.
| | - Eun-Ok Im
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710 USA.
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021 USA.
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Santa-Maria CA, Bardia A, Blackford AL, Snyder C, Connolly RM, Fetting JH, Hayes DF, Jeter SC, Miller RS, Nguyen A, Quinlan K, Rosner GL, Slater S, Storniolo AM, Wolff AC, Zorzi J, Henry NL, Stearns V. A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial. Breast Cancer Res Treat 2018; 171:121-129. [PMID: 29752687 DOI: 10.1007/s10549-018-4811-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are common adverse events of AIs often leading to drug discontinuation. We initiated a prospective clinical trial to evaluate whether bisphosphonates are associated with reduced incidence of AIMSS. METHODS In the single-arm trial, the Zoledronic Acid Prophylaxis (ZAP) trial, we compared the incidence of AIMSS against historical controls from the Exemestane and Letrozole Pharmacogenomics (ELPh) trial. Eligible women were postmenopausal with stage 0-III breast cancer planning to receive adjuvant AIs. AIMSS was assessed using the Health Assessment Questionnaire and Visual Analog Scale over 12 months in both trials. Participants in the ZAP trial received zoledronic acid prior to initiating letrozole and after 6 months; ELPh participants included in the analysis were taking letrozole but not bisphosphonates. We analyzed patient-reported outcomes (PROs) and bone density in the ZAP trial using mixed-effects linear regression models and paired t tests, respectively. RESULTS From 2011 to 2013, 59 postmenopausal women enrolled in ZAP trial. All 59 (100%) women received baseline and 52 (88%) received 6-month zoledronic acid, and had similar characteristics to historical controls from the ELPh trial (n = 206). Cumulatively during the first year of AI, 37 and 67% of ZAP and ELPh participants reported AIMSS (p < 0.001), respectively. Within the ZAP trial, we did not observe significant changes in other PROs; however, we report improvements in bone mineral density. CONCLUSIONS Compared to historical controls, zoledronic acid administered concomitantly with adjuvant AIs was associated with a reduced incidence of AIMSS. A randomized controlled trial is required to confirm these findings.
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Affiliation(s)
- Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aditya Bardia
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John H Fetting
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - Stacie C Jeter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Anne Nguyen
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, USA
| | - Katie Quinlan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shannon Slater
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jane Zorzi
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nora Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- University of Utah, Salt Lake City, USA
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Yeh CH, Lin WC, Kwai-Ping Suen L, Park NJ, Wood LJ, van Londen GJ, Howard Bovbjerg D. Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors: A Pilot Study. Oncol Nurs Forum 2018. [PMID: 28632237 DOI: 10.1188/17.onf.476-487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the feasibility of auricular point acupressure to manage aromatase inhibitor-induced arthralgia.
. DESIGN Wait list control design.
. SETTING Outpatient clinics and oncology center.
. SAMPLE 20 women with aromatase inhibitor-induced arthralgia.
. METHODS After baseline data were collected, participants waited one month before they received acupressure once per week for four weeks at a convenient time. The baseline data served as the control comparison. Self-reported measures and blood samples were obtained at baseline, at preintervention, weekly during the intervention, and at post-intervention.
. MAIN RESEARCH VARIABLES The primary outcomes included pain intensity, pain interference, stiffness, and physical function. Inflammatory cytokines and chemokines were tested.
. FINDINGS After the four-week intervention, participants reported decreases in worst pain and pain interference, and improvements in physical function, cancer-related symptom severity, and interference. The proinflammatory cytokines and chemokines displayed a trend of a mean percentage reduction. The anti-inflammatory cytokine interleukin-13 increased from pre- to postintervention.
. CONCLUSIONS Auricular point acupressure is feasible and may be effective in managing arthralgia in breast cancer survivors.
. IMPLICATIONS FOR NURSING Nurses can administer acupressure in clinical settings, which could enhance the management of aromatase inhibitor-induced arthralgia and contribute to a shift from traditional disease-based biomedical models to a broader, integrative, medical paradigm for managing aromatase inhibitor-induced arthralgia.
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Affiliation(s)
- Chao Hsing Yeh
- School of Nursing, University of Pittsburgh, Pennsylvania
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Elzohry AAM, Abd Elhamed MF, Mahran MH. Post Mastectomy Pain is No Longer Nightmare. JOURNAL OF FAMILY MEDICINE 2018; 1:1-11. [DOI: 10.14302/issn.2640-690x.jfm-17-1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast. Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite important disease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead to increased patient’s satisfaction and decrease fear of cancer breast. Objective Discuss different methods for management of PMPS with less side effects, adequate analgesia, improvement of quality of life, and better patient satisfaction in the future. Methods Treatment approaches include both pharmacological interventions and non-pharmacological strategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment. Conclusion Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanyl intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.
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Affiliation(s)
- Alaa Ali M Elzohry
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University
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46
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Bao T, Li SQ, Dearing JL, Piulson LA, Seluzicki CM, Sidlow R, Mao JJ. Acupuncture versus medication for pain management: a cross-sectional study of breast cancer survivors. Acupunct Med 2018; 36:80-87. [PMID: 29440043 DOI: 10.1136/acupmed-2017-011435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/27/2022]
Abstract
AIM OF THE STUDY Breast cancer survivors who take aromatase inhibitors (AI) often suffer from chronic pain. Emerging evidence supports the use of acupuncture as an effective pain management strategy for this condition, but its acceptability among cancer survivors is unknown. We evaluated breast cancer survivors' preferences for acupuncture as compared with medication use and identified factors predictive of this preference. METHODS We conducted a cross-sectional study among breast cancer survivors who were currently, or had been, taking an AI. The primary outcome was degree of preference for acupuncture as compared with medication for pain management. We conducted multivariate logistic regression analyses to evaluate the effects of socioeconomic status (SES) factors and health beliefs on treatment preference. RESULTS Among 592 participants, 160 (27.0%) preferred acupuncture, 153 (25.8%) preferred medication and 279 (47.1%) had no clear preference. In a multivariate analysis that only included SES, higher education and white race were significantly associated with greater preference for acupuncture. When health beliefs were added, SES effects were attenuated, while greater expectation of acupuncture's effect, lower perceived barriers to its use, higher social norm (endorsement from family members and healthcare professionals) related to acupuncture and higher holistic health beliefs were associated with greater preference for acupuncture. CONCLUSION We found similar rates of preference for acupuncture versus medication among breast cancer survivors for pain management. Specific attitudes and beliefs predicted such preferences, highlighting the importance of a patient-centred approach to align patient beliefs and preferences with therapeutic options for more effective pain management. TRIAL REGISTRATION NUMBER NCT01013337; Results.
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Affiliation(s)
- Ting Bao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Susan Q Li
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Josh L Dearing
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Lauren A Piulson
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Robert Sidlow
- Division of Survivorship and Supportive Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
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Bao T, Seidman A, Li Q, Seluzicki C, Blinder V, Meghani SH, Farrar JT, Mao JJ. Living with chronic pain: perceptions of breast cancer survivors. Breast Cancer Res Treat 2018; 169:133-140. [PMID: 29350307 DOI: 10.1007/s10549-018-4670-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/13/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Breast cancer treatments may lead to chronic pain. For some breast cancer survivors (BCS), this experience can develop into the perception of living with chronic pain. The majority of BCS are postmenopausal and have hormone receptor-positive (HR+) breast cancer requiring aromatase inhibitors (AIs). Neither the prevalence nor risk factors associated with the perception of living with chronic pain among this population are well defined. METHODS We conducted a cross-sectional survey among postmenopausal, HR+ BCS who previously took or were currently taking AIs. The primary outcome was patients' perception of living with chronic pain over the past 6 months. We measured pain and demographic and clinical variables. Multivariable logistic regression analysis was performed to evaluate risk factors associated with the perception of chronic pain. RESULTS Among 1280 participants, 167 (13%) reported having the perception of living with chronic pain before their breast cancer diagnosis; 426 (34%) reported this perception after completion of non-hormonal cancer treatment. Seventy-eight percent of BCSs reported experiencing at least one type of treatment-related pain within the past 7 days, with 23% experiencing at least three types. The most common types of pain were AI-induced musculoskeletal pain (49%) and pain at the surgery or radiation site (31%). Younger age (< 56), BMI > 25, and the perception of living with chronic pain before diagnosis were risk factors associated with the perception of living with chronic pain. CONCLUSIONS One in three postmenopausal, HR+ BCS considered themselves to be living with chronic pain. Effective interventions to reduce chronic pain are needed.
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Affiliation(s)
- Ting Bao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - Andrew Seidman
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Qing Li
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Christina Seluzicki
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Victoria Blinder
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | | | - John T Farrar
- University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
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48
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Ng HS, Koczwara B, Roder DM, Niyonsenga T, Vitry AI. Comorbidities in Australian women with hormone‐dependent breast cancer: a population‐based analysis. Med J Aust 2018; 208:24-28. [DOI: 10.5694/mja17.00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/18/2017] [Indexed: 01/06/2023]
Affiliation(s)
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, SA
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA
| | - David M Roder
- Centre for Population Health Research, University of South Australia, Adelaide, SA
| | - Theo Niyonsenga
- University of South Australia, Adelaide, SA
- Health Research Institute/CeRAPH, University of Canberra, Canberra, ACT
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Zaidi S, Hussain S, Verma S, Veqar Z, Khan A, Nazir SU, Singh N, Moiz JA, Tanwar P, Srivastava A, Rath GK, Mehrotra R. Efficacy of Complementary Therapies in the Quality of Life of Breast Cancer Survivors. Front Oncol 2018; 7:326. [PMID: 29376027 PMCID: PMC5768617 DOI: 10.3389/fonc.2017.00326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most common cancer diagnosed in women and the second most common cancer overall, ranking as the fifth cause of death from cancer. The chronicity of the disease produces long-term physiological and psychological manifestations, which adversely affect the quality of life of the individual. The primary treatment while managing cancer presents with various debilitating side effects. With the recent advances in treatment techniques that have improved the survival rate, patients suffer from continuing posttreatment complications. Patients seem to cope well with the stress of treatment of BC and sustain a normal life; however, the deterioration in physical well-being makes the patient functionally inefficient. Exercise has been proven to be an effective, safe, and feasible tool in combating the adverse effects of treatment, prevents complications and decreases the risk of BC-specific mortality. This review briefly presents an overview of the burden of the disease and its management strategies. Owing to the heterogeneity of the population and the multitude of therapies they receive, the response of each patient to treatment is different and so is the magnitude of adverse effects. The review discusses the late sequelae following treatment and evidence supporting the role of physical activity in their management. In conclusion, there is a need for personalized physical activity plans to be developed to suit the individual and their circumstances.
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Affiliation(s)
- Sahar Zaidi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Showket Hussain
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Shalini Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Asiya Khan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sheeraz Un Nazir
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Neha Singh
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenberg University, Gothenberg, Sweden
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Pranay Tanwar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - G K Rath
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
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50
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Reinbolt RE, Sonis S, Timmers CD, Fernández-Martínez JL, Cernea A, de Andrés-Galiana EJ, Hashemi S, Miller K, Pilarski R, Lustberg MB. Genomic risk prediction of aromatase inhibitor-related arthralgia in patients with breast cancer using a novel machine-learning algorithm. Cancer Med 2017; 7:240-253. [PMID: 29168353 PMCID: PMC5773952 DOI: 10.1002/cam4.1256] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 02/06/2023] Open
Abstract
Many breast cancer (BC) patients treated with aromatase inhibitors (AIs) develop aromatase inhibitor‐related arthralgia (AIA). Candidate gene studies to identify AIA risk are limited in scope. We evaluated the potential of a novel analytic algorithm (NAA) to predict AIA using germline single nucleotide polymorphisms (SNP) data obtained before treatment initiation. Systematic chart review of 700 AI‐treated patients with stage I‐III BC identified asymptomatic patients (n = 39) and those with clinically significant AIA resulting in AI termination or therapy switch (n = 123). Germline DNA was obtained and SNP genotyping performed using the Affymetrix UK BioBank Axiom Array to yield 695,277 SNPs. SNP clusters that most closely defined AIA risk were discovered using an NAA that sequentially combined statistical filtering and a machine‐learning algorithm. NCBI PhenGenI and Ensemble databases defined gene attribution of the most discriminating SNPs. Phenotype, pathway, and ontologic analyses assessed functional and mechanistic validity. Demographics were similar in cases and controls. A cluster of 70 SNPs, correlating to 57 genes, was identified. This SNP group predicted AIA occurrence with a maximum accuracy of 75.93%. Strong associations with arthralgia, breast cancer, and estrogen phenotypes were seen in 19/57 genes (33%) and were functionally consistent. Using a NAA, we identified a 70 SNP cluster that predicted AIA risk with fair accuracy. Phenotype, functional, and pathway analysis of attributed genes was consistent with clinical phenotypes. This study is the first to link a specific SNP/gene cluster to AIA risk independent of candidate gene bias.
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Affiliation(s)
- Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Stephen Sonis
- Primary Endpoint Solutions, Watertown, Massachusetts.,Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cynthia D Timmers
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Ana Cernea
- Primary Endpoint Solutions, Watertown, Massachusetts.,University of Oviedo, Oviedo, Spain
| | | | - Sepehr Hashemi
- Primary Endpoint Solutions, Watertown, Massachusetts.,Harvard School of Dental Medicine, Boston, Massachusetts
| | - Karin Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Robert Pilarski
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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