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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Aromatase Inhibitors
Carpal Tunnel Syndrome
Fingers
Breast Neoplasms
exemestane
letrozole
Therapeutics
Pharmacogenetics
Routine Diagnostic Tests
Early Diagnosis
Arm
Randomized Controlled Trials
Quality of Life
Hormones
Drug Therapy
Incidence

Keywords

  • Aromatase inhibitor induced musculoskeletal symptoms
  • Breast cancer survivor
  • Carpal tunnel syndrome
  • Early detection
  • Endocrine therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy. / Sheng, Jennifer Y.; Blackford, Amanda L.; Bardia, Aditya; Venkat, Raghunandan; Rosson, Gedge; Giles, Jon; Hayes, Daniel F.; Jeter, Stacie C.; Zhang, Zhe; Hayden, Jill; Nguyen, Anne; Storniolo, Anna Maria; Tarpinian, Karineh; Henry, Norah Lynn; Stearns, Vered.

In: Breast Cancer Research and Treatment, 01.01.2019.

Research output: Contribution to journalArticle

Sheng, JY, Blackford, AL, Bardia, A, Venkat, R, Rosson, G, Giles, J, Hayes, DF, Jeter, SC, Zhang, Z, Hayden, J, Nguyen, A, Storniolo, AM, Tarpinian, K, Henry, NL & Stearns, V 2019, 'Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy', Breast Cancer Research and Treatment. https://doi.org/10.1007/s10549-019-05270-4
Sheng, Jennifer Y. ; Blackford, Amanda L. ; Bardia, Aditya ; Venkat, Raghunandan ; Rosson, Gedge ; Giles, Jon ; Hayes, Daniel F. ; Jeter, Stacie C. ; Zhang, Zhe ; Hayden, Jill ; Nguyen, Anne ; Storniolo, Anna Maria ; Tarpinian, Karineh ; Henry, Norah Lynn ; Stearns, Vered. / Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy. In: Breast Cancer Research and Treatment. 2019.
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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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author = "Sheng, {Jennifer Y.} and Blackford, {Amanda L.} and Aditya Bardia and Raghunandan Venkat and Gedge Rosson and Jon Giles and Hayes, {Daniel F.} and Jeter, {Stacie C.} and Zhe Zhang and Jill Hayden and Anne Nguyen and Storniolo, {Anna Maria} and Karineh Tarpinian and Henry, {Norah Lynn} and Vered Stearns",
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T1 - Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy

AU - Sheng, Jennifer Y.

AU - Blackford, Amanda L.

AU - Bardia, Aditya

AU - Venkat, Raghunandan

AU - Rosson, Gedge

AU - Giles, Jon

AU - Hayes, Daniel F.

AU - Jeter, Stacie C.

AU - Zhang, Zhe

AU - Hayden, Jill

AU - Nguyen, Anne

AU - Storniolo, Anna Maria

AU - Tarpinian, Karineh

AU - Henry, Norah Lynn

AU - Stearns, Vered

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Aromatase inhibitor induced musculoskeletal symptoms

KW - Breast cancer survivor

KW - Carpal tunnel syndrome

KW - Early detection

KW - Endocrine therapy

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