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

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.

• Authors: C C Hack, L Häberle, S Y Brucker, W Janni, B Volz, C R Loehberg, A D Hartkopf, C-B Walter, G Baake, A Fridman, W Malter, R Wuerstlein, N Harbeck, O Hoffmann, S Kuemmel, B Martin, C Thomssen, H Graf, C Wolf, M P Lux, C M Bayer, C Rauh, K Almstedt, P Gass, F Heindl, T Brodkorb, L Willer, C Lindner, H-C Kolberg, P Krabisch, M Weigel, D Steinfeld-Birg, A Kohls, C Brucker, V Schulz, G Fischer, V Pelzer, B Rack, M W Beckmann, T Fehm, A Rody, N Maass, A Hein, P A Fasching, N Nabieva
• Journal: Breast (Edinburgh, Scotland) (Breast) Vol. 50 Pg. 11-18 (Apr 2020) ISSN: 1532-3080 [Electronic] Netherlands
• PMID: 31958661 (Publication Type: Clinical Trial, Phase IV, Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Aromatase Inhibitors
• Letrozole

Topics

• Aged
• Aromatase Inhibitors (adverse effects)
• Arthralgia (chemically induced)
• Breast Neoplasms (drug therapy)
• Complementary Therapies
• Female
• Germany (epidemiology)
• Humans
• Letrozole (adverse effects)
• Middle Aged
• Musculoskeletal Pain (chemically induced)
• Myalgia (chemically induced)
• Postmenopause