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Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2015

01-12-2015 | Original Article

Relations between arthralgia and fear of recurrence: results of a cross-sectional study of breast cancer patients treated with adjuvant aromatase inhibitors therapy

Authors: Clémentine Lopez, Cécile Charles, Pascal Rouby, Diane Boinon, Sophie Laurent, Annie Rey, Marc Spielmann, Sarah Dauchy

Published in: Supportive Care in Cancer | Issue 12/2015

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Abstract

Purpose

The aim of this study was to explore associations between arthralgia and fear of recurrence in breast cancer patients treated by aromatase inhibitors (AI).

Method

We sent a set of questionnaires to 100 patients examining their pain characteristics, anxiety (STAI), depression (BDI-SF), quality of life (SF-36), fear of recurrence (FCRI), and representations of AI treatment (ad hoc questionnaire). Nonparametric tests were used to investigate between-group comparisons (arthralgia vs. nonarthralgia) in these domains as well as the associations between arthralgia and fear of recurrence.

Results

Of the 77 patients who returned the questionnaires (response rate = 77 %), 60 (78 %) reported arthralgia. The mean score of fear of recurrence exceeded the pathological threshold in the arthralgia group and was significantly higher than that in the nonarthralgia group (14.8 vs. 10.7, p < 0.01). Significant associations were observed between fear of recurrence and pain intensity (r = 0.274, p < 0.05) and pain relief (r = −0.409, p < 0.05). More than 80 % of the total sample declared that they were well informed about the aim of AI, their side effects, and the risk of developing arthralgia. Fear of recurrence did not appear to be associated with representations of AI.

Conclusion

The study revealed a close relationship between pain intensity and fear of recurrence. In particular, it showed that effective pain management was accompanied by a reduced fear of recurrence. Information, although essential, appeared insufficient to overcome patients' concerns about pain. Therefore, the implement of a systematic screening for arthralgia and the improvement of analgesic treatment are essential issues. New strategies for pharmacological and nonpharmacological treatment must be developed.
Literature
1.
Aydiner A (2013) Meta-analysis of breast cancer outcome and toxicity in adjuvant trials of aromatase inhibitors in postmenopausal women. Breast 22:121–129CrossRefPubMed
2.
Amir E, Seruga B, Niraula S, Carlsson L, Ocaña A (2011) Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst 103:1299–1309CrossRefPubMed
3.
4.
Gaillard S, Stearns V (2011) Aromatase inhibitor-associated bone and musculoskeletal effects: new evidence defining etiology and strategies for management. Breast Cancer Res 13:205PubMedCentralCrossRefPubMed
5.
Buzdar A, Howell A, Cuzick J et al (2006) Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol 7:633–643CrossRefPubMed
6.
Coates AS, Keshaviah A, Thürlimann B et al (2007) Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. J Clin Oncol 25:486–492CrossRefPubMed
7.
Coombes RC, Kilburn LS, Snowdon CF et al (2007) Survival and safety of exemestane versus tamoxifen after 2–3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 369:559–570CrossRefPubMed
8.
Goss PE, Ingle JN, Martino S et al (2005) Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 97:1262–1271CrossRefPubMed
9.
Takei H, Ohsumi S, Shimozuma K, Takehara M, Suemasu K, Ohashi Y, Hozumi Y (2012) Health-related quality of life, psychological distress, and adverse events in postmenopausal women with breast cancer who receive tamoxifen, exemestane, or anastrozole as adjuvant endocrine therapy: National Surgical Adjuvant Study of Breast Cancer 04 (N-SAS BC 04). Breast Cancer Res Treat 133:227–236CrossRefPubMed
10.
Fallowfield LJ, Kilburn LS, Langridge C, Snowdon CF, Bliss JM, Coombes RC (2012) Long-term assessment of quality of life in the Intergroup Exemestane Study: 5 years post-randomisation. Br J Cancer 106:1062–1067PubMedCentralCrossRefPubMed
11.
Cella D, Fallowfield L, Barker P, Cuzick J, Locker G, Howell A (2006) Quality of life of postmenopausal women in the ATAC ("Arimidex", tamoxifen, alone or in combination) trial after completion of 5 years' adjuvant treatment for early breast cancer. Breast Cancer Res Treat 100:273–284CrossRefPubMed
12.
van Nes JG, Fontein DB, Hille ET, Voskuil DW, van Leeuwen FE, de Haes JC, Putter H, Seynaeve C, Nortier JW, van de Velde CJ (2012) Quality of life in relation to tamoxifen or exemestane treatment in postmenopausal breast cancer patients: a Tamoxifen Exemestane Adjuvant Multinational (TEAM) Trial side study. Breast Cancer Res Treat 134:267–276PubMedCentralCrossRefPubMed
13.
Whelan TJ, Goss PE, Ingle JN et al (2005) Assessment of quality of life in MA.17: a randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. J Clin Oncol 23:6931–6940CrossRefPubMed
14.
Laroche F, Coste J, Medkour T et al (2014) Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study. J Pain 15:293–303CrossRefPubMed
15.
Olufade T, Gallicchio L, MacDonald R, Helzlsouer KJ (2015) Musculoskeletal pain and health-related quality of life among breast cancer patients treated with aromatase inhibitors. Support Care Cancer 23:447–455CrossRefPubMed
16.
Mao JJ, Stricker C, Bruner D, Xie S, Bowman MA, Farrar JT, Greene BT, DeMichele A (2009) Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer 115:3631–3639PubMedCentralCrossRefPubMed
17.
Henry NL, Giles JT, Ang D et al (2008) Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. Breast Cancer Res Treat 111:365–372PubMedCentralCrossRefPubMed
18.
Crew KD, Greenlee H, Capodice J, Raptis G, Brafman L, Fuentes D, Sierra A, Hershman DL (2007) Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol 25:3877–3883CrossRefPubMed
19.
Presant CA, Bosserman L, Young T, Vakil M, Horns R, Upadhyaya G, Ebrahimi B, Yeon C, Howard F (2007) Aromatase inhibitor-associated arthralgia and/ or bone pain: frequency and characterization in non-clinical trial patients. Clin Breast Cancer 7:775–778CrossRefPubMed
20.
Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, Gralow J (2008) Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry 30:112–126CrossRefPubMed
21.
Reich M, Lesur A, Perdrizet-Chevallier C (2008) Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 110:9–17CrossRefPubMed
22.
Crist JV, Grunfeld EA (2013) Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology 22:978–986CrossRefPubMed
23.
van den Beuken-van Everdingen MH, Peters ML, de Rijke JM, Schouten HC, van Kleef M, Patijn J (2008) Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study. Psychooncology 17:1137–1145CrossRefPubMed
24.
Janz NK, Hawley ST, Mujahid MS, Griggs JJ, Alderman A, Hamilton AS, Graff JJ, Jagsi R, Katz SJ (2011) Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer. Cancer 117:1827–1836PubMedCentralCrossRefPubMed
25.
Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G (2013) Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv 7:300–322CrossRefPubMed
26.
Leventhal H, Diefenbach M, Leventhal EA (1992) Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res 16:143–163CrossRef
27.
Lee-Jones C, Humphris G, Dixon R, Hatcher MB (1997) Fear of cancer recurrence–a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology 6:95–105CrossRefPubMed
28.
Corter AL, Findlay M, Broom R, Porter D, Petrie KJ (2013) Beliefs about medicine and illness are associated with fear of cancer recurrence in women taking adjuvant endocrine therapy for breast cancer. Br J Health Psychol 18:168–181CrossRefPubMed
29.
Leplège A, Ecosse E, Verdier A, Perneger TV (1998) The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51:1013–1023CrossRefPubMed
30.
Furlanetto LM, Mendlowicz MV, Romildo Bueno J (2005) The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients. J Affect Disord 86:87–91CrossRefPubMed
31.
Bruchon-Schweitzer M, Paulhan I (1993) Manuel de l'inventaire d'anxiété état-trait forme Y (STAI-Y) de Spielberger. Editions du Centre de Psychologie Appliquée, Paris
32.
Simard S, Savard J (2009) Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 17:241–251CrossRefPubMed
33.
Paul SM, Zelman DC, Smith M, Miaskowski C (2005) Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. Pain 113:37–44CrossRefPubMed
34.
Schilder CM, Eggens PC, Seynaeve C, Linn SC, Boogerd W, Gundy CM, Beex LV, Van Dam FS, Schagen SB (2009) Neuropsychological functioning in postmenopausal breast cancer patients treated with tamoxifen or exemestane after AC-chemotherapy: cross-sectional findings from the neuropsychological TEAM-side study. Acta Oncol 48:76–85CrossRefPubMed
35.
Cunningham NR, Kashikar-Zuck S (2013) Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep 15:306PubMedCentralCrossRefPubMed
36.
Mao JJ, Xie SX, Farrar JT, Stricker CT, Bowman MA, Bruner D, DeMichele A (2014) A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer 50:267–276PubMedCentralCrossRefPubMed
37.
Bao T, Cai L, Giles JT et al (2013) A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Res Treat 138:167–174PubMedCentralCrossRefPubMed
38.
Simard S, Savard J, Ivers H (2010) Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Surviv 4:361–371CrossRefPubMed
39.
Alford BA, Beck AT (1997) The integrative power of cognitive therapy. The Guilford Press, New York
40.
Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34CrossRefPubMed
41.
Herschbach P, Book K, Dinkel A, Berg P, Waadt S, Duran G, Engst-Hastreiter U, Henrich G (2010) Evaluation of two group therapies to reduce fear of progression in cancer patients. Support Care Cancer 18:471–479CrossRefPubMed
42.
Ehde DM, Dillworth TM, Turner JA (2014) Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol 69:153–166CrossRefPubMed
43.
44.
Watson CP, Gilron I, Sawynok J, Lynch ME (2011) Nontricyclic antidepressant analgesics and pain: are serotonin norepinephrine reuptake inhibitors (SNRIs) any better? Pain 152:2206–2210CrossRefPubMed
45.
Henry NL, Banerjee M, Wicha M, Van Poznak C, Smerage JB, Schott AF, Griggs JJ, Hayes DF (2011) Pilot study of duloxetine for treatment of aromatase inhibitor-associated musculoskeletal symptoms. Cancer 117:5469–5475CrossRefPubMed
Metadata
Title
Relations between arthralgia and fear of recurrence: results of a cross-sectional study of breast cancer patients treated with adjuvant aromatase inhibitors therapy
Authors
Clémentine Lopez
Cécile Charles
Pascal Rouby
Diane Boinon
Sophie Laurent
Annie Rey
Marc Spielmann
Sarah Dauchy
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2722-9

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