Joint pain severity predicts premature discontinuation of aromatase inhibitors in breast cancer survivors

Abstract

BackgroundPremature discontinuation of aromatase inhibitors (AIs) in breast cancer survivors compromises treatment outcomes. We aimed to evaluate whether patient-reported joint pain predicts premature discontinuation of AIs.MethodsWe conducted a retrospective cohort study of postmenopausal women with breast cancer on AIs who had completed a survey about their symptom experience on AIs with specific measurements of joint pain. The primary outcome was premature discontinuation of AIs, defined as stopping the medication prior to the end of prescribed therapy. Multivariate Cox regression modeling was used to identify predictors of premature discontinuation.ResultsAmong 437 patients who met eligibility criteria, 47 (11%) prematurely discontinued AIs an average of 29 months after initiation of therapy. In multivariate analyses, patient-reported worst joint pain score of 4 or greater on the Brief Pain Inventory (BPI) (Hazard Ratio [HR] 2.09, 95% Confidence Interval [CI] 1.14-3.80, P = 0.016) and prior use of tamoxifen (HR 2.01, 95% CI 1.09-3.70, P = 0.026) were significant predictors of premature discontinuation of AIs. The most common reason for premature discontinuation was joint pain (57%) followed by other therapy-related side effects (30%). While providers documented joint pain in charts for 82% of patients with clinically important pain, no quantitative pain assessments were noted, and only 43% provided any plan for pain evaluation or management.ConclusionWorst joint pain of 4 or greater on the BPI predicts premature discontinuation of AI therapy. Clinicians should monitor pain severity with quantitative assessments and provide timely management to promote optimal adherence to AIs.

Perceived barriers to treatment predict adherence to aromatase inhibitors among breast cancer survivors

“…Joint pain was measured with the worst pain item of the pain intensity subscale of the Brief Pain Inventory. This single item has been found to predict premature discontinuation among survivors of breast cancer who are receiving treatment with AIs . Clinical variables, including cancer stage and prior use of tamoxifen, were abstracted from medical charts.…”

Association between self-report adherence measures and oestrogen suppression among breast cancer survivors on aromatase inhibitors

“…Non-adherence is a common problem for women undergoing hormonal treatment [5][6][7]. Early discontinuation of adjuvant hormonal therapy (adjusted hazard ratio [HR], 1.26; 95% confidence interval (CI), 1.09-1.46), as well as frequent missed doses among those who have continued therapy ([HR], 1.49; 95% CI, 1.23-1.81), have each been shown to be independently associated with increased mortality even after controlling for age and disease factors [8].…”

Acupuncture for Aromatase Inhibitor–Induced Arthralgia

“…6,[14][15][16][17][18] AI-induced arthralgia affects medication adherence and leads to premature discontinuation of AIs. [17][18][19] Patients use doctorprescribed medications, complementary medicine and alternative therapies to control AI-induced arthralgia. As adjunctive medications, anti-inflammatories, codeine, morphine, paracetamol, and chondroitin are used.…”