Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors

N. Lynn Henry, Jon T. Giles, Dennis Ang, Monika Mohan, Dina Dadabhoy, Jason Robarge, Jill Hayden, Suzanne Lemler, Karineh Shahverdi, Penny Powers, Lang Li, David Flockhart, Vered Stearns, Daniel F. Hayes, Anna Maria Storniolo, Daniel J. Clauw

Research output: Contribution to journalArticle

141 Citations (Scopus)

Abstract

Purpose: Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods: Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results: Forty-four of 97 eligible patients (45.4%) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions: Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10% of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.

Original languageEnglish
Pages (from-to)365-372
Number of pages8
JournalBreast Cancer Research and Treatment
Volume111
Issue number2
DOIs
StatePublished - Sep 2008

Fingerprint

Aromatase Inhibitors
Breast Neoplasms
exemestane
letrozole
Visual Analog Scale
Health
Referral and Consultation
Hormones
Therapeutics
Rheumatology
Randomized Controlled Trials
Inflammation
Pain

Keywords

  • Aromatase inhibitor
  • Arthralgia
  • Breast cancer
  • Musculoskeletal symptoms
  • Rheumatology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. / Henry, N. Lynn; Giles, Jon T.; Ang, Dennis; Mohan, Monika; Dadabhoy, Dina; Robarge, Jason; Hayden, Jill; Lemler, Suzanne; Shahverdi, Karineh; Powers, Penny; Li, Lang; Flockhart, David; Stearns, Vered; Hayes, Daniel F.; Storniolo, Anna Maria; Clauw, Daniel J.

In: Breast Cancer Research and Treatment, Vol. 111, No. 2, 09.2008, p. 365-372.

Research output: Contribution to journalArticle

Henry, NL, Giles, JT, Ang, D, Mohan, M, Dadabhoy, D, Robarge, J, Hayden, J, Lemler, S, Shahverdi, K, Powers, P, Li, L, Flockhart, D, Stearns, V, Hayes, DF, Storniolo, AM & Clauw, DJ 2008, 'Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors', Breast Cancer Research and Treatment, vol. 111, no. 2, pp. 365-372. https://doi.org/10.1007/s10549-007-9774-6
Henry, N. Lynn ; Giles, Jon T. ; Ang, Dennis ; Mohan, Monika ; Dadabhoy, Dina ; Robarge, Jason ; Hayden, Jill ; Lemler, Suzanne ; Shahverdi, Karineh ; Powers, Penny ; Li, Lang ; Flockhart, David ; Stearns, Vered ; Hayes, Daniel F. ; Storniolo, Anna Maria ; Clauw, Daniel J. / Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. In: Breast Cancer Research and Treatment. 2008 ; Vol. 111, No. 2. pp. 365-372.
@article{507451089d4c4a0db17827192de3fddd,
title = "Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors",
abstract = "Purpose: Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods: Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results: Forty-four of 97 eligible patients (45.4{\%}) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions: Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10{\%} of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.",
keywords = "Aromatase inhibitor, Arthralgia, Breast cancer, Musculoskeletal symptoms, Rheumatology",
author = "Henry, {N. Lynn} and Giles, {Jon T.} and Dennis Ang and Monika Mohan and Dina Dadabhoy and Jason Robarge and Jill Hayden and Suzanne Lemler and Karineh Shahverdi and Penny Powers and Lang Li and David Flockhart and Vered Stearns and Hayes, {Daniel F.} and Storniolo, {Anna Maria} and Clauw, {Daniel J.}",
year = "2008",
month = "9",
doi = "10.1007/s10549-007-9774-6",
language = "English",
volume = "111",
pages = "365--372",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",
number = "2",

}

TY - JOUR

T1 - Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors

AU - Henry, N. Lynn

AU - Giles, Jon T.

AU - Ang, Dennis

AU - Mohan, Monika

AU - Dadabhoy, Dina

AU - Robarge, Jason

AU - Hayden, Jill

AU - Lemler, Suzanne

AU - Shahverdi, Karineh

AU - Powers, Penny

AU - Li, Lang

AU - Flockhart, David

AU - Stearns, Vered

AU - Hayes, Daniel F.

AU - Storniolo, Anna Maria

AU - Clauw, Daniel J.

PY - 2008/9

Y1 - 2008/9

N2 - Purpose: Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods: Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results: Forty-four of 97 eligible patients (45.4%) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions: Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10% of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.

AB - Purpose: Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods: Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results: Forty-four of 97 eligible patients (45.4%) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions: Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10% of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.

KW - Aromatase inhibitor

KW - Arthralgia

KW - Breast cancer

KW - Musculoskeletal symptoms

KW - Rheumatology

UR - http://www.scopus.com/inward/record.url?scp=48149090898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=48149090898&partnerID=8YFLogxK

U2 - 10.1007/s10549-007-9774-6

DO - 10.1007/s10549-007-9774-6

M3 - Article

C2 - 17922185

AN - SCOPUS:48149090898

VL - 111

SP - 365

EP - 372

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 2

ER -