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01-08-2019 | Carpal Tunnel Syndrome | Clinical trial

Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy

Authors: Jennifer Y. Sheng, Amanda L. Blackford, Aditya Bardia, Raghunandan Venkat, Gedge Rosson, Jon Giles, Daniel F. Hayes, Stacie C. Jeter, Zhe Zhang, Jill Hayden, Anne Nguyen, Anna Maria Storniolo, Karineh Tarpinian, Norah Lynn Henry, Vered Stearns

Published in: Breast Cancer Research and Treatment | Issue 3/2019

Abstract

Purpose

Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs.

Methods

Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant.

Results

Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms.

Conclusion

For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.

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Title: Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy
Authors: Jennifer Y. Sheng
Amanda L. Blackford
Aditya Bardia
Raghunandan Venkat
Gedge Rosson
Jon Giles
Daniel F. Hayes
Stacie C. Jeter
Zhe Zhang
Jill Hayden
Anne Nguyen
Anna Maria Storniolo
Karineh Tarpinian
Norah Lynn Henry
Vered Stearns
Publication date: 01-08-2019
Publisher: Springer US
Keywords: Carpal Tunnel Syndrome
Breast Cancer
Breast Cancer
Carpal Tunnel Syndrome
Exemestane
Letrozole
Published in: Breast Cancer Research and Treatment / Issue 3/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05270-4

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