Aromatase inhibitor (AI) therapy has a proven track record to enhance disease-free survival and lower recurrence rates in women with hormone receptor-positive postmenopausal breast cancer. However, this therapy is protracted (i.e., up to a decade) and is associated with the presence of arthralgias which can compromise quality of life and result in premature discontinuation of therapy.
AI-induced arthralgias (AIA) present as symmetrical joint pains most commonly effecting the wrists, hands, and knees and often have muscular corollaries to these symptoms. Because these symptoms have not been deemed life-threatening, there is an underappreciation of their impact on the quality of breast cancer survivorsí life post diagnosis.
AIAs prominence has been estimated anywhere between 5% and 50% of women receiving these therapies. Yet despite the prevalence of this toxicity, it is understudied and is characterized by the absence of a valid instrument to assess its nature and prominence.
Several mechanisms of action have been postulated for the prominence of AIAs such as estrogen deprivation and an autoimmune response. A recent meta-analysis with the goal to isolate risk factors for AI-associated arthralgias resulted in the following findings.1
Predictors reported as significant included body mass index > 25, a history of taxane-based chemotherapy, previous use of endocrine therapy, and early-stage breast cancer. Variables not associated with this symptom included age, type and duration of AI therapy, past history of arthritis, presence of comorbidity, race, and evidence of metastasis.
While there is no consensus on management guidelines for AIAs, strategies have been identified all of which require more in-depth study as to their efficacy alone or in combination. They include drug, acupuncture, relaxation, nutrition, and exercise interventions. Exercise may have the most potential to manage this symptom based on parallel recommendations for osteoarthritis. Also, discontinuation of AI therapy and switching to another AI or tamoxifen are common strategies to minimize symptom distress.
Breast cancer survivors represent a major population cohort of those living beyond active cancer treatment and their numbers are expected to rise in the future.2 Increased attention is required to investigate modalities to enhance their quality of survival in light of this prominent toxicity associated with AI therapy.
- Beckwe D, Leysen L, Meuwis K, Adriaenssens N. Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: A systematic review and meta-analysis. Support Care Cancer. 2017 Feb 15.
- Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016 Jul;66(4):271-89.