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Published in: Supportive Care in Cancer 6/2016

01-06-2016 | Original Article

Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity

Authors: Kirsten A. Nyrop, Leigh F. Callahan, Christine Rini, Mary Altpeter, Betsy Hackney, Amy DePue, Anne Wilson, Arielle Schechter, Hyman B. Muss

Published in: Supportive Care in Cancer | Issue 6/2016

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Abstract

Purpose

Breast cancer survivors on aromatase inhibitors (AI) often experience side effects of joint pain, stiffness, or achiness (arthralgia). This study presents findings from a qualitative study of survivors on an AI regarding their knowledge of potential joint pain side effects and how both AI side effects and their management through moderate physical activity could be discussed during routine visits with their oncology provider.

Methods

Qualitative data from semi-structured interviews were content analyzed for emergent themes. Descriptive statistics summarize sample characteristics.

Results

Our sample included 36 survivors, mean age of 67 (range 46–87); 86 % Caucasian and 70 % had education beyond high school. AI experience are as follows: 64 % anastrozole/Arimidex, 48 % letrozole/Femara, and 31 % exemestane/Aromasin. Participants expressed interest in having more information about potential joint pain side effects when the AI was prescribed so they could understand their joint symptoms when they appeared or intensified. They were relieved to learn that their joint symptoms were not unusual or “in their head.” Participants would have been especially motivated to try walking as a way to manage their joint pain if physical activity had been recommended by their oncologist.

Conclusions

Breast cancer survivors who are prescribed an AI as part of their adjuvant treatment want ongoing communication with their oncology provider about the potential for joint pain side effects and how these symptoms may be managed through regular physical activity. The prescription of an AI presents a “teachable moment” for oncologists to recommend and encourage their patients to engage in regular physical activity.
Literature
2.
go back to reference Anderson WF, Pfeiffer RM, Dores GM, Sherman ME (2006) Comparison of age distribution patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomark Prev 15(10):1899–1905CrossRef Anderson WF, Pfeiffer RM, Dores GM, Sherman ME (2006) Comparison of age distribution patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomark Prev 15(10):1899–1905CrossRef
4.
go back to reference Taylor WC, Muss HB (2010) Adjuvant therapy for older women with breast cancer. Cancer J 16:289–293CrossRefPubMed Taylor WC, Muss HB (2010) Adjuvant therapy for older women with breast cancer. Cancer J 16:289–293CrossRefPubMed
5.
go back to reference Burstein HJ, Griggs JJ, Prestrud AA, Temin S (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 6(5):243–246 Burstein HJ, Griggs JJ, Prestrud AA, Temin S (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 6(5):243–246
6.
go back to reference Boonstra A, van Zadelhoff J, Timmer-Bonte A, Ottevanger PB, Beurskens CHG, van Laarhoven HWM (2013) Arthralgia during aromatase inhibitor treatment in early breast cancer. Cancer Nurs 0(0):1–8 Boonstra A, van Zadelhoff J, Timmer-Bonte A, Ottevanger PB, Beurskens CHG, van Laarhoven HWM (2013) Arthralgia during aromatase inhibitor treatment in early breast cancer. Cancer Nurs 0(0):1–8
7.
go back to reference Crew KD, Greenlee H, Capodice J et al (2007) Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol 25(25):3877–3883CrossRefPubMed Crew KD, Greenlee H, Capodice J et al (2007) Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol 25(25):3877–3883CrossRefPubMed
8.
go back to reference Dizdar O, Ozcakar L, Malas FU, Harputluoglu H, Bulut N et al (2009) Sonographic and electrodiagnostic evaluations in patients with aromatase inhibitor-related arthralgia. J Clin Oncol 27(30):4955–4960CrossRefPubMed Dizdar O, Ozcakar L, Malas FU, Harputluoglu H, Bulut N et al (2009) Sonographic and electrodiagnostic evaluations in patients with aromatase inhibitor-related arthralgia. J Clin Oncol 27(30):4955–4960CrossRefPubMed
9.
go back to reference Oberguggenberger A, Hubalek M, Sztankay M, Meraner V, Beer B et al (2011) Is the toxicity of adjuvant aromatase inhibitor therapy underestimated? Complementary information from patient-reported outcomes (PROs). Breast Cancer Res Treat 128(2):553–561CrossRefPubMed Oberguggenberger A, Hubalek M, Sztankay M, Meraner V, Beer B et al (2011) Is the toxicity of adjuvant aromatase inhibitor therapy underestimated? Complementary information from patient-reported outcomes (PROs). Breast Cancer Res Treat 128(2):553–561CrossRefPubMed
10.
go back to reference Presant CA, Bosserman L, Young T et al (2007) Aromatase inhibitor-associated arthralgia and/or bone pain: frequency and characterization in non-clinical trial patients. Clin Breast Cancer 7(10):775–778CrossRefPubMed Presant CA, Bosserman L, Young T et al (2007) Aromatase inhibitor-associated arthralgia and/or bone pain: frequency and characterization in non-clinical trial patients. Clin Breast Cancer 7(10):775–778CrossRefPubMed
11.
go back to reference Kanematsu M, Morimoto M, Honda J, Nagao T, Nakagawa M et al (2011) The time since last menstrual period is important as a clinical predictor of non-steroidal aromatase inhibitor-related arthralgia. BMC Cancer 10(11):436CrossRef Kanematsu M, Morimoto M, Honda J, Nagao T, Nakagawa M et al (2011) The time since last menstrual period is important as a clinical predictor of non-steroidal aromatase inhibitor-related arthralgia. BMC Cancer 10(11):436CrossRef
12.
go back to reference Mao JJ, Stricker C, Bruner D et al (2009) Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer 115:3631–3639CrossRefPubMedPubMedCentral Mao JJ, Stricker C, Bruner D et al (2009) Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer 115:3631–3639CrossRefPubMedPubMedCentral
13.
go back to reference Singer O, Cigler T, Moore AB, Levine AB, Hentel K et. al (2012) Defining aromatase inhibitor musculoskeletal symptom: a prospective study. Arth Care Res Singer O, Cigler T, Moore AB, Levine AB, Hentel K et. al (2012) Defining aromatase inhibitor musculoskeletal symptom: a prospective study. Arth Care Res
14.
go back to reference Nyrop KA, Muss HB, Hackney B, Cleveland R, Altpeter M, Callahan LF (2015) Feasibility and promise of a 6-week program to encourage physical activity and reduce joint symptoms among elderly breast cancer survivors on aromatase inhibitor therapy. J Geriatr Oncol 5(2):148–155CrossRef Nyrop KA, Muss HB, Hackney B, Cleveland R, Altpeter M, Callahan LF (2015) Feasibility and promise of a 6-week program to encourage physical activity and reduce joint symptoms among elderly breast cancer survivors on aromatase inhibitor therapy. J Geriatr Oncol 5(2):148–155CrossRef
15.
go back to reference Nyrop KA, Callahan LF, Rini C et al (2015) Adaptation of an evidence-based arthritis program for breast cancer survivors on aromatase inhibitor therapy who are experiencing joint pain. Prev Chronic Dis Nyrop KA, Callahan LF, Rini C et al (2015) Adaptation of an evidence-based arthritis program for breast cancer survivors on aromatase inhibitor therapy who are experiencing joint pain. Prev Chronic Dis
16.
go back to reference Arthritis Foundation (2010) Walk with ease: your guide to walking for better health, improved fitness and less pain (Third edition). Arthritis Foundation, Atlanta Arthritis Foundation (2010) Walk with ease: your guide to walking for better health, improved fitness and less pain (Third edition). Arthritis Foundation, Atlanta
17.
go back to reference Callahan LF, Shreffler JH, Altpeter M et al (2011) Evaluation of group and self-directed formats of the Arthritis Foundation’s (AF) Walk With Ease (WWE) program. Arth Care Res 63(8):1098–1107CrossRef Callahan LF, Shreffler JH, Altpeter M et al (2011) Evaluation of group and self-directed formats of the Arthritis Foundation’s (AF) Walk With Ease (WWE) program. Arth Care Res 63(8):1098–1107CrossRef
18.
go back to reference Nyrop KA, Cleveland R, Callahan LF (2014) Achievement of exercise objectives and satisfaction with the walk with ease program-group and self-directed participants. Am J Health Promot 28(4):228–230CrossRefPubMed Nyrop KA, Cleveland R, Callahan LF (2014) Achievement of exercise objectives and satisfaction with the walk with ease program-group and self-directed participants. Am J Health Promot 28(4):228–230CrossRefPubMed
19.
20.
go back to reference Dent SF, Gaspo R, Kissner M, Prichard KI (2011) Aromatase inhibitor therapy: toxicities and management strategies in the treatment of postmenopausal women with hormone-sensitive early breast cancer. Breast Cancer Res Treat 126:296–310CrossRef Dent SF, Gaspo R, Kissner M, Prichard KI (2011) Aromatase inhibitor therapy: toxicities and management strategies in the treatment of postmenopausal women with hormone-sensitive early breast cancer. Breast Cancer Res Treat 126:296–310CrossRef
21.
go back to reference Castel LD, Hartmann KE, Mayer IA et al (2013) Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort. Cancer 119(13):2317–2382CrossRef Castel LD, Hartmann KE, Mayer IA et al (2013) Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort. Cancer 119(13):2317–2382CrossRef
22.
go back to reference Eheman C, Henley J, Ballard-Barbash R, Jacobs EJ, Schymura MJ et al (2012) Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 118(9):2338–2366CrossRefPubMedPubMedCentral Eheman C, Henley J, Ballard-Barbash R, Jacobs EJ, Schymura MJ et al (2012) Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 118(9):2338–2366CrossRefPubMedPubMedCentral
23.
go back to reference Harrison S, Hayes SC, Newman B (2009) Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psycho-Oncology 18:387–394CrossRefPubMed Harrison S, Hayes SC, Newman B (2009) Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psycho-Oncology 18:387–394CrossRefPubMed
24.
go back to reference Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2204CrossRefPubMed Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2204CrossRefPubMed
25.
go back to reference Sabiston CM, Brunet J, Vallance JK, Meterissian S (2014) Prospective examination of objectively assessed physical activity and sedentary time after breast cancer treatment: sitting on the crest of the teachable moment. Cancer Epidemiol Biomarkers Prev Sabiston CM, Brunet J, Vallance JK, Meterissian S (2014) Prospective examination of objectively assessed physical activity and sedentary time after breast cancer treatment: sitting on the crest of the teachable moment. Cancer Epidemiol Biomarkers Prev
26.
go back to reference Alfano CM, Day JM, Katz ML et al (2009) Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804. Psychooncology 18(2):128–133CrossRefPubMedPubMedCentral Alfano CM, Day JM, Katz ML et al (2009) Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804. Psychooncology 18(2):128–133CrossRefPubMedPubMedCentral
27.
go back to reference Humpel N, Magee C, Jones SC (2007) The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. Support Care Cancer 15(6):621–630CrossRefPubMed Humpel N, Magee C, Jones SC (2007) The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. Support Care Cancer 15(6):621–630CrossRefPubMed
28.
go back to reference Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 88(3):674–684CrossRefPubMed Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 88(3):674–684CrossRefPubMed
29.
go back to reference Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830CrossRefPubMedPubMedCentral Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830CrossRefPubMedPubMedCentral
30.
go back to reference Olufade T, Gallicchio L, MacDonald R, Helzlsouer K (2015) Musculoskeletal pain and health-related quality of life among breast cancer patients treated with aromatase inhibitors. Support Care Cancer 23(2):447–455CrossRefPubMed Olufade T, Gallicchio L, MacDonald R, Helzlsouer K (2015) Musculoskeletal pain and health-related quality of life among breast cancer patients treated with aromatase inhibitors. Support Care Cancer 23(2):447–455CrossRefPubMed
31.
go back to reference Bender JL, Hohenadel J, Wong J et al (2008) What patients with cancer want to know about pain: a qualitative study. J Pain Symptom Manag 35(2):177–187CrossRef Bender JL, Hohenadel J, Wong J et al (2008) What patients with cancer want to know about pain: a qualitative study. J Pain Symptom Manag 35(2):177–187CrossRef
32.
go back to reference Davidson B, Vogel V, Wickerham L (2007) Oncologist-patient discussion of adjuvant hormonal therapy in breast cancer: results of a linguistic study focusing on adherence and persistence to therapy. J Support Oncol 5(3):139–143PubMed Davidson B, Vogel V, Wickerham L (2007) Oncologist-patient discussion of adjuvant hormonal therapy in breast cancer: results of a linguistic study focusing on adherence and persistence to therapy. J Support Oncol 5(3):139–143PubMed
33.
go back to reference Kenyon M, Mayer DK, Owens AK (2014) Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner. J Obstet Gynecol Neonatal Nurs 43(3):382–398CrossRefPubMed Kenyon M, Mayer DK, Owens AK (2014) Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner. J Obstet Gynecol Neonatal Nurs 43(3):382–398CrossRefPubMed
34.
go back to reference Jenkins V, Solis-Trapala I, Langridge C, Catt S, Talbot DC, Fallowfield LJ (2011) What oncologists believe they said and what patients believe they heard: an analysis of phase I trial discussions. J Clin Oncol 29(1):61–68CrossRefPubMed Jenkins V, Solis-Trapala I, Langridge C, Catt S, Talbot DC, Fallowfield LJ (2011) What oncologists believe they said and what patients believe they heard: an analysis of phase I trial discussions. J Clin Oncol 29(1):61–68CrossRefPubMed
35.
go back to reference Yeom HE, Heidrich SM (2013) Relationships between three beliefs as barriers to symptom management and quality of life in older breast cancer survivors. Oncol Nurs Forum 40(3):E108–E118CrossRefPubMed Yeom HE, Heidrich SM (2013) Relationships between three beliefs as barriers to symptom management and quality of life in older breast cancer survivors. Oncol Nurs Forum 40(3):E108–E118CrossRefPubMed
36.
go back to reference Jones LW, Courneya KS (2002) Exercise discussions during cancer treatment consultations. Cancer Pract 10(2):66–74CrossRefPubMed Jones LW, Courneya KS (2002) Exercise discussions during cancer treatment consultations. Cancer Pract 10(2):66–74CrossRefPubMed
37.
go back to reference Park J-H, Yoon YJ, Lee CW, Lee J, Oh M et al (2014) The effects of oncologists’ physical activity recommendations and information packages on level of physical activity and the quality of life in cancer survivors. J Clin Oncol 32(5s):Abstract 9629 Park J-H, Yoon YJ, Lee CW, Lee J, Oh M et al (2014) The effects of oncologists’ physical activity recommendations and information packages on level of physical activity and the quality of life in cancer survivors. J Clin Oncol 32(5s):Abstract 9629
38.
go back to reference Ruiz-Casado A, Lucia A (2014) The time has come for oncologists to recommend physical activity to cancer survivors. Arch Exerc Health Dis 4(1):214–215 Ruiz-Casado A, Lucia A (2014) The time has come for oncologists to recommend physical activity to cancer survivors. Arch Exerc Health Dis 4(1):214–215
39.
go back to reference Santa Mina D, Alibhai SM, Matthew AG et al (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol 19(3):e136–e144CrossRefPubMedPubMedCentral Santa Mina D, Alibhai SM, Matthew AG et al (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol 19(3):e136–e144CrossRefPubMedPubMedCentral
40.
go back to reference Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH (2012) Implementing the exercise guidelines for cancer survivors. J Support Oncol 10(5):171–177CrossRefPubMedPubMedCentral Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH (2012) Implementing the exercise guidelines for cancer survivors. J Support Oncol 10(5):171–177CrossRefPubMedPubMedCentral
41.
go back to reference Irwin ML, Cartmel B, Gross C, Ercolano E, Fielin M et al (2015) Randomized controlled trial of exercise vs. usual care on aromatase-inhibitor associated arthralgias in women with breast cancer: the hormones and physical exercise (HOPE) study. J Clin Oncol 33 Irwin ML, Cartmel B, Gross C, Ercolano E, Fielin M et al (2015) Randomized controlled trial of exercise vs. usual care on aromatase-inhibitor associated arthralgias in women with breast cancer: the hormones and physical exercise (HOPE) study. J Clin Oncol 33
42.
go back to reference Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ (2012) Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther 11(4):313–320CrossRefPubMed Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ (2012) Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther 11(4):313–320CrossRefPubMed
43.
go back to reference DeNysschen CA, Burton H, Ademuyiwa F, Levine E, Tetewsky S, O’Connor T (2014) Exercise intervention in breast cancer patients with aromatase inhibitor-associated arthralgia: a pilot study. Eur J Cancer Care 23(4):493–501CrossRef DeNysschen CA, Burton H, Ademuyiwa F, Levine E, Tetewsky S, O’Connor T (2014) Exercise intervention in breast cancer patients with aromatase inhibitor-associated arthralgia: a pilot study. Eur J Cancer Care 23(4):493–501CrossRef
44.
go back to reference Cantarero-Villanueva I, Fernandez-Lao C, Caro-Moran E, Morillas-Ruiz J, Galiano-Castillo N et al (2013) Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: a pragmatic controlled trial. Clin Rehab 27(2):123–132CrossRef Cantarero-Villanueva I, Fernandez-Lao C, Caro-Moran E, Morillas-Ruiz J, Galiano-Castillo N et al (2013) Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: a pragmatic controlled trial. Clin Rehab 27(2):123–132CrossRef
45.
go back to reference Galantino ML, Callens ML, Cardena GJ, Piela NL, Mao JJ (2013) Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Altern Ther Health Med 19(6):38–44PubMed Galantino ML, Callens ML, Cardena GJ, Piela NL, Mao JJ (2013) Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Altern Ther Health Med 19(6):38–44PubMed
Metadata
Title
Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity
Authors
Kirsten A. Nyrop
Leigh F. Callahan
Christine Rini
Mary Altpeter
Betsy Hackney
Amy DePue
Anne Wilson
Arielle Schechter
Hyman B. Muss
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-3065-2

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