Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients. (April 2020)

• Record Type: Journal Article
• Authors: Hack, C.C.; Häberle, L.; Brucker, S.Y.; Janni, W.; Volz, B.; Loehberg, C.R.; Hartkopf, A.D.; Walter, C.-B.; Baake, G.; Fridman, A.; Malter, W.; Wuerstlein, R.; Harbeck, N.; Hoffmann, O.; Kuemmel, S.; Martin, B.; Thomssen, C.; Graf, H.; Wolf, C.; Lux, M.P.; Bayer, C.M.; Rauh, C.; Almstedt, K.; Gass, P.; Heindl, F.; Brodkorb, T.; Willer, L.; Lindner, C.; Kolberg, H.-C.; Krabisch, P.; Weigel, M.; Steinfeld-Birg, D.; Kohls, A.; Brucker, C.; Schulz, V.; Fischer, G.; Pelzer, V.; Rack, B.; Beckmann, M.W.; Fehm, T.; Rody, A.; Maass, N.; Hein, A.; Fasching, P.A.; Nabieva, N.;
• Is Part Of: Breast. Volume 50(2020)
• Page Start: 11
• Page End: 18
• Publication Date: 2020-04
• Subjects: Breast cancer -- Endocrine therapy/treatment -- Aromatase inhibitors -- Letrozole -- Integrative medicine -- Complementary and alternative medicine -- Arthralgia -- Myalgia; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2019.12.017
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. Patients and methods: The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. Results: Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. Conclusions: CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients. Highlights: Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake. Within one year pain levels increase in both, CAM users as well as non-CAM users. In CAM users pain levels were higher at all time points than in non-CAM users. The greatest increase of pain levels was noted in the first six treatment months. CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.