Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort
Open accessAbstract
BACKGROUND: More than 80,000 postmenopausal breast cancer patients in the United States each year are estimated to begin a 5‐year course of aromatase inhibitors (AIs) to prevent recurrence. AI‐related arthralgia (joint pain and/or stiffness) may contribute to nonadherence, but longitudinal data are needed on arthralgia risk factors, trajectories, and background in postmenopause. This study sought to describe 1‐year arthralgia trajectories and baseline covariates among patients with AI and a postmenopausal comparison group. METHODS: Patients initiating AIs (n = 91) were surveyed at the time of AI initiation and at 6 repeated assessments over 1 year. A comparison group of postmenopausal women without breast cancer (n = 177) completed concomitantly timed surveys. Numeric rating scales (0–10) were used to measure pain in 8 joint pair groups (bilateral fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes). Poisson regression models were used to analyze arthralgia trajectories and risk factors. RESULTS: By week 6, the AI‐initiating group had more severe arthralgia than did the comparison group (ratio of means = 1.8, 95% confidence interval = 1.24‐2.7, P = .002), adjusting for baseline characteristics. Arthralgia then worsened further over 1 year in the AI group. Menopausal symptom severity and existing joint‐related comorbidity at baseline among women initiating AI were associated with more severe arthralgia over time. CONCLUSIONS: Patients initiating AI should be told about the timing of arthralgia over the first year of therapy, and advised that it does not appear to resolve over the course of a year. Menopausal symptoms and joint‐related comorbidity at AI initiation can help identify patients at risk for developing AI‐related arthralgia. Cancer 2013;119:2375–2382. © 2013 American Cancer Society.
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Most symptoms occur in the first year of using HT.
“Most symptoms occur in the first year of using HT, suggesting this period could be the optimal opportunity for delivering supportive care for this patient group [20–22].”
From Acceptance and Commitment Therapy to support medication decision-making and quality of life in women with breast cancer: protocol for a pilot randomised controlled trial (2022) · cites this paper as [22]
The Results and Discussion report that arthralgia increased by six weeks after aromatase inhibitor initiation and worsened over the first year, supporting early attention to that symptom. The study tracked arthralgia, not most symptoms of hormone therapy, and did not observe patients beyond a year to establish when most symptoms occur. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe first year of using HT could be the optimal opportunity for delivering supportive care for this patient group.
“Most symptoms occur in the first year of using HT, suggesting this period could be the optimal opportunity for delivering supportive care for this patient group [20–22].”
From Acceptance and Commitment Therapy to support medication decision-making and quality of life in women with breast cancer: protocol for a pilot randomised controlled trial (2022) · cites this paper as [22]
The Discussion reports that arthralgia emerges by six weeks after aromatase inhibitor initiation and recommends follow-up during that interval to address it. This supports early supportive care for arthralgia, but the paper does not establish that most symptoms of hormonal therapy occur in the first year or that the first year is the optimal period for supportive care. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Castel, L. D., Hartmann, K. E., Mayer, I. A., Saville, B. R., Alvarez, J., Boomershine, C. S., Abramson, V. G., Chakravarthy, A. B., Friedman, D. L., & Cella, D. F.
- Affiliations
- Vanderbilt University Medical Center (US)
- Vanderbilt University (US)
- Northwestern University (US)
- Corresponding author
- Castel, Liana D.
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2013-04-10
- Volume
- 119
- Issue
- 13
- Pages
- 2375-2382
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- PMC
- PMC3687009
- OpenAlex
- W1861000319
- Cited by
- 43
- References
- 37
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 9 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 5
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Cancer Society
- Vanderbilt University (UL1 RR024975)
- Vanderbilt Institute for Clinical and Translational Research (UL1 RR024975, UL1TR000011)
- National Institutes of Health (UL1TR000445, UL1TR000011)
- National Cancer Institute (K23CA127469)
- National Center for Research Resources (UL1RR024975)
- National Center for Advancing Translational Sciences (UL1 TR000011)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (5K12HD43483-10, K12HD043483)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- aromatase inhibitors, joint pain, breast cancer, postmenopausal women, menopausal symptoms, medication adherence, adverse drug reactions, risk factors
- MeSH terms
- Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Follow-Up Studies, Humans, Middle Aged, Prospective Studies, Risk Factors, Multivariate Analysis, Poisson Distribution, Postmenopause, Arthralgia, Antineoplastic Agents, Hormonal, Aromatase Inhibitors
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