Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy

Kelley M. Kidwell, Steven E. Harte, Daniel F. Hayes, Anna Maria Storniolo, Janet Carpenter, David A. Flockhart, Vered Stearns, Daniel J. Clauw, David A. Williams, Norah Lynn Henry

Research output: Contribution to journalArticle

37 Scopus citations


BACKGROUND Aromatase inhibitor (AI) therapy results in substantial survival benefits for patients with hormone receptor-positive breast cancer. The rates of poor adherence and discontinuation of AI therapy are high, primarily because of treatment-related toxicities like musculoskeletal pain. Although pain-related symptoms may worsen during AI therapy, the authors hypothesized that nonpersistence with AI therapy was associated with symptoms that were present before treatment initiation. METHODS Postmenopausal women initiating AI therapy who were enrolled in a prospective clinical trial completed questionnaires at baseline to assess sleep, fatigue, mood, and pain. Reasons for treatment discontinuation during the first year of treatment were recorded. Associations between baseline patient-reported symptoms and treatment discontinuation because of toxicity were identified using logistic regression. RESULTS Four hundred forty-nine patients were evaluable. The odds of treatment discontinuation were higher in patients who reported a greater number of symptoms before AI initiation. Baseline poor sleep quality was associated with early treatment discontinuation, with an odds ratio (OR) of 1.91 (95% confidence interval [CI], 1.26-2.89; P = .002). Baseline presence of tired feeling and forgetfulness had similar ORs for discontinuation (tired feeling: OR, 1.76; 95% CI, 1.15-2.67; P = .009; forgetfulness: OR, 1.66; 95% CI, 1.11-2.48; P = .015). An increasing total number of baseline symptoms was associated with an increased likelihood of treatment discontinuation, with an OR of 1.89 (95% CI, 1.20-2.96; P = .006) for 3 to 5 symptoms versus 0 to 2 symptoms. CONCLUSIONS Symptom clusters in breast cancer survivors that are present before the initiation of adjuvant AI therapy may have a negative impact on a patient's persistence with therapy. Interventions to manage these symptoms may improve breast cancer outcomes and quality of life.

Original languageEnglish (US)
Pages (from-to)2403-2411
Number of pages9
Issue number16
StatePublished - Aug 15 2014


  • aromatase inhibitor
  • breast cancer
  • nonpersistence
  • patient-reported outcomes
  • symptoms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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    Kidwell, K. M., Harte, S. E., Hayes, D. F., Storniolo, A. M., Carpenter, J., Flockhart, D. A., Stearns, V., Clauw, D. J., Williams, D. A., & Henry, N. L. (2014). Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy. Cancer, 120(16), 2403-2411.