Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options

Lombard, Janine; Zdenkowski, Nicholas; Wells, Kathy; Beckmore, Corinna; Reaby, Linda; Forbes, John F.; Chirgwin, Jacquie

doi:10.1007/s00520-015-3001-5

Cited by 42 publications

(44 citation statements)

References 42 publications

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“…Other trials have also reported on the influence of preexisting joint and muscle/limb pain on musculoskeletal pain syndrome during treatment with AIs . The severity of pain during AI treatment has also been evaluated in other studies .…”

Section: Discussionmentioning

confidence: 99%

“…The most common and typical AEs associated with AIs are vasomotor and general climacteric symptoms, as well as musculoskeletal pain syndrome . The latter, involving myalgia and arthralgia, is usually the reason for early discontinuation of AIs and is therefore a topic of special interest …”

Section: Introductionmentioning

confidence: 99%

“…In addition, patients with a history of hormone replacement therapy or chemotherapy—especially taxane‐based—also report musculoskeletal AEs more often. Another risk factor for AI‐induced pain syndrome is preexisting musculoskeletal symptoms …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients

Nabieva

Häberle

Brucker

et al. 2019

Intl Journal of Cancer

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One of the most common adverse events (AEs) occurring during treatment with aromatase inhibitors (AIs) is musculoskeletal pain. The aim of our study was to analyze the influence of preexisting muscle/limb pain and joint pain on the development of AI‐induced musculoskeletal AEs. Women eligible for upfront adjuvant endocrine therapy with letrozole were included in the PreFace study, a multicenter phase IV trial. During the first treatment year, they were asked to record musculoskeletal AEs monthly by answering questions regarding pain symptoms and rating the pain intensity on a numeric rating scale from 0 (no pain) to 10 (very strong pain). Pain values were compared using nonparametric statistical tests. Overall, 1,416 patients were evaluable. The average pain value over all time points in women with preexisting muscle/limb pain was 4.3 (median 4.3); in those without preexisting pain, it was 2.0 (median 1.7). In patients without preexisting muscle/limb pain, pain levels increased relatively strongly within the first 6 months (mean increase +0.9, p < 0.00001) in comparison with those with preexisting pain (mean increase +0.3, p < 0.001), resulting in a statistically significant difference (p < 0.00001) between the two groups. The development of joint pain was similar in the two groups. Women without preexisting muscle/limb pain or joint pain have the greatest increase in pain after the start of adjuvant AI therapy. Women with preexisting pain have significantly higher pain values. The main increase in pain values takes place during the first 6 months of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients

Nabieva

Häberle

Brucker

et al. 2019

Intl Journal of Cancer

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“…Clinical trials of adjuvant AIs report AIMSS in up to 36% of patients; however, community‐based series report considerably higher rates. In a survey of Australian women taking AIs, 82% of women reported AIMSS 15 . Any joint can be affected but hands, hips, feet and knees were most commonly involved.…”

Section: Aromatase Inhibitor Musculoskeletal Syndromementioning

confidence: 99%

Supportive care of women with breast cancer: key concerns and practical solutions

Zdenkowski

Tesson

Lombard

et al. 2016

Medical Journal of Australia

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Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.

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“…Studies have demonstrated that 25–32% of women will discontinue AI prior to completing a 5-year course, and in studies where 10 years of AI therapy was recommended, adherence decreased to 38% [2–4]. A common cause for AI discontinuation is AI-associated musculoskeletal symptoms (AIMSS), which result in an 18–24% discontinuation rates during the first 2 years [2, 5]. …”

Section: Introductionmentioning

confidence: 99%

A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial

Santa-Maria

Bardia

Blackford

et al. 2018

Breast Cancer Res Treat

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Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options

Abstract: We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.

Cited by 42 publications

References 42 publications

Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients

Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients

Supportive care of women with breast cancer: key concerns and practical solutions

A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial

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