1
|
Mibu A, Manfuku M, Nishigami T, Yamashita H, Imai R, Kanamori H, Sumiyoshi K. Association of Aromatase Inhibitor-Induced Musculoskeletal Symptoms with Central Sensitization-Related Symptoms: A Cross-Sectional Study. Breast Care (Basel) 2024; 19:207-214. [PMID: 39185132 PMCID: PMC11341075 DOI: 10.1159/000539867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/16/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Aromatase inhibitor (AI)-induced musculoskeletal symptoms (AIMSS) can decrease health-related quality of life and lead to discontinuation of AI therapy for postmenopausal women with breast cancer (BC). Although central sensitization (CS) may contribute to AIMSS, the relevance of CS-related symptoms to AIMSS has not been fully clarified. This study aimed to investigate the relationship between AIMSS and CS-related symptoms in women with BC who received AI therapy. Methods This cross-sectional study recruited women who underwent BC surgery before at least 1 year and were taking AI for at least 6 months. Participants were assessed for joint pain and CS-related symptoms using the central sensitization inventory (CSI). The severity of CS-related symptoms was classified into three groups, and the prevalence of AIMSS was calculated. Multiple logistic regression analysis was used to assess the relationship between AIMSS and factors of possible relevance to AIMSS, including CSI severity. Results Of the 73 women who were included in this study, 31 (42.4%) were categorized into the AIMSS group and 42 (57.6%) into the non-AIMSS group. Participants with a history of chemotherapy and higher CSI score were significantly more likely to have AIMSS. Multiple logistic regression analysis showed that a history of chemotherapy (odds ratio = 4.21) and higher CSI severity (odds ratio = 13.43) had significantly associated with AIMSS. Conclusion CS-related symptoms assessed using CSI may be strongly associated with AIMSS. Further longitudinal studies to investigate the causal relationship and effectiveness of CS-targeted interventions are needed to prevent and treat AIMSS effectively.
Collapse
Affiliation(s)
- Akira Mibu
- Department of Physical Therapy, Konan Women’s University, Kobe, Japan
| | - Masahiro Manfuku
- Department of Rehabilitation, Breast Care Sensyu Clinic, Kishiwada, Japan
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Mihara, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Hirofumi Yamashita
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Mihara, Japan
- Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Higashihiroshima, Japan
| | - Ryota Imai
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Hiroe Kanamori
- Department of Breast Surgery, Breast Care Sensyu Clinic, Kishiwada, Japan
| | - Kazuhiro Sumiyoshi
- Department of Breast Surgery, Breast Care Sensyu Clinic, Kishiwada, Japan
| |
Collapse
|
2
|
Stearns V, Jegede OA, Chang VTS, Skaar TC, Berenberg JL, Nand R, Shafqat A, Jacobs NL, Luginbuhl W, Gilman P, Benson AB, Goodman JR, Buchschacher GL, Henry NL, Loprinzi CL, Flynn PJ, Mitchell EP, Fisch MJ, Sparano JA, Wagner LI. A Cohort Study to Evaluate Genetic Predictors of Aromatase Inhibitor Musculoskeletal Symptoms: Results from ECOG-ACRIN E1Z11. Clin Cancer Res 2024; 30:2709-2718. [PMID: 38640040 PMCID: PMC11287923 DOI: 10.1158/1078-0432.ccr-23-2137] [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: 07/29/2023] [Revised: 10/13/2023] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS) are common and frequently lead to AI discontinuation. SNPs in candidate genes have been associated with AIMSS and AI discontinuation. E1Z11 is a prospective cohort study designed to validate the association between 10 SNPs and AI discontinuation due to AIMSS. PATIENTS AND METHODS Postmenopausal women with stage I to III hormone receptor-positive breast cancer received anastrozole 1 mg daily and completed patient-reported outcome measures to assess AIMSS (Stanford Health Assessment Questionnaire) at baseline, 3, 6, 9, and 12 months. We estimated that 40% of participants would develop AIMSS and 25% would discontinue AI treatment within 12 months. Enrollment of 1,000 women with a fixed number per racial stratum provided 80% power to detect an effect size of 1.5 to 4. SNPs were found in ESR1 (rs2234693, rs2347868, and rs9340835), CYP19A1 (rs1062033 and rs4646), TCL1A (rs11849538, rs2369049, rs7158782, and rs7159713), and HTR2A (rs2296972). RESULTS Of the 970 evaluable women, 43% developed AIMSS and 12% discontinued AI therapy within 12 months. Although more Black and Asian women developed AIMSS than White women (49% vs. 39%, P = 0.017; 50% vs. 39%, P = 0.004, respectively), the AI discontinuation rates were similar across groups. None of the SNPs were significantly associated with AIMSS or AI discontinuation in the overall population or in distinct cohorts. The OR for rs2296972 (HTR2A) approached significance for developing AIMSS. CONCLUSIONS We were unable to prospectively validate candidate SNPs previously associated with AI discontinuation due to AIMSS. Future analyses will explore additional genetic markers, patient-reported outcome predictors of AIMSS, and differences by race.
Collapse
Affiliation(s)
- Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Opeyemi A. Jegede
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Victor Tsu-Shih Chang
- Veterans Administration New Jersey Health Care System, East Orange, NJ and Rutgers New Jersey Medical School, Newark NJ
| | - Todd C. Skaar
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Atif Shafqat
- Heartland Cancer Research NCORP-Missouri Baptist Medical Center, Saint Louis, MO
| | | | | | - Paul Gilman
- Main Line Oncology Hematology Associates, Wynnewood, PA
| | | | | | | | - N. Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Joseph A. Sparano
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | | |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Wong BWX, Chan YH, Logan S, Kramer MS, Yong EL. Arthralgia in midlife Singaporean women: the Integrated Women's Health Program (IWHP). Climacteric 2024; 27:178-186. [PMID: 38099561 DOI: 10.1080/13697137.2023.2287626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Arthralgia is a common menopausal complaint in midlife women, and its causes remain unclear. We examined the prevalence of menopausal arthralgia with various factors including sleep quality, depression/anxiety, muscle strength and physical performance among midlife Singaporean women. METHODS The Integrated Women's Health Program (IWHP) comprised 1120 healthy, community-dwelling women of Chinese, Malay or Indian ethnicities (aged 45-69 years) attending well-women clinics at the National University Hospital, Singapore. Sociodemographic, menopausal, reproductive and health data were obtained with validated questionnaires. Muscle strength, physical performance and dual-energy X-ray absorptiometry were measured. Women with moderate to very severe symptoms using the Menopause Rating Scale were classified as having arthralgia. Multivariable logistic regression analyses examined risk factors for arthralgia. RESULTS One-third of the participants reported arthralgia, and 12.7%, 16.2% and 71.2% were in the premenopausal, perimenopausal and postmenopausal period, respectively. Menopausal symptoms, such as vaginal dryness (adjusted odds ratio [aOR]: 2.64, 95% confidence interval [CI]: 1.64, 4.24) and physical/mental exhaustion (aOR: 2.83, 95% CI: 1.79, 4.47), were independent risk factors for arthralgia. Poor muscle strength (aOR: 2.20, 95% CI: 1.29, 3.76), obesity (aOR: 1.94, 95% CI: 1.13, 3.32) and rheumatoid arthritis (aOR: 7.73, 95% CI: 4.47, 13.36) were also independently associated with arthralgia after adjustment for confounders. CONCLUSIONS Arthralgia in midlife Singaporean women was associated with menopausal symptoms of vaginal dryness and physical and mental exhaustion. Women with poor muscle strength were more likely to experience menopausal arthralgia.
Collapse
Affiliation(s)
- B W X Wong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y H Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Logan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Quebec, Canada
| | - E L Yong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Tanabe S, Tsuboi K. Rheumatoid Arthritis-Like Symptoms After Taking Relugolix, With Primary Exacerbation After Discontinuation of the Drug. Cureus 2024; 16:e53584. [PMID: 38318276 PMCID: PMC10839165 DOI: 10.7759/cureus.53584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 02/07/2024] Open
Abstract
We report a case of a 43-year-old woman who developed rheumatoid arthritis-like symptoms after taking relugolix, presenting a diagnostic challenge in distinguishing between initial symptoms of rheumatoid arthritis and the side effects of the drug. The patient, scheduled for a total laparoscopic hysterectomy owing to uterine fibroids, started taking relugolix five and a half months prior to surgery. Three months later, she developed rheumatoid arthritis-like stiffness in both hands, especially in the mornings. Despite consultations with the rheumatology department and negative blood and imaging findings for rheumatoid arthritis, her joint symptoms worsened after surgery. Treatment for early-stage rheumatoid arthritis was initiated, and the symptoms peaked after six months. Similar to estrogen-lowering aromatase inhibitors that are known to cause joint symptoms, relugolix might also induce these effects.
Collapse
Affiliation(s)
- Shohei Tanabe
- Obstetrics and Gynecology, Kobe City Medical Center West Hospital, Kobe, JPN
| | - Kazuyuki Tsuboi
- Collagen Disease and Rheumatology, Kobe City Medical Center West Hospital, Kobe, JPN
| |
Collapse
|
6
|
Wilson KL, Grewelle RE, Gupta T, Kim SH, Katsumoto TR. Aromatase inhibitor-induced arthralgia ameliorated by Mediterranean diet and active lifestyle guided by continuous glucose monitoring: a case report and review of the literature. Front Oncol 2024; 14:1189287. [PMID: 38361780 PMCID: PMC10867103 DOI: 10.3389/fonc.2024.1189287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Aromatase inhibitors (AIs) are a cornerstone adjuvant treatment of many hormone receptor-positive breast cancers, and nearly half of women taking aromatase inhibitors suffer from AI-induced arthralgia (AIA), also known as AI-associated musculoskeletal syndrome (AIMSS), for which there are limited evidence-based treatments. Pharmacologic management and complementary methods including supplements, exercise, physical therapy, yoga, acupuncture, and massage have all shown mixed results. Comprehensive diet and lifestyle strategies are understudied in AIA/AIMSS despite their disease-modifying effects across many chronic conditions. Here we report a case of a woman with stage 2 estrogen and progesterone receptor-positive invasive ductal carcinoma on adjuvant anastrozole whose AI-induced arthralgia was durably controlled through a Mediterranean plant-forward diet and daily physical activity guided by continuous glucose monitoring. We posit that diet and a lifestyle inclusive of daily physical activity constitute a low-cost, low-risk, and potentially high-reward strategy for controlling common AI-induced musculoskeletal symptoms and that more investigation in this arena, including well-designed randomized trials, is warranted.
Collapse
Affiliation(s)
- Kalin L. Wilson
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Richard E. Grewelle
- Department of Biology, Stanford University, Stanford, CA, United States
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, United States
| | - Tanya Gupta
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Sun H. Kim
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, United States
| | - Tamiko R. Katsumoto
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
7
|
Lippi L, de Sire A, Folli A, Turco A, Moalli S, Marcasciano M, Ammendolia A, Invernizzi M. Obesity and Cancer Rehabilitation for Functional Recovery and Quality of Life in Breast Cancer Survivors: A Comprehensive Review. Cancers (Basel) 2024; 16:521. [PMID: 38339271 PMCID: PMC10854903 DOI: 10.3390/cancers16030521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and rehabilitation treatment planning to address long-term survivorship issues. The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. The biological basis linking obesity and cancer involves complex interactions in adipose tissue and the tumor microenvironment. Various mechanisms, such as hormonal alterations, chronic inflammation, immune system modulation, and mitochondrial dysfunction, contribute to cancer development. The review underlines the importance of comprehensive oncologic rehabilitation, including physical, psychological, and nutritional aspects. Cancer rehabilitation plays a crucial role in managing obesity-related symptoms, offering interventions for physical impairments, pain management, and lymphatic disorders, and improving both physical and psychological well-being. Personalized and technology-driven approaches hold promise for optimizing rehabilitation effectiveness and improving long-term outcomes for obese cancer patients. The comprehensive insights provided in this review contribute to the evolving landscape of cancer care, emphasizing the importance of tailored rehabilitation in optimizing the well-being of obese cancer patients.
Collapse
Affiliation(s)
- Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (A.T.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (A.T.); (S.M.); (M.I.)
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (A.T.); (S.M.); (M.I.)
| | - Stefano Moalli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (A.T.); (S.M.); (M.I.)
| | - Marco Marcasciano
- Experimental and Clinical Medicine Department, Division of Plastic and Reconstructive Surgery, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (A.T.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| |
Collapse
|
8
|
Saraf A, Tahir I, Hu B, Dietrich ASW, Tonnesen PE, Sharp GC, Tillman G, Roeland EJ, Nipp RD, Comander A, Peppercorn J, Fintelmann FJ, Jimenez RB. Association of Sarcopenia With Toxicity-Related Discontinuation of Adjuvant Endocrine Therapy in Women With Early-Stage Hormone Receptor-Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2024; 118:94-103. [PMID: 37506979 DOI: 10.1016/j.ijrobp.2023.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Sarcopenia, an age-related decline in muscle mass and physical function, is associated with increased toxicity and worse outcomes in women with breast cancer (BC). Sarcopenia may contribute to toxicity-related early discontinuation of adjuvant endocrine therapy (aET) in women with hormone receptor-positive (HR+) BC but remains poorly characterized. METHODS AND MATERIALS This multicenter, retrospective cohort study included consecutive women with stage 0-II HR+ BC who received breast conserving therapy (lumpectomy and radiation therapy) and aET from 2011 to 2017 with a 5-year follow-up. Skeletal muscle index (SMI, cm2/m2) was analyzed using a deep learning model on routine cross-sectional radiation simulation imaging; sarcopenia was dichotomized according to previously validated reports. The primary endpoint was toxicity-related aET discontinuation; logistic regression analysis evaluated associations between SMI/sarcopenia and aET discontinuation. Cox regression analysis evaluated associations with time to aET toxicity, ipsilateral breast tumor recurrence (IBTR), and disease-free survival (DFS). RESULTS A total of 305 women (median follow-up, 89 months) were included with a median age of 67 years and early-stage BC (12% stage 0, 65% stage I). A total of 60 (20%) women experienced toxicity-related aET discontinuation. Sarcopenia was associated with toxicity-related early discontinuation of aET (odds ratio, 2.18; P = .036) and shorter time to aET toxicity (hazard ratio [HR], 1.62; P = .031). SMI or sarcopenia were not independently associated with IBTR or DFS; toxicity-related aET discontinuation was associated with worse IBTR (HR, 9.47; P = .002) and worse DFS (HR, 4.53; P = .001). CONCLUSIONS Among women with early-stage HR+ BC who receive adjuvant radiation therapy and hormone therapy, sarcopenia is associated with toxicity-related early discontinuation of aET. Further studies should validate these findings in women who did not receive adjuvant radiation therapy. These high-risk patients may be candidates for aggressive symptom management and/or alternative treatment strategies to improve outcomes.
Collapse
Affiliation(s)
- Anurag Saraf
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Ismail Tahir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - P Erik Tonnesen
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory C Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gayle Tillman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric J Roeland
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Ryan D Nipp
- Department of Medical Oncology, University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Amy Comander
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffery Peppercorn
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
9
|
Dorfman CS, Fisher HM, Thomas S, Kelleher SA, Winger JG, Mitchell NS, Miller SN, Somers TJ. Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden. Support Care Cancer 2023; 31:604. [PMID: 37782420 PMCID: PMC10721211 DOI: 10.1007/s00520-023-08064-z] [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: 12/20/2022] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increased symptoms. However, the role of physical activity in buffering the relationship between higher BMI and greater symptoms is unclear. METHODS Baseline data from a randomized trial investigating Pain Coping Skills Training among breast cancer survivors (N = 327) with pain were used to examine the relationship between self-reported BMI (kg/m2) and physical activity level (Rapid Assessment of Physical Activity; suboptimal vs. optimal) with pain (Brief Pain Inventory; severity and interference), fatigue (PROMIS-Fatigue short form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). Analyses were conducted in SPSS. Hayes PROCESS macro (Model 1) assessed whether physical activity moderated the relationship between BMI and symptoms. RESULTS Lower BMI (B = .06, p < .01) and optimal physical activity (B = - .69, p < .01) were independently associated with lower pain interference. Lower BMI was also associated with lower pain severity (B = .04, p < .001). Neither BMI nor physical activity was associated with fatigue or depressive symptoms. Physical activity did not moderate the relationship between BMI and symptoms. CONCLUSIONS Among breast cancer survivors experiencing pain, higher BMI and being less physically active were related to greater pain (i.e., severity and/or interference). Physical activity did not buffer the relationships between BMI and pain, fatigue, and depressive symptoms, suggesting that physical activity alone may not be sufficient to influence the strength of the relationships between BMI and symptoms.
Collapse
Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nia S Mitchell
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
10
|
Zhao Y, Tang L, Shao J, Chen D, Jiang Y, Tang P, Wang X. The effectiveness of exercise on the symptoms in breast cancer patients undergoing adjuvant treatment: an umbrella review of systematic reviews and meta-analyses. Front Oncol 2023; 13:1222947. [PMID: 37799468 PMCID: PMC10548878 DOI: 10.3389/fonc.2023.1222947] [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: 05/15/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
Background Exercise has the potential to reduce symptoms for breast cancer patients during adjuvant treatment, and high-quality systematic reviews are essential for guiding clinical practice. The objective of this umbrella review is to examine current research evidence concerning the effectiveness of exercise on symptom management in breast cancer patients undergoing adjuvant treatment. Methods An umbrella review was conducted. We searched for eligible systematic reviews through 11 databases until August 13rd, 2023. Two authors independently screened titles and abstracts, assessing the full-text studies based on inclusion criteria. We used AMSTAR-2 to appraise the quality of the meta-analyses. The results would be presented with narrative summaries if the replication rate of the original study for a symptom was higher than 5% (calculated via the Corrected Covered Area, CCA). The protocol was documented in the PROSPERO registry (CRD42023403990). Results Of the 807 systematic reviews identified, 15 met the inclusion criteria, and 7 symptoms were the main focus. The main form of exercise mentioned was aerobic combined resistance exercise. The results of the quality assessment were mostly critically low (10/15). The repetition rate calculated by CCA showed moderate to very high repetition rates (10% to 18.6%). The findings of the included reviews indicated that the effects of exercise on relieving symptoms during breast cancer adjuvant treatment were mixed. Conclusions Research is still needed to confirm the majority of studies' recommendations for exercise during adjuvant treatment for breast cancer patients, as it is crucial for managing symptoms in the rehabilitation process. To increase the efficiency of exercise in symptom management, future studies may focus more on the application of bridge symptoms, symptom networks, and ecological instantaneous assessment.
Collapse
Affiliation(s)
- Yuan Zhao
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Leiwen Tang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Shao
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dandan Chen
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yueying Jiang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Panpan Tang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xueqing Wang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
11
|
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.
Collapse
|
12
|
LeVee A, Mortimer J. The Challenges of Treating Patients with Breast Cancer and Obesity. Cancers (Basel) 2023; 15:cancers15092526. [PMID: 37173991 PMCID: PMC10177120 DOI: 10.3390/cancers15092526] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Obesity is defined as a body mass index (BMI) of 30 kg/m2 or more and is associated with worse outcomes in patients with breast cancer, resulting in an increased incidence of breast cancer, recurrence, and death. The incidence of obesity is increasing, with almost half of all individuals in the United States classified as obese. Patients with obesity present with unique pharmacokinetics and physiology and are at increased risk of developing diabetes mellitus and cardiovascular disease, which leads to specific challenges when treating these patients. The aim of this review is to summarize the impact of obesity on the efficacy and toxicity of systemic therapies used for breast cancer patients, describe the molecular mechanisms through which obesity can affect systemic therapies, outline the existing American Society of Clinical Oncology (ASCO) guidelines for treating patients with cancer and obesity, and highlight additional clinical considerations for treating patients with obesity and breast cancer. We conclude that further research on the biological mechanisms underlying the obesity-breast cancer link may offer new treatment strategies, and clinicals trials that focus on the treatment and outcomes of patients with obesity and all stages of breast cancer are needed to inform future treatment guidelines.
Collapse
Affiliation(s)
- Alexis LeVee
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| |
Collapse
|
13
|
Gulati M, Dursun E, Vincent K, Watt FE. The influence of sex hormones on musculoskeletal pain and osteoarthritis. THE LANCET. RHEUMATOLOGY 2023; 5:e225-e238. [PMID: 38251525 DOI: 10.1016/s2665-9913(23)00060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 03/22/2023]
Abstract
The association of female sex with certain rheumatic symptoms and diseases is now indisputable. Some of the most striking examples of this association occur in individuals with musculoskeletal pain and osteoarthritis, in whom sex-dependent changes in incidence and prevalence of disease are seen throughout the lifecourse. Joint and muscle pain are some of the most common symptoms of menopause, and there is increasingly compelling evidence that changes in or loss of sex hormones (be it natural, autoimmune, pharmacological, or surgical) influence musculoskeletal pain propensity and perhaps disease. However, the effects of modulation or replacement of sex hormones in this context are far less established, particularly whether these approaches could represent a preventative or therapeutic opportunity once symptoms have developed. In this Review, we present evidence for the association of changes in sex hormones with musculoskeletal pain and painful osteoarthritis, discussing data from diverse natural, therapeutic, and experimental settings in humans and relevant animal models relating to hormone loss or replacement and the consequent effects on health, pain, and disease. We also postulate mechanisms by which sex hormones could mediate these effects. Further research is needed; however, increased scientific understanding of this complex area could lead to real benefits in musculoskeletal and women's health.
Collapse
Affiliation(s)
- Malvika Gulati
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Eren Dursun
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Rheumatology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
Huifang L, Jie G, Yi F. Neuro-immune-endocrine mechanisms with poor adherence to aromatase inhibitor therapy in breast cancer. Front Oncol 2022; 12:1054086. [PMID: 36578931 PMCID: PMC9791186 DOI: 10.3389/fonc.2022.1054086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
As the most commonly used endocrine therapy regimen for patients with hormone receptor-positive (HR+) breast cancer (BC) at present, aromatase inhibitors (AIs) reduce the risk of localized and distant recurrence, contralateral BC and secondary cancer, and prolong disease-free survival. Clinical data show that poor adherence during AI treatment is mainly attributed to muscle and joint pain, fatigue, anxiety, depression and sleep disturbances during treatment. The rapid decline of estrogen caused by AIs in a short period of time enhances sympathetic activity, activates T cells in the body, produces inflammatory factors such as tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and interleukin (IL)-17A, and promotes the occurrence of inflammation and bone loss. This article reviewed the mechanism of poor dependence on AIs in BC patients from the neuro-immuno-endocrine (NIE) perspective and provided clues for clinical intervention against poor adherence.
Collapse
Affiliation(s)
- Li Huifang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Gao Jie
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Feng Yi
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China,*Correspondence: Feng Yi,
| |
Collapse
|
16
|
Panevin TS, Bobkova AO, Karateev AE, Zotkin EG. Endogenous estrogen deficiency and the development of chronic musculoskeletal pain: A review. TERAPEVT ARKH 2022; 94:683-688. [DOI: 10.26442/00403660.2022.05.201490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
Sexual dimorphism of chronic diseases is a phenomenon determined by differences in the hormonal status of men and women. In this regard, estrogens, which have a complex effect on the body, are of great interest. In particular, estrogens play an important role in the natural control of pain and inflammation. A decrease in estrogen levels associated with menopause or iatrogenic effects (hysterectomy, use of aromotase inhibitors), as well as mutations of genes responsible for the synthesis of structural components of membrane estrogen receptors (ESR1 and ESR2), can significantly reduce the positive effects of these hormones. Deficiency of estrogen can become one of the reasons for the development of serious pathological changes in particular, the formation of chronic pain associated with the pathology of the musculoskeletal system.
Collapse
|
17
|
Ballinger TJ, Jiang G, Shen F, Miller KD, Sledge GW, Schneider BP. Impact of African ancestry on the relationship between body mass index and survival in an early-stage breast cancer trial (ECOG-ACRIN E5103). Cancer 2022; 128:2174-2181. [PMID: 35285940 PMCID: PMC9086123 DOI: 10.1002/cncr.34173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/09/2022] [Accepted: 02/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND African ancestry (AA) and obesity are associated with worse survival in early-stage breast cancer. Obesity disproportionately affects women of AA; however, the intersection between ancestry and obesity on breast cancer outcomes remains unclear. METHODS A total of 2854 patients in the adjuvant trial E5103 were analyzed. Genetic ancestry was determined using principal components from a genome-wide array. The impact of continuous or binary body mass index (BMI) on disease-free survival (DFS) and overall survival (OS) was evaluated by multivariable Cox proportional hazards models in AA patients and European ancestry (EA) patients. RESULTS There were 2471 EA patients and 383 AA patients. Higher BMI was significantly associated with worse DFS and OS only in AA patients (DFS hazard ratio [HR], 1.25; 95% CI, 1.07-1.46; OS HR, 1.38; 95% CI, 1.10-1.73), not in EA patients (DFS HR, 0.97; 95% CI, 0.90-1.05; OS HR, 1.03; 95% CI, 0.93-1.14). Severe obesity (BMI ≥40) was significantly associated with worse survival in AA patients (DFS HR, 2.04; 95% CI, 1.21-3.43; OS HR, 2.21; 95% CI, 1.03-4.75) but had no impact on that of EA patients. In the estrogen receptor-positive (ER+) and triple-negative breast cancer subgroups, BMI was significantly associated with worse outcomes only in those AA patients with ER+ disease. Within the AA group, BMI remained associated with worse survival regardless of the AA proportion. CONCLUSIONS Higher BMI was statistically significantly associated with worse breast cancer outcomes in AA but not EA patients. This association was most significant for severe obesity and those with ER+ disease. These observations help define optimal populations for weight change interventions designed to affect disparities and survival in early-stage breast cancer. LAY SUMMARY African ancestry and obesity are both risk factors for worse survival after early-stage breast cancer. Women of African descent are also disproportionately affected by obesity; however, it is unclear what impact body weight has on racial disparities in breast cancer. Data from a large phase 3 clinical trial in high-risk, early-stage breast cancer were used to determine how body weight affects survival outcomes in European versus African Americans. Study results demonstrate that a higher body mass index is associated with increased risk of breast cancer recurrence and worse survival in women of African ancestry but not in women of European ancestry.
Collapse
Affiliation(s)
- Tarah J. Ballinger
- Division of Hematology and OncologyIndiana University School of MedicineIndianapolisIndiana
| | - Guanglong Jiang
- School of Informatics and ComputingIndiana University Purdue University IndianapolisIndianapolisIndiana
| | - Fei Shen
- Division of Hematology and OncologyIndiana University School of MedicineIndianapolisIndiana
| | - Kathy D. Miller
- Division of Hematology and OncologyIndiana University School of MedicineIndianapolisIndiana
| | | | - Bryan P. Schneider
- Division of Hematology and OncologyIndiana University School of MedicineIndianapolisIndiana
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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]
|
20
|
Wang T, Huang YY, Liu XL, Molassiotis A, Yao LQ, Zheng SL, Tan JY(B, Huang HQ. Prevalence and correlates of joint pain among Chinese breast cancer survivors receiving aromatase inhibitor treatment. Support Care Cancer 2022; 30:9279-9288. [PMID: 36065027 PMCID: PMC9633515 DOI: 10.1007/s00520-022-07345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Aromatase inhibitor (AI)-induced joint pain is a common toxicity of AI treatment. Although many studies have been conducted to examine the occurrence and severity of AI-induced joint pain in breast cancer survivors, none of the studies focused on the Chinese population with breast cancer. Given that the differences in cultural background and the genetic structure between Asians and Caucasians may contribute to different phenotypes of joint pain, this cross-sectional study was therefore conducted to examine the prevalence of AI-induced joint pain among Chinese breast cancer survivors receiving AI treatment and the correlates of pain. METHODS This cross-sectional study was conducted in a tertiary hospital in China. Breast cancer survivors undergoing AI treatment were recruited to complete the following questionnaires: a self-designed baseline data form, the Nordic Musculoskeletal Questionnaire (NMQ), the Brief Pain Inventory (BPI), the 36-Item Short Form Health Survey (SF-36), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Based on the assessment results of NMQ (if the participant indicated pain in specific body parts), participants were then invited to complete other questionnaires to specifically assess the joint symptoms, including the Oxford Knee Score (OKS), the Oxford Hip Score (OHS), the Michigan Hand Outcomes Questionnaire (MHQ), and the Manchester Foot Pain Disability Questionnaire (MFPDQ). Descriptive analysis was used to analyse participants' baseline data and the prevalence of pain. Stepwise multiple regression was used to identify the correlates of pain. RESULTS Four hundred and ten participants were analysed. According to the NMQ, 71.7% of the participants experienced joint symptoms in at least one joint, and the most frequently mentioned joint was knee (39.0%). The diagram in BPI indicated that 28.0% of the participants had the worst pain around knees. In patients with knee pain, the mean OKS score was 40.46 ± 6.19. The sub-scores of BPI for pain intensity and pain interference were 1.30 ± 1.63 and 1.24 ± 1.79, respectively. Patients' poorer physical well-being/functioning, previous use of AI treatment, presence of osteoarthritis, and receiving of physiotherapy were identified as four common correlates of greater severity of pain and pain interference (p < 0.05). CONCLUSIONS Chinese breast cancer survivors can experience joint pain at various locations, particularly knees. In addition to increasing the use of interventions for pain alleviation, a comprehensive assessment of survivors' conditions such as physical functioning, history of AI treatment, and presence of osteoarthritis should be emphasized to identify survivors who need more attention and tailored interventions.
Collapse
Affiliation(s)
- Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD 4000 Australia
| | - Yu-Yan Huang
- School of Nursing, Southwest Medical University, 319 Zhongshan Rd 3rd Section, Luzhou, 646000 Sichuan China
| | - Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD 4000 Australia
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Li-Qun Yao
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD 4000 Australia
| | - Si-Lin Zheng
- The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000 Sichuan China
| | - Jing-Yu (Benjamin) Tan
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD 4000 Australia
| | - Hou-Qiang Huang
- The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000 Sichuan China
| |
Collapse
|
21
|
de Sire A, Lippi L, Ammendolia A, Cisari C, Venetis K, Sajjadi E, Fusco N, Invernizzi M. Physical Exercise with or without Whole-Body Vibration in Breast Cancer Patients Suffering from Aromatase Inhibitor—Induced Musculoskeletal Symptoms: A Pilot Randomized Clinical Study. J Pers Med 2021; 11:jpm11121369. [PMID: 34945841 PMCID: PMC8707128 DOI: 10.3390/jpm11121369] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 12/29/2022] Open
Abstract
In this study, we aimed to assess the safety and efficacy of physical exercise, with or without whole-body vibration (WBV), in patients with aromatase inhibitor-induced musculoskeletal symptoms (AIMSS). Eligible patients were adults (≥18 years) with a history of breast cancer and current AIMSS. Enrolled patients (n = 22) were randomly assigned 1:1 to receive physical exercise combined with WBV or sham WBV for 4 weeks. The primary endpoint was pain intensity measured by numerical pain rating scale (NPRS). The secondary endpoints were muscle strength, physical function, physical performance, and quality of life. The WBV group (mean age: 51.73 ± 10.73 years; body mass index (BMI): 25.56 ± 5.17 kg/m2) showed a statistically significant pain reduction (NPRS: 6.82 ± 1.17 vs. 5.73 ± 1.01; p = 0.031), whereas patients in the sham WBV group (mean age: 58.55 ± 9.71 years; BMI: 27.31 ± 3.84 kg/m2), did not reach statistical significance (NPRS: 6.91 ± 2.02 vs. 5.91 ± 2.51; p = 0.07). Concurrently, muscle strength, physical performance, and quality of life significantly improved in both groups, without significant differences between groups. No dropouts and no side effects were recorded. Both patients and the physical therapist reported a high level of satisfaction with the intervention. Our findings suggest that physical exercise and WBV combination might be a safe therapeutic option for improving the rehabilitative management of patients with AIMSS.
Collapse
Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Correspondence: (A.d.S.); (L.L.); Tel.: +39-096-171-2819 (A.d.S.); +39-032-1373-4800 (L.L.)
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Correspondence: (A.d.S.); (L.L.); Tel.: +39-096-171-2819 (A.d.S.); +39-032-1373-4800 (L.L.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
| | - Konstantinos Venetis
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.V.); (E.S.); (N.F.)
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20144 Milan, Italy
| | - Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.V.); (E.S.); (N.F.)
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20144 Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.V.); (E.S.); (N.F.)
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20144 Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Pistelli M, Natalucci V, Scortichini L, Agostinelli V, Lenci E, Crocetti S, Merloni F, Bastianelli L, Taus M, Fumelli D, Giulietti G, Cola C, Capecci M, Serrani R, Ceravolo MG, Ricci M, Nicolai A, Barbieri E, Nicolai G, Ballatore Z, Savini A, Berardi R. The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience. Cancers (Basel) 2021; 13:cancers13215539. [PMID: 34771702 PMCID: PMC8583345 DOI: 10.3390/cancers13215539] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.
Collapse
Affiliation(s)
- Mirco Pistelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
| | - Valentina Natalucci
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Laura Scortichini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Sonia Crocetti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Filippo Merloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Lucia Bastianelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Marina Taus
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Daniele Fumelli
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Gloria Giulietti
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Claudia Cola
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Marianna Capecci
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Roberta Serrani
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Maurizio Ricci
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Albano Nicolai
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Elena Barbieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Giulia Nicolai
- Department of Medical Emergency, AOU Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy;
| | - Zelmira Ballatore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Agnese Savini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
| |
Collapse
|
24
|
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: 9] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
25
|
Shang X, Zhang L, Jin R, Yang H, Tao H. Estrogen Regulation of the Expression of Pain Factor NGF in Rat Chondrocytes. J Pain Res 2021; 14:931-940. [PMID: 33859494 PMCID: PMC8043850 DOI: 10.2147/jpr.s297442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/11/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Pain is the main symptom of osteoarthritis (OA). Nerve growth factor (NGF) plays a crucial role in the generation of OA pain. And estrogen-alone used resulted in a sustained joint pain reduction in postmenopausal women. So we aim to find whether estrogen alters chondrocytes' NGF level, affecting OA pain. METHODS Primary chondrocytes and cartilage explants isolated from Sprague Dawley rat knees were cultured with physiological concentrations of estrogen (17β-Estradiol ≥ 98%, E2), Estrogen Receptor α (ERα) inhibitor and stimulants. Then, chondrocytes NGF mRNA expression and protein release were analyzed by a quantitative real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) respectively. Additionally, cultures were pre-incubated with MEK-ERK inhibitor to identify the signaling pathway that estrogen alters NGF mRNA and protein levels. RESULTS We found that chondrocytes NGF expression and release were decreased by E2. E2 also reduced chondrocytes IL-1β-stimulated or TGF-β1-stimulated NGF expression. Phosphorylated extracellular signal-regulated kinasep1/2 (p-ERK1/2) signals were detected stronger than the control group by Western Blotting (WB). When we cultured chondrocytes with PD98059 (MEK-ERK inhibitor, PD), NGF mRNA expression was added to 1.41Ct (2.07±0.1 fold). CONCLUSION We showed that E2 reduces chondrocytes NGF expression significantly, even after stimulation by TGF-β1 or IL-1β. MEK-ERK signaling is involved in this process.
Collapse
Affiliation(s)
- Xiushuai Shang
- Department of Orthopedics Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Liaoran Zhang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Rilong Jin
- Department of Orthopedics Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hu Yang
- Department of Orthopedics Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
26
|
Impact of obesity on clinical outcomes in hormone receptor-positive breast cancer: a systematic review. Breast Cancer 2021; 28:755-764. [PMID: 33428124 DOI: 10.1007/s12282-020-01213-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The relationship between obesity and prognosis of early breast cancer is complex. Increased levels of aromatase present in adipose tissue of obese postmenopausal women may lead to suboptimal suppression of systemic estrogens. However, studies have been mixed with respect to the association between use of aromatase inhibitors (AIs) and clinical outcomes in obese women with early breast cancer. METHODS We conducted a systematic literature review following PRISMA guidelines to examine the impact of obesity on the efficacy of AIs in early-stage hormone receptor-positive breast cancer. Primary outcome measures included disease-free survival, relapse-free survival, distant recurrence-free survival, breast cancer-free survival, and overall survival. RESULTS Of 491 studies identified, eight studies met criteria for inclusion: three retrospective cohort studies, one prospective cohort study and four randomized controlled trials. Four studies limited eligibility to postmenopausal women. Percentage of obese patients in studies ranged from 10 to 30%. Two studies examined use of AIs alone while the remainder included patients treated with either AIs or tamoxifen. Five out of seven studies suggested a negative impact of obesity on AI efficacy. CONCLUSIONS The results of our systematic review highlight a need for further research exploring the optimal endocrine therapies for obese women. There is insufficient evidence at present to recommend tailoring adjuvant endocrine therapy with use of specific AIs or for dosing modifications of AIs in this patient population.
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Borreani C, Alfieri S, Infante G, Miceli R, Mariani P, Bosisio M, Vernieri C, Bianchi GV, Capri G. Aromatase Inhibitors in Postmenopausal Women with Hormone Receptor-Positive Breast Cancer: Profiles of Psychological Symptoms and Quality of Life in Different Patient Clusters. Oncology 2020; 99:84-95. [PMID: 32992318 DOI: 10.1159/000509651] [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: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) as adjuvant therapy after breast cancer (BC) surgery have demonstrated to reduce the risk of disease recurrence, to lower the risk of contralateral BC, and to improve survival when compared to tamoxifen in patients with limited-stage hormone receptor-positive (HR+) BC. However, AIs are associated with adverse events that can have a significant impact on patient quality of life (QoL). AIM This study aimed to identify profiles of psychological symptoms and QoL in HR+ BC patients undergoing AI therapy. METHOD Data were collected with questionnaires administered at three time points: AI initiation (t0); 3 months after AI initiation (t1); and 6 months after AI initiation (t2). The FACT-G, FACT-B, and FACT-ES questionnaires were used to assess QoL; psychological symptoms were assessed using the SCL-90-R. RESULTS 43 women were enrolled in the study (t0), and 37 completed the t1 evaluation and 29 the t2 evaluation. We found (1) a progressive decrease over time in FACT-G and FACT-ES scores, in particular in the Physical, Emotional, and Endocrine subscales, and an increase in the SOM (somatization) subscale of the SCL-90-R; (2) the presence of 4 clusters related to different psychological symptoms and QoL evolution over time; (3) that patients belonging to the cluster characterized by worsening symptoms and QoL during time differed from the others in the Emotional subscale of the FACT-B and in the GSI (Global Score), OCD (obsessive-compulsive), DEP (depression), ANX (anxiety), and SLP (sleep disorders) dimensions of the SCL-90-R and had significantly higher BMI levels; and (4) that 3 items from the SCL-90-R and 2 items from FACT Emotional Well-Being subscale were predictive of the "worst" cluster. CONCLUSIONS Although larger studies are needed to confirm these results, our data open up new ways of investigation into the effects of AIs on QoL in HR+ BC patients.
Collapse
Affiliation(s)
- Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,
| | - Gabriele Infante
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Mariani
- Clinica Polispecialistica San Carlo, Paderno Dugnano, Milan, Italy
| | - Marco Bosisio
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Vernieri
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,IFOM, the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Giulia V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
29
|
Jackisch C, Kreienberg R, Blettner M, Harbeck N, Lück HJ, Haidinger R, Schmitt DC, Schulte H, Windemuth-Kieselbach C, Zaun S, Hadji P. Assessment of Quality of Life in Postmenopausal Women with Early Breast Cancer Participating in the PACT Trial: The Impact of Additional Patient Information Material Packages and Patient Compliance. Breast Care (Basel) 2020; 15:236-245. [PMID: 32774217 DOI: 10.1159/000500771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 05/01/2019] [Indexed: 02/04/2023] Open
Abstract
Background Breast cancer patients' self-understanding of their disease can impact their quality of life (QoL); the relationship between compliance and QoL is poorly understood. Patients and Methods The Patient's Anastrozole Compliance to Therapy (PACT) program, a prospective, randomized study, investigated the effect of additional patient information material (IM) packages on compliance with adjuvant aromatase inhibitor (AI) therapy in postmenopausal women with hormone receptor-positive early breast cancer. The QoL subanalysis presented here examined the impact of IM packages on QoL and the association between QoL and compliance. European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires were completed at baseline, 12 and 24 months, or study termination to assess health-related QoL and disease-related symptoms. Results Of the 4,844 patients randomized to standard therapy or standard therapy + IM packages (1:1), 4,253 were available for QoL analysis. No difference in QoL was observed between groups at baseline. IM packages did not have a statistically significant impact on patient QoL at the 12- or 24-month follow-up. Compliant patients experienced improvement in multiple items across the QLQ-C30 and QLQ-BR23 scales at 12 months. However, those results should be interpreted carefully due to limitations in the statistical analyses. Conclusions Provision of IM packages did not influence patients' QoL or satisfaction with care during AI therapy. Compliant patients appear to experience improved QoL compared to noncompliant patients, perhaps indicating a more self-empowered perception of their condition.
Collapse
Affiliation(s)
| | | | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nadia Harbeck
- Breast Center, University of Munich (LMU), Munich, Germany
| | | | | | | | | | | | | | - Peyman Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany
| |
Collapse
|
30
|
Tarhan F, Keser G, Alacacıoğlu A, Akar S. Rheumatological Findings in Patients with Breast Cancer. Eur J Breast Health 2019; 16:55-60. [PMID: 31912015 DOI: 10.5152/ejbh.2019.5128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022]
Abstract
Objective Breast Cancer (BC) is the most frequently diagnosed malignancy worldwide. Not only may BC be associated with rheumatic symptoms and diseases, but also the drugs used in the treatment of this disease, including aromatase inhibitors (AIs), may lead to musculoskeletal system symptoms. In this study, we aimed to investigate the spectrum of rheumatic symptoms and diseases developing in patients with BC having no previous diagnosis of any inflammatory rheumatic disease. Materials and Methods Patients with a history of BC referring to Rheumatology Outpatient Clinics with complaints of musculoskeletal system symptoms at two centers between 2008 and 2018 were screened retrospectively. Patients with a previous diagnosis of any inflammatory rheumatic diseases before the occurrence of BC were excluded. Demographic data, onset and duration of BC, as well as onset and duration of rheumatic symptoms/diseases were recorded. Relevant laboratory tests, including autoantibodies, available imaging findings and the treatments received were also registered. Results Mean age of 128 BC patients at the time of admission was found to be 54.76±8.21 years. Mean durations of disease for BC and rheumatic disorders were 85.705±15.507 and 60.84±19.20 months, respectively. Out of 128 BC patients, nearly one third (n: 41; 32.03%), developed an inflammatory rheumatic disease, and rheumatoid arthritis was the most frequent pathology. Nonspecific arthralgia and myalgia were more frequent in patients receiving AIs than those receiving tamoxifen, despite lack of significant difference (p=0.421, p=0.411). Conclusion Given that nearly one third of the patients developed an inflammatory rheumatic disease, it should be remembered that locomotor symptoms in patients with BC may be caused not only by bone metastasis or paraneoplastic effects, but they may also suggest the presence of associated rheumatic diseases.
Collapse
Affiliation(s)
- Figen Tarhan
- Department of Internal Medicine, Division of Rheumatology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Gökhan Keser
- Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Alacacıoğlu
- Department of Internal Medicine, Division of Oncology, İzmir Katip Çelebi University School of Medicine, Izmir, Turkey
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, İzmir Katip Çelebi University School of Medicine, Izmir, Turkey
| |
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Suzuki H, Seki A, Hosaka T, Matsumoto N, Tomita M, Takahashi M, Yamauchi H. Effects of a structured group intervention on obesity among breast cancer survivors. Breast Cancer 2019; 27:236-242. [PMID: 31617073 DOI: 10.1007/s12282-019-01013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obesity is associated with an increased risk for developing breast cancer and poor cancer-related outcomes. Endocrine therapy is a key part of treatment for breast cancer, but can result in weight gain. This study examined the efficacy of a structured group intervention during adjuvant endocrine therapy for obese patients with breast cancer. The intervention involved a combination of proper nutrition, exercise, and group coaching. METHODS Participants were patients with breast cancer who were undergoing adjuvant endocrine therapy and exhibited apparent weight gain while undergoing therapy, or had a diagnosis of abnormal lipid metabolism. We conducted a single-arm prospective study with a combined intervention. The intervention comprised 15 min of nutrition education, a 30-min group health coaching program, and three 45-min group aerobic exercise sessions. We evaluated participants' parameters (e.g., body weight, body mass index [BMI], cholesterol, psychological distress) at baseline, and at 1, 3, and 6 months after the intervention. RESULTS At 1 month after the intervention, there were significant reductions in body weight (p < 0.01), BMI (p < 0.01), triglyceride levels (p < 0.05), total cholesterol levels (p < 0.01), psychological distress (p < 0.05), and cancer-related fatigue (p < 0.01). At 3 and 6 months after the intervention, we observed further reductions in body weight, BMI, and triceps skinfold thickness. CONCLUSION Our study showed that a short-term structured intervention helped modify dietary and exercise behaviors and promote health among breast cancer survivors, and resulted in favorable changes in participants' body weight.
Collapse
Affiliation(s)
- Hitomi Suzuki
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Akina Seki
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takashi Hosaka
- Department of Psycho-Oncology, HOSAKA Psycho-Oncology Clinic, St. Luke's International Hospital, Tokyo, Japan
| | - Noriko Matsumoto
- Department of Nutrition, St. Luke's International Hospital, Tokyo, Japan
| | - Makiko Tomita
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.,Research and Development Group, Analysis and Innovation Department, Business Development Division, SMS Co., Ltd., Tokyo, Japan
| | - Miyako Takahashi
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| |
Collapse
|
33
|
Basal C, Vertosick E, Gillis TA, Li Q, Bao T, Vickers A, Mao JJ. Joint pain and falls among women with breast cancer on aromatase inhibitors. Support Care Cancer 2019; 27:2195-2202. [PMID: 30306326 PMCID: PMC6758909 DOI: 10.1007/s00520-018-4495-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls. METHODS We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up. RESULTS Among 667 participants (median age 63 years, interquartile range 57-69 years), 232 (35%, 95% CI 31 to 39%) reported falls 12-24 months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12 months by their primary care physician (44%) or oncologist (36%). CONCLUSION Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.
Collapse
Affiliation(s)
- Coby Basal
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Emily Vertosick
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Theresa A Gillis
- Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Qing Li
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ting Bao
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Andrew Vickers
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Jun J Mao
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| |
Collapse
|
34
|
Anand K, Niravath P. Acupuncture and Vitamin D for the Management of Aromatase Inhibitor-Induced Arthralgia. Curr Oncol Rep 2019; 21:51. [PMID: 30997616 DOI: 10.1007/s11912-019-0795-1] [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: 01/15/2023]
Abstract
PURPOSE OF REVIEW Aromatase inhibitor-induced arthralgia (AIA) is a very common syndrome which significantly affects breast cancer survivors' quality of life, and it often leads to non-compliance with aromatase inhibitor (AI) therapy. However, the treatment of AIA remains a clinical challenge. Here, we will review the current data for acupuncture and vitamin D in the management of AIA. RECENT FINDINGS Acupuncture has been shown to improve AIA symptoms, but it has not consistently been proven to offer significantly more clinical benefit than sham acupuncture. Similarly, while some vitamin D trials have shown benefit, the studies have not consistently shown improvement in AIA symptoms. Neither acupuncture nor vitamin D can be touted as standard treatments for AIA. However, many patients do experience subjective improvement of their symptoms with these therapies. When other treatments, such as exercise and duloxetine, are not feasible or not effective, it is reasonable to offer a trial of acupuncture or vitamin D to patients who are suffering from AIA, as the potential harms are very few, and they do offer possible relief from AIA symptoms.
Collapse
Affiliation(s)
- Kartik Anand
- Houston Methodist Cancer Center/Weill Cornell Medicine, Outpatient Tower, Floor 24, 6445 Main Street, Houston, TX, 77030, USA
| | - Polly Niravath
- Houston Methodist Cancer Center/Weill Cornell Medicine, Outpatient Tower, Floor 24, 6445 Main Street, Houston, TX, 77030, USA.
| |
Collapse
|
35
|
Nabieva N, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Hack CC, Almstedt K, Gass P, Heindl F, Brodkorb T, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA. Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients. Int J Cancer 2019; 145:2114-2121. [PMID: 30901076 DOI: 10.1002/ijc.32294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/16/2018] [Accepted: 01/10/2019] [Indexed: 01/14/2023]
Abstract
One of the most common adverse events (AEs) occurring during treatment with aromatase inhibitors (AIs) is musculoskeletal pain. The aim of our study was to analyze the influence of preexisting muscle/limb pain and joint pain on the development of AI-induced musculoskeletal AEs. Women eligible for upfront adjuvant endocrine therapy with letrozole were included in the PreFace study, a multicenter phase IV trial. During the first treatment year, they were asked to record musculoskeletal AEs monthly by answering questions regarding pain symptoms and rating the pain intensity on a numeric rating scale from 0 (no pain) to 10 (very strong pain). Pain values were compared using nonparametric statistical tests. Overall, 1,416 patients were evaluable. The average pain value over all time points in women with preexisting muscle/limb pain was 4.3 (median 4.3); in those without preexisting pain, it was 2.0 (median 1.7). In patients without preexisting muscle/limb pain, pain levels increased relatively strongly within the first 6 months (mean increase +0.9, p < 0.00001) in comparison with those with preexisting pain (mean increase +0.3, p < 0.001), resulting in a statistically significant difference (p < 0.00001) between the two groups. The development of joint pain was similar in the two groups. Women without preexisting muscle/limb pain or joint pain have the greatest increase in pain after the start of adjuvant AI therapy. Women with preexisting pain have significantly higher pain values. The main increase in pain values takes place during the first 6 months of treatment.
Collapse
Affiliation(s)
- Naiba Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sara Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - Wolfgang Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Bernhard Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,St. Theresien Hospital, Nuremberg, Germany
| | | | | | - Gerold Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - Alexander Fridman
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Oliver Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - Sherko Kuemmel
- Breast Unit, Essen Mitte Clinics, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Heiko Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | | | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Katrin Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tobias Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | | | - Petra Krabisch
- Department of Gynecology, Clinic of Chemnitz gGmbH, Chemnitz, Germany
| | - Michael Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | | | - Andreas Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - Cosima Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | | | | | - Volker Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - Brigitte Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany.,Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - Achim Rody
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Lübeck, Schleswig-Holstein, Germany
| | - Nicolai Maass
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Kiel, Schleswig-Holstein, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| |
Collapse
|
36
|
Henry NL, Unger JM, Till C, Schott AF, Crew KD, Lew DL, Fisch MJ, Moinpour CM, Wade JL, Hershman DL. Association between body mass index and response to duloxetine for aromatase inhibitor-associated musculoskeletal symptoms in SWOG S1202. Cancer 2019; 125:2123-2129. [PMID: 30861098 DOI: 10.1002/cncr.32024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS) negatively impact adherence to and persistence with therapy. In SWOG S1202, patients with AIMSS who were treated with duloxetine, a serotonin norepinephrine reuptake inhibitor, reported improvement in pain by 12 weeks compared with placebo. Based on the authors' prior observation that responses to pain interventions differ between obese and nonobese patients, the current study examined whether response to duloxetine therapy differed by obesity status. METHODS In SWOG S1202, a total of 299 AI-treated postmenopausal women with stage I to III (AJCC 7th Edition) breast cancer who developed new or worsening average pain were enrolled, randomized to duloxetine or placebo, and treated for 12 weeks. Patient-reported outcomes were obtained at baseline and through 12 weeks. Patients were categorized into nonobese (body mass index [BMI] <30 kg/m2 ) or obese (BMI ≥30 kg/m2 ). The authors tested the interaction between intervention and obesity with respect to average pain at 12 weeks in the 289 eligible patients, using a P value of .05 to indicate statistical significance. RESULTS In approximately 54% of evaluable patients with a BMI ≥30 kg/m2 , the reduction in the mean average pain score between baseline and 12 weeks was statistically significantly greater for patients treated with duloxetine compared with those receiving placebo (-2.73 vs -1.64 points; P = .003). Conversely, in the nonobese patients, the reduction in the mean average pain score was similar in the 2 cohorts (-2.46 vs -2.34 points; P = .75). The P value for interaction was .02, thereby meeting the threshold criteria of the current study. Similar findings were evident for other pain-related patient-reported outcomes. CONCLUSIONS In this trial, obese patients with AIMSS obtained more analgesic benefit from duloxetine compared with nonobese patients. Additional studies are warranted to determine the biologic basis for these findings.
Collapse
Affiliation(s)
- N Lynn Henry
- Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, Utah
| | - Joseph M Unger
- SWOG Statistics and Data Management Center, Seattle, Washington.,Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Cathee Till
- SWOG Statistics and Data Management Center, Seattle, Washington.,Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anne F Schott
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Danika L Lew
- SWOG Statistics and Data Management Center, Seattle, Washington.,Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Carol M Moinpour
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - James L Wade
- Heartland National Cancer Institute Community Oncology Research Program, Decatur, Illinois
| | - Dawn L Hershman
- Department of Medicine, Columbia University, New York, New York
| |
Collapse
|
37
|
Baglia ML, Lin IH, Cartmel B, Sanft T, Ligibel J, Hershman DL, Harrigan M, Ferrucci LM, Li FY, Irwin ML. Endocrine-related quality of life in a randomized trial of exercise on aromatase inhibitor-induced arthralgias in breast cancer survivors. Cancer 2019; 125:2262-2271. [PMID: 30840336 DOI: 10.1002/cncr.32051] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the role of a 12-month exercise intervention on endocrine-related quality of life (QOL) and overall QOL among breast cancer survivors with aromatase inhibitor (AI)-induced arthralgia in the Hormones and Physical Exercise (HOPE) Study. METHODS This was a randomized controlled trial of 121 breast cancer survivors who were currently receiving AIs and experiencing at least mild arthralgia. QOL was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaires and the 36-Item Short Form Survey (SF-36) at baseline, 6 months, and 12 months. Participants were randomized to either a 1-year gym-based, supervised exercise intervention group (150 minutes of aerobic exercise and 2 strength-training sessions each week) or a usual care group. Effects of the intervention on QOL were assessed using mixed-model, repeated-measures analysis. RESULTS At 12 months, the exercise group had greater improvement in the overall QOL measures as well as the breast cancer-specific (scores, 2.2 vs 0.7; P = .02), endocrine-specific (scores, 5.6 vs 1.6; P < .001), and fatigue-specific (score, 5.8 vs 0.5; P < .001) subscales compared with the usual care group. The results indicated a stronger effect at 12 months versus 6 months after the intervention. CONCLUSIONS Combined aerobic and resistance exercise, such as treadmill walking and strength training, improved endocrine-related and overall QOL among breast cancer survivors who were experiencing adverse side effects from AIs. Because adverse side effects associated with AI use are quite common and this is the main reason for treatment discontinuation, this nonpharmacologic intervention could benefit many breast cancer survivors and increase successful adherence to AIs in breast cancer treatment.
Collapse
Affiliation(s)
| | - I-Hsin Lin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Tara Sanft
- Yale Cancer Center, New Haven, Connecticut
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| |
Collapse
|
38
|
Pieters HC, Green E, Khakshooy S, Sleven M, Stanton AL. A qualitative comparison of how older breast cancer survivors process treatment information regarding endocrine therapy. PLoS One 2019; 14:e0210972. [PMID: 30703119 PMCID: PMC6354984 DOI: 10.1371/journal.pone.0210972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/04/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It remains unclear how information about aromatase inhibitors (AI) impacts women's decision-making about persistence with endocrine therapy. PURPOSE To describe and compare how women treated for primary early stage breast cancer either persisting or not persisting with an AI received, interpreted, and acted upon AI-related information. DESIGN Thematic analysis was used to sort and compare the data into the most salient themes. PARTICIPANTS Women (N = 54; 27 persisting, 27 not persisting with an AI) aged 65-93 years took part in qualitative interviews. RESULTS Women in both subgroups described information similarly in terms of its value, volume, type, and source. Aspects of AI-related information that either differed between the subgroups or were misunderstood by one or both subgroups included: (1) knowledge of AI or tamoxifen prior to cancer diagnosis, (2) use of online resources, (3) misconceptions about estrogen, hormone replacement therapies and AI-related symptoms, and (4) risk perception and the meaning and use of recurrence statistics such as Oncotype DX. CONCLUSIONS Persisters and nonpersisters were similar in their desire for more information about potential side effects and symptom management at AI prescription and subsequent appointments. Differences included how information was obtained and interpreted. Interactive discussion questions are shared that can incorporate these findings into clinical settings.
Collapse
Affiliation(s)
- Huibrie C Pieters
- School of Nursing, University of California at Los Angeles, Los Angeles, United States of America
| | - Emily Green
- School of Nursing, University of California at Los Angeles, Los Angeles, United States of America
| | - Sally Khakshooy
- Cedars Sinai Medical Center, Los Angeles, United States of America
| | - Miriam Sleven
- Torrance Memorial Medical Center, Torrance, California, United States of America
| | - Annette L Stanton
- Departments of Psychology and Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, United States of America
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
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
| |
Collapse
|
41
|
Pires de Carvalho K, Miranda Lima MT, Mazzutti FS, Dias Custódio ID, Lajolo Canto PP, Paiva CE, Paiva Maia YCD. Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy. Clin Breast Cancer 2018; 19:e208-e219. [PMID: 30316543 DOI: 10.1016/j.clbc.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/07/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To study the use of functional capacity (FC) level and duration of aromatase inhibitor (AI) therapy with adiposity parameters in women with breast cancer. PATIENTS AND METHODS FC was evaluated through the Health Assessment Questionnaire, which was assessed by classification and divided into 3 groups: G1 = mild to moderate difficulty, G2 = moderate to severe disability, and G3 = severe or very severe disability. Body mass, height, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Bioelectrical impedance analysis was used to calculate body fat (BF) and fat-free mass. The women were divided into 2 time groups (T1 and T2), which were determined by the median months of AI use (T1 ≤ 29.5 and T2 > 29.5 months). RESULTS Impaired FC and adiposity parameters were significantly positively correlated. In addition, physical exercise was significantly lower in women assessed as G2 and G3 compared to those assessed as G1. The effect of FC on BMI, BF, and WC was also verified, as was the effect of the duration of AI receipt on BMI and BF. Women at T1 had significantly greater functional disability, BMI, and BF values. In addition, although not statistically significant, women in T1 who were assessed as G3 presented higher BMI, WC, and BF values than those in T2. CONCLUSION Adiposity above the recommended parameters and impaired FC were associated with the shortest time of receipt of adjuvant endocrine therapy with AI.
Collapse
Affiliation(s)
- Kamila Pires de Carvalho
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Fernanda Silva Mazzutti
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil; Nutrition Course, Medical Faculty, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Paula Philbert Lajolo Canto
- Department of Clinical Oncology, Clinic's Hospital, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil; Nutrition Course, Medical Faculty, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
| |
Collapse
|
42
|
Martínez N, Herrera M, Frías L, Provencio M, Pérez-Carrión R, Díaz V, Morse M, Crespo MC. A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study. Clin Transl Oncol 2018; 21:489-498. [PMID: 30293230 DOI: 10.1007/s12094-018-1950-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.
Collapse
Affiliation(s)
- N Martínez
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Herrera
- Hospital Clínico San Carlos, Madrid, Spain
| | - L Frías
- Hospital Universitario La Paz, Madrid, Spain
| | - M Provencio
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - V Díaz
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - M C Crespo
- IMDEA-Food, CEI UAM + CSIC, Madrid, Spain
| |
Collapse
|
43
|
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.
Collapse
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.
| |
Collapse
|
44
|
Wulaningsih W, Garmo H, Ahlgren J, Holmberg L, Folkvaljon Y, Wigertz A, Van Hemelrijck M, Lambe M. Determinants of non-adherence to adjuvant endocrine treatment in women with breast cancer: the role of comorbidity. Breast Cancer Res Treat 2018; 172:167-177. [PMID: 30030708 PMCID: PMC6208918 DOI: 10.1007/s10549-018-4890-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine factors associated with non-adherence during 5 years of endocrine treatment, including the possible influence of comorbidity burden and specific medical conditions. METHODS From all women diagnosed with stage I-III, ER-positive breast cancer in Stockholm-Gotland, Uppsala-Örebro and Northern Sweden between 2006 and 2009, we included 4645 women who had at least one dispensation of tamoxifen or aromatase inhibitors (AIs) and 5 years of follow-up without distant recurrence. A medical possession ratio of < 80% was used to define non-adherence. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of non-adherence. RESULTS During follow-up, 977 (21%) women became non-adherents. Non-adherence was associated with greater comorbidity burden assessed by Charlson comorbidity index (CCI) during follow-up (OR 1.43; 95% CI 1.08-1.88 for ≥ 2 additional scores compared to 0), pre-diagnostic HRT use (OR 1.99; 1.58-2.49), not married (OR 1.42; 1.23-1.64), high educational level (OR 1.25; 1.02-1.53 compared to lowest level), and use of symptom-relieving drugs. HER-2 positivity (OR 0.61; 0.45-0.81) and adjuvant chemotherapy (OR 0.42; 0.35-0.52) were associated with lower odds of non-adherence. Similar patterns were observed for the presence of lymph node metastasis, higher tumour grade, and use of AIs compared to tamoxifen. Myocardial infarction and chronic pulmonary disease was suggested as leading conditions associated with non-adherence in women with increasing CCI. CONCLUSION We identified subgroups of women with breast cancer at increased risk of non-adherence. Our findings related to comorbidity suggest the importance of focusing on the presence of specific co-existing conditions when monitoring adherence.
Collapse
Affiliation(s)
- W Wulaningsih
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK.
| | - H Garmo
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - J Ahlgren
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
- Faculty of Medicine, University of Örebro, Örebro, Sweden
| | - L Holmberg
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - Y Folkvaljon
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - A Wigertz
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - M Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - M Lambe
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
45
|
Conejo I, Pajares B, Alba E, Cuesta-Vargas AI. Effect of neuromuscular taping on musculoskeletal disorders secondary to the use of aromatase inhibitors in breast cancer survivors: a pragmatic randomised clinical trial. Altern Ther Health Med 2018; 18:180. [PMID: 29890985 PMCID: PMC5996544 DOI: 10.1186/s12906-018-2236-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/21/2018] [Indexed: 12/27/2022]
Abstract
Background Aromatase inhibitors reduce breast cancer recurrence rates in postmenopausal women by about 30% compared with tamoxifen while treatments differ. Unfortunately, nearly half of women taking AIs report AI-associated arthralgia (AIA), leading to therapy abandon in on third of patients, which could lead to cancer recurrence. The purpose of the current study was to evaluate the effectiveness of Neuromuscular Taping (NMT) in the treatment of AIA in women who have been treated of BC. Methods This study included 40 BC survivors receiving endocrine therapy (either AIs or TMX) from Hospital Universitario Virgen de la Victoria (Málaga, Spain) suffered from AIA. Patients were randomized to one of the two groups that made this pilot study: A. Placebo intervention B. Real NMT. Clinical data were collected from medical history, grip strength, algometry measured, questionnaires and VAS scale. There have been three interventions prior to the completion of the study, 5 weeks later. The primary objective of this pilot study was to achieve an improvement of pain by 20% decrease of VAS. Results Significant differences in measures of VAS (p = 0.009), global health status/QoL (p = 0.005), fatigue (p = 0.01) and pain (p = 0.04) were observed post intervention with NMT. Conclusions An intervention by NMT to MSCM under treatment with AIs improves their subjective sensation of pain. In addition, this taping had an impact on variables related to the quality of life. This pilot study may be the basis for others to support the use of NMT for the treatment of AIAs, thereby improving their well-being and reducing the dropout rate. Trial registration ClinicalTrials.gov Identifier: NCT02406794. Registered on 2 April 2015 Retrospectively registered.
Collapse
|
46
|
Wagner LI, Zhao F, Goss PE, Chapman JAW, Shepherd LE, Whelan TJ, Mattar BI, Bufill JA, Schultz WC, LaFrancis IE, Nagargoje GG, Vemuri R, Nikcevich DA, Sledge GW, Cella D. Patient-reported predictors of early treatment discontinuation: treatment-related symptoms and health-related quality of life among postmenopausal women with primary breast cancer randomized to anastrozole or exemestane on NCIC Clinical Trials Group (CCTG) MA.27 (E1Z03). Breast Cancer Res Treat 2018; 169:537-548. [PMID: 29455298 PMCID: PMC6092930 DOI: 10.1007/s10549-018-4713-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Aromatase inhibitors are the most commonly prescribed adjuvant endocrine therapy for hormone-dependent early breast cancer in postmenopausal women. Among Canadian Cancer Trials Group MA.27 participants, anastrozole and exemestane had comparable 5-year event-free survival. This companion study examined differences in patient-reported treatment-related symptoms (TRS) and health-related quality of life (HRQL) among postmenopausal women randomized to anastrozole or exemestane. METHODS MA.27 participants (N = 686, of 7576) randomized to 5 years of anastrozole (1 mg/day, n = 371, Arm A) or exemestane (25 mg/day, n = 315, Arm E) completed the 56-item Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) questionnaire to assess TRS and HRQL. The FACT-ES was completed at baseline, 3, 6, 12, and 24 months. RESULTS No significant differences in FACT-ES median scores measuring TRS and HRQL were observed between treatment arms at any time point. Change in TRS from baseline was statistically significant at 3, 6, 12, and 24 months. HRQL was stable over time in both arms. Greater TRS burden was associated with poorer HRQL (coefficient = 0.57, p < 0.001). Twenty percent of patients discontinued AI therapy by month 24 and 32% discontinued AIs at 4 years. In both arms, patients reporting more side effect bother prior to initiating study treatment had a higher risk of discontinuing treatment before completing protocol therapy (hazard ratio [HR] 1.29, 95% CI 1.08-1.55, p = 0.01). CONCLUSIONS TRS and HRQL were comparable between anastrozole and exemestane. TRS negatively affect HRQL. Women who report being bothered by treatment side effects prior to initiating an AI are at increased risk for early treatment discontinuation.
Collapse
Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27151, USA.
| | | | - Paul E Goss
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Timothy J Whelan
- Canadian Cancer Trials Group (CCTG), Kingston, Canada
- McMaster University, Hamilton, ON, Canada
| | | | - Jose A Bufill
- Michiana Hematology-Oncology, P.C., Mishawaka, IN, USA
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Campbell A, Heydarian R, Ochoa C, Dwivedi AK, Nahleh ZA. Single arm phase II study of oral vitamin B12 for the treatment of musculoskeletal symptoms associated with aromatase inhibitors in women with early stage breast cancer. Breast J 2018; 24:260-268. [PMID: 29442401 DOI: 10.1111/tbj.12951] [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: 03/02/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Abstract
Breast cancer patients receiving endocrine therapy with aromatase Inhibitors (AIs) often experience musculoskeletal and joint-related side effects. The purpose of this study was to evaluate the effect of Vitamin B12 supplements on musculoskeletal symptoms such as pain and arthralgias induced by AIs and to correlate response with serum and inflammatory biomarkers. Upon receiving approval by the Institutional Review Board (IRB), the majority of the patients consented into the study were treated at the Texas Tech Breast Care Center. Included were patients who had a diagnosis of invasive breast cancer (Stages I-III), and were experiencing significant musculoskeletal symptoms associated to AIs. Only patients with an average pain score ≥ 4, as assessed by the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, were included in the study. Participants received 2500 mcg of sublingual vitamin B12 daily for 90 days. Assessments at baseline and at 3 months included: BPI-SF pain scores, the impact on quality of life determined by Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), and correlative serum markers relative to baseline (a pre-post study). A total of forty-one patients were enrolled. Average pain scores were improved by 34% (P < .0001) at 3 months compared to baseline. In addition, a 23% improvement in worst pain was noted (P = .0003). Analysis of the results for the FACT-ES scoring showed improvement on all scales. No significant adverse events were observed. Decrease in pain score was correlated with increased serum B12 levels. This study suggests that Vitamin B12 reduces pain and improves quality of life for patients taking AIs who experienced AI-related musculoskeletal symptoms. If confirmed in large randomized prospective trials, Vitamin B12 would be a safe and cost-effective option for the treatment of AI-related musculoskeletal symptoms.
Collapse
Affiliation(s)
- Aleli Campbell
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX, USA.,Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso (UTEP), El Paso, TX, USA
| | - Rosalinda Heydarian
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX, USA
| | - Cecilia Ochoa
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX, USA
| | - Zeina A Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| |
Collapse
|
48
|
Laroche F, Perrot S, Medkour T, Cottu PH, Pierga JY, Lotz JP, Beerblock K, Tournigand C, Chauvenet L, Bouhassira D, Coste J. Quality of life and impact of pain in women treated with aromatase inhibitors for breast cancer. A multicenter cohort study. PLoS One 2017; 12:e0187165. [PMID: 29117210 PMCID: PMC5678681 DOI: 10.1371/journal.pone.0187165] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/14/2017] [Indexed: 12/02/2022] Open
Abstract
Women with hormone-dependent breast cancer are treated with aromatase inhibitors (AI) to slow disease progression by decreasing estrogen levels. However, AI have adverse effects, including pain, with potentially serious impact on quality of life (QOL) and treatment compliance. We evaluated quality of life during the first year of AI treatment, focusing particularly on the impact of pain. In a multicenter cohort study of 135 women with early-stage breast cancer, free of pain at the initiation of AI treatment, quality of life (by the EORTC QLQ-BR23), somatic and psychic symptoms, psychological characters, temperament and coping strategies were assessed at baseline and at each follow-up visit (1, 3, 6 and 12 months). The impact of treatment-induced pain on quality of life during follow-up was determined with repeated-measures regression models. These models were constructed to assess the effects of pain and pain type on quality of life during follow-up, taking into account predictors associated with quality of life at baseline. Prior ganglion resection, taxane treatment and chemotherapy, a high amplification score on the pain catastrophizing scale, and a high harm avoidance score on the personality questionnaire were associated with a significantly lower baseline QOL. Fifty-seven percent of women developed pain of five different types: upper or lower limb joint pain, diffuse pain, neuropathic pain, tendon pain and mixed pain. A significant decrease in QOL was noted in the women with pain, particularly for body image, sexual functioning and future perspectives. Moreover, the impact of pain on QOL depended on the type of pain experienced. In conclusion, women treated with aromatase inhibitors display changes in quality of life and the degree of change in quality of life depends mostly on the type of pain experienced. Oncologists and patients should be aware of painful adverse effects of AI and encouraged to provide or receive earlier and more appropriate management of these effects.
Collapse
Affiliation(s)
- Françoise Laroche
- Pain Clinic, Saint Antoine Hospital, Paris, France
- INSERM U 987 and U 938, Paris, France
| | - Serge Perrot
- INSERM U 987 and U 938, Paris, France
- Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris, France
| | - Terkia Medkour
- Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris, France
| | | | | | | | | | | | | | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Hôtel Dieu Hospital, Paris, France
- * E-mail:
| |
Collapse
|
49
|
Morimoto Y, Sarumaru S, Oshima Y, Tsuruta C, Watanabe K. Joint symptoms associated with anastrozole and letrozole in patients with breast cancer: a retrospective comparative study. J Pharm Health Care Sci 2017; 3:25. [PMID: 29177067 PMCID: PMC5688801 DOI: 10.1186/s40780-017-0095-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background Joint symptoms are a common side effect of aromatase inhibitors. However, it is not known if the risk of these symptoms varies between the members of this drug class. The aim of this study was to compare the frequency of joint symptoms associated with anastrozole and that associated with letrozole. Methods We retrospectively reviewed patients with breast cancer who were treated with anastrozole or letrozole at Tsukiji Breast Clinic, Japan, between April 2008 and July 2014. Joint symptoms were deemed to include both joint pain and painless joint symptoms. The time to onset of joint symptoms in the anastrozole group was compared with that in the letrozole group using Kaplan–Meier curves and the log-rank test. Results Of 141 patients identified to have received aromatase inhibitors, 70 had been treated with anastrozole and 71 with letrozole. Joint symptoms occurred in 60.3% of the 141 patients (60.0% in the anastrozole group and 60.6% in the letrozole group; p = 1). Median time to appearance of joint symptoms was 583 days, with no significant difference between the anastrozole and letrozole groups (p = 0.962). There was no significant difference in time to onset of joint pain (p = 0.139); however, time to onset of painless joint symptoms was significantly shorter in the anastrozole group (p = 0.022). The sites at which joint symptoms occurred were similar in the two groups. Conclusions The results of this study indicate that there is no difference in the pattern of occurrence of joint symptoms caused by anastrozole and those caused by letrozole. Trial registration Trial registration was not required for this study because of its retrospective nature and lack of intervention.
Collapse
Affiliation(s)
- Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Shuhei Sarumaru
- Breast Clinic Tsukiji, Kaken Tsukiji Building 4F, 11-6 Akashi-cho, Chuo-ku, Tokyo, 104-0044 Japan
| | - Yuko Oshima
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Chiho Tsuruta
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| |
Collapse
|
50
|
Weight gain in hormone receptor-positive (HR+) early-stage breast cancer: is it menopausal status or something else? Breast Cancer Res Treat 2017; 167:235-248. [DOI: 10.1007/s10549-017-4501-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022]
|