Quality of life and impact of pain in women treated with aromatase inhibitors for breast cancer. A multicenter cohort study

Abstract

Women with hormone-dependent breast cancer are treated with aromatase inhibitors (AI) to slow disease progression by decreasing estrogen levels. However, AI have adverse effects, including pain, with potentially serious impact on quality of life (QOL) and treatment compliance. We evaluated quality of life during the first year of AI treatment, focusing particularly on the impact of pain. In a multicenter cohort study of 135 women with early-stage breast cancer, free of pain at the initiation of AI treatment, quality of life (by the EORTC QLQ-BR23), somatic and psychic symptoms, psychological characters, temperament and coping strategies were assessed at baseline and at each follow-up visit (1, 3, 6 and 12 months). The impact of treatment-induced pain on quality of life during follow-up was determined with repeated-measures regression models. These models were constructed to assess the effects of pain and pain type on quality of life during follow-up, taking into account predictors associated with quality of life at baseline. Prior ganglion resection, taxane treatment and chemotherapy, a high amplification score on the pain catastrophizing scale, and a high harm avoidance score on the personality questionnaire were associated with a significantly lower baseline QOL. Fifty-seven percent of women developed pain of five different types: upper or lower limb joint pain, diffuse pain, neuropathic pain, tendon pain and mixed pain. A significant decrease in QOL was noted in the women with pain, particularly for body image, sexual functioning and future perspectives. Moreover, the impact of pain on QOL depended on the type of pain experienced. In conclusion, women treated with aromatase inhibitors display changes in quality of life and the degree of change in quality of life depends mostly on the type of pain experienced. Oncologists and patients should be aware of painful adverse effects of AI and encouraged to provide or receive earlier and more appropriate management of these effects.

Women’s coping strategies during the first three months of adjuvant endocrine therapy for breast cancer

“…Our results highlight the diversity of experiences of side effects as many patients reported different side effects from one day to the next, with substantial variance in how distressful the event was perceived. Previous studies have reported hot flashes, night sweats, fatigue, mood swings and weight loss/gain (Moon et al, ), as well as musculoskeletal symptoms and sleeping disorders (Laroche et al, ). However, a strength of this study was that data were collected for a longer period of time than in previous studies.…”

“…For women diagnosed with hormone‐receptor‐positive breast cancer, endocrine therapy (ET), that is tamoxifen (TAM) or aromatase inhibitors (AI) is recommended for at least five years, to reduce recurrence and rates of mortality (Davies, Godwin, & Gray, ). Patients may experience diverse side effects related to their specific treatment (Laroche, Perrot, & Medkour, ; Moon, Hunter, Moss‐Morris, & Hughes, ), and difficulties in managing these side effects have been identified as obstacles for treatment adherence (Bluethmann et al, ).…”

Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications

“…Other studies found beneficial effects of vitamin D supplementation on musculoskeletal pain in BC patients receiving aromatase inhibitor therapy [22,45,46]. Among adverse effects of aromatase inhibitors, pain has a negative impact on quality of life, on treatment compliance and on survival of BC patients [47][48][49][50]. A possible mechanism for the beneficial effect of vitamin D arthralgia and myalgia may be its anti-inflammatory activity.…”

Health‐related quality of life associated with different cancer treatments in Chinese breast cancer survivors in Taiwan

“…Understanding the impact of breast cancer treatment on the QoL of patients is not only important for patients and their health care providers but also critical for policymakers to evaluate the cost‐effectiveness of cancer treatments. Most previous studies focused on the QoL associated with a specific breast cancer treatment of interest (i.e., tamoxifen only; Boehm et al, ; Kilickap et al, ; van Nes et al, , AIs only; Kilickap et al, ; Laroche et al, ; van Nes et al, , chemotherapy only; Bayram et al, ; Browall et al, ; Galalae et al, ; Ganz et al, ; Hwang et al, ; Tiezzi et al, , radiotherapy only; Rahn et al, ; Xiao et al, , mastectomy only; Kaminska et al, ; Szutowicz‐Wydra et al, ), whereas this study comprehensively evaluated the QoL across different cancer treatments. We found that the use of chemotherapy had the most significant association with the QoL of breast cancer survivors, with adjustment for patient's characteristics and other breast cancer treatments; no significant association was not found for other types of breast cancer treatment.…”