Cited by 286Breast Cancer Treatment StudiesCancer survivorship and careMenopause: Health Impacts and Treatments

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Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy

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Cella, David, Fallowfield, Lesley J.·2008·Breast Cancer Research and Treatment

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Abstract

In postmenopausal women with hormone receptor-positive early-stage breast cancer, the use of aromatase inhibitors (AIs) to suppress estrogen is associated with improved clinical outcomes compared with tamoxifen therapy. Women receiving such endocrine therapy may experience treatment-related side effects that negatively affect health-related quality of life (QoL) and adherence to therapy. In published clinical trials and in clinical practice, adverse events (AEs) constitute the main reason for nonadherence to endocrine treatment. Serious AEs are sometimes resolved by switching to a different agent, whereas other side effects can often be managed to allow patients to remain on therapy without sacrificing QoL. Across all adjuvant endocrine trials, regardless of the treatment received, vasomotor symptoms such as hot flashes are the most common side effects. Other frequently reported side effects, such as vaginal discharge, vaginal dryness, dyspareunia, and arthralgia, vary in prevalence between tamoxifen and AIs. Here we provide an overview of reported AEs of adjuvant endocrine therapy, focusing on those that are amenable to pharmacologic or nonpharmacologic management without treatment discontinuation. Also highlighted are specific management strategies that may improve patient QoL and thereby optimize adherence to therapy, which in turn might improve patient outcomes.

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1 retracted

RETRACTED: Drug-induced lupus erythematosus
Sarzi‐Puttini, P., Atzeni, F., Sarzi‐Puttini, P., Atzeni, F., CAPSONI, F., Sarzi‐Puttini, P., Atzeni, F., CAPSONI, F., Lubrano, E., Sarzi‐Puttini, P., et al. (2005) · Autoimmunity · doi:10.1080/08916930500285857 · Cited by 125
Retracted
Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer
Howell, A., Cuzick, J. M., Baum, M., Buzdar, A. U., Dowsett, M., Forbes, J., Hoctin-Boes, G., Houghton, J., Locker, G. Y., & Tobias, J. S. (2005) · The Lancet · doi:10.1016/s0140-6736(04)17666-6 · Cited by 2,284 · cited 1×
“Conversely, the systemic estrogen deprivation that results from AI therapy in postmenopausal women can result in bone resorption and osteoporosis, with higher fracture rates [2, 4, 7].”
Background
Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial
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A Randomized Trial of Letrozole in Postmenopausal Women after Five Years of Tamoxifen Therapy for Early-Stage Breast Cancer
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A Randomized Trial of Exemestane after Two to Three Years of Tamoxifen Therapy in Postmenopausal Women with Primary Breast Cancer
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Self-citation
A Comparison of Letrozole and Tamoxifen in Postmenopausal Women with Early Breast Cancer
The Breast International Group (BIG) 1-98 Collaborative Group (2005) · New England Journal of Medicine · doi:10.1056/nejmoa052258 · Cited by 1,584
Randomized Trial of Letrozole Following Tamoxifen as Extended Adjuvant Therapy in Receptor-Positive Breast Cancer: Updated Findings from NCIC CTG MA.17
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“005), suggesting inhibition of endometrial proliferation by the AI [7].”
BackgroundMethodInfluential
American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor–Positive Breast Cancer: Status Report 2004
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Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.
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“Loss of libido Better patient/physician communication Transdermal testosterone Shifren et al. [ 66 ]”
Background
CYP2D6 Genotype, Antidepressant Use, and Tamoxifen Metabolism During Adjuvant Breast Cancer Treatment
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Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years' adjuvant tamoxifen: combined results of ABCSG trial 8 and ARNO 95 trial
Jakesz, R., Jonat, W., Gnant, M., Mittlboeck, M., Greil, R., Tausch, C., Hilfrich, J., Kwasny, W., Menzel, C., Samonigg, H., et al. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67059-6 · Cited by 877
Active Tamoxifen Metabolite Plasma Concentrations After Coadministration of Tamoxifen and the Selective Serotonin Reuptake Inhibitor Paroxetine
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Background
Impairment of Cognitive Function in Women Receiving Adjuvant Treatment for High-Risk Breast Cancer: High-Dose Versus Standard-Dose Chemotherapy
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Background
Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial
Loprinzi, C. L., Kugler, J. W., Sloan, J. A., Mailliard, J. A., LaVasseur, B. I., Barton, D. L., Novotny, P. J., Dakhil, S. R., Rodger, K., Rummans, T. A., et al. (2000) · The Lancet · doi:10.1016/s0140-6736(00)03403-6 · Cited by 737 · cited 1×
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Background
Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer
Partridge, A. H., Wang, P. S., Winer, E. P., & Avorn, J. (2003) · Journal of Clinical Oncology · doi:10.1200/jco.2003.07.071 · Cited by 676 · cited 1×
“In a study of adherence to tamoxifen therapy in a clinical practice setting, nearly 25% of patients missed taking their oral dose on more than 20% of days during the first year of treatment, and overall adherence decreased to 50% by Year 4 [13].”
Background
Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women.
Powles, T., Hickish, T., Kanis, J. А., Tidy, A., & Ashley, S. (1996) · Journal of Clinical Oncology · doi:10.1200/jco.1996.14.1.78 · Cited by 646 · cited 1×
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HABITS (hormonal replacement therapy after breast cancer—is it safe?), a randomised comparison: trial stopped
Holmberg, L., & Anderson, H. (2004) · The Lancet · doi:10.1016/s0140-6736(04)15493-7 · Cited by 533
Paroxetine Controlled Release in the Treatment of Menopausal Hot Flashes: A Randomized Controlled Trial
Stearns, V., Beebe, K. L., Iyengar, M., & Dube, E. (2003) · JAMA · doi:10.1001/jama.289.21.2827 · Cited by 496
Phase III Evaluation of Fluoxetine for Treatment of Hot Flashes
Loprinzi, C. L., Sloan, J. A., Perez, E. A., Quella, S. K., Stella, P. J., Mailliard, J. A., Halyard, M. Y., Pruthi, S., Novotny, P. J., & Rummans, T. A. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.20.6.1578 · Cited by 473
Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial
‡ (2006) · The Lancet Oncology · doi:10.1016/s1470-2045(06)70767-7 · Cited by 462
Switching to Anastrozole Versus Continued Tamoxifen Treatment of Early Breast Cancer: Preliminary Results of the Italian Tamoxifen Anastrozole Trial
Boccardo, F., RUBAGOTTI, A., Puntoni, M., Guglielmini, P., AMOROSO, D., Fini, A., Paladini, G., Mesiti, M., Romeo, D., Rinaldini, M., et al. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.04.120 · Cited by 445 · cited 1×
“In the ITA trial, the anastrozole group had a significantly higher incidence of lipid metabolism disorders, though similar incidence of cardiovascular disease, compared with the tamoxifen group [6].”
Result
Neurocognitive Performance in Breast Cancer Survivors Exposed to Adjuvant Chemotherapy and Tamoxifen
Castellon, S. A., Ganz, P. A., Bower, J. E., Petersen, L., Abraham, L., & Greendale, G. A. (2004) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803390490510905 · Cited by 409 · cited 1×
“In retrospective studies of breast cancer survivors, some investigators found cognitive decline (especially in verbal learning, visuospatial functioning, and visual memory) to be greater in patients who received tamoxifen plus chemotherapy (compared with chemotherapy alone or surgery alone), while others reported that…”
Background
A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer
Jenkins, V. A., Shilling, V. M., Deutsch, G. P., Bloomfield, D. J., Morris, R. G., Allan, S., Bishop, H., Hodson, N. J., Mitra, S. S., Sadler, G., et al. (2006) · British Journal of Cancer · doi:10.1038/sj.bjc.6603029 · Cited by 407
ATAC trial update
Howell, A. (2005) · The Lancet · doi:10.1016/s0140-6736(05)74803-0 · Cited by 398
Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast carcinoma patients with at least one osteolytic lesion
Rosen, L. S., Gordon, D. H., Dugan, W., Major, P. P., Eisenberg, P. D., Provencher, L., Kaminski, M., Simeone, J., Seaman, J. J., Chen, B., et al. (2003) · Cancer · doi:10.1002/cncr.11892 · Cited by 335 · cited 1×
“Zoledronic acid is a potent nitrogen-containing bisphosphonate, delivered by infusion, that has proven effective in reducing skeletalrelated events and hypercalcemia of malignancy in metastatic breast cancer patients [35].”
Background
Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial
Pandya, K. J., Morrow, G. R., Roscoe, J. A., Zhao, H., Hickok, J. T., Pajon, E. R., Sweeney, T. J., Banerjee, T. K., & Flynn, P. J. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67215-7 · Cited by 332 · cited 1×
“Gabapentin, a medication for nerve pain, is yet another additional treatment option reported to reduce hot flashes in women with breast cancer [60].”
Background
Adherence to tamoxifen over the five-year course
Lash, T. L., Fox, M. P., Westrup, J., Fink, A. K., & Silliman, R. A. (2006) · Breast Cancer Research and Treatment · doi:10.1007/s10549-006-9193-0 · Cited by 321
Antidepressant-Induced Sexual Dysfunction
Gregorian, R. S., Golden, K. A., Bahce, A., Goodman, C., Kwong, W. J., & Khan, Z. M. (2002) · Annals of Pharmacotherapy · doi:10.1345/aph.1a195 · Cited by 320
Quality of Life of Postmenopausal Women in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) Adjuvant Breast Cancer Trial
Fallowfield, L. J., Cella, D. F., Cuzick, J. M., Francis, S., Locker, G. Y., & Howell, A. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.08.029 · Cited by 310 · cited 3×
“reunia (painful intercourse) and loss of libido, which were reported with a significantly higher incidence in patients treated with anastrozole compared with tamoxifen in the ATAC trial [20, 22].”
BackgroundSelf-citation
Intentional and non-intentional non-adherence to medication amongst breast cancer patients
Atkins, L., & Fallowfield, L. (2006) · European Journal of Cancer · doi:10.1016/j.ejca.2006.03.004 · Cited by 300 · cited 2×
“Overall, nonadherence to treatment represents a missed opportunity for health gain, and renders the interpretation of clinical trial data as potentially unrealistic in the absence of adherence data [15].”
BackgroundSelf-citation
Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women
Goldstat, R., Briganti, E. M., Tran, J., Wolfe, R. S., & Davis, S. R. (2003) · Menopause The Journal of The North American Menopause Society · doi:10.1097/01.gme.0000060256.03945.20 · Cited by 299
Caution: Vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors
Kendall, A., Dowsett, M., Folkerd, E. J., & Smith, I. (2006) · Annals of Oncology · doi:10.1093/annonc/mdj127 · Cited by 276 · cited 1×
“In a study of AI-treated patients with breast cancer who used vaginal estradiol tablets, investigators documented significant increases in systemic estradiol levels, at least in the short term (2–4 weeks), and therefore considered these preparations contraindicated for women with HR + breast cancer [63, 64].”
Background
Sexuality and Fertility after Cancer
Schover, L. R. (2005) · Hematology · doi:10.1182/asheducation-2005.1.523 · Cited by 257
Quality of Life of Postmenopausal Women in the ATAC (“Arimidex”, Tamoxifen, Alone or in Combination) Trial after Completion of 5 years' Adjuvant Treatment for Early Breast Cancer
Cella, D. F., Fallowfield, L. J., Barker, P. N., Cuzick, J. M., Locker, G. Y., Howell, A., & On behalf of the ATAC Trialistsȁ9 Group (2006) · Breast Cancer Research and Treatment · doi:10.1007/s10549-006-9260-6 · Cited by 251 · cited 2×
“reunia (painful intercourse) and loss of libido, which were reported with a significantly higher incidence in patients treated with anastrozole compared with tamoxifen in the ATAC trial [20, 22].”
BackgroundSelf-citation
Adherence beliefs among breast cancer patients taking tamoxifen
Grunfeld, E. A., Hunter, M. S., Sikka, P., & Mittal, S. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2004.10.005 · Cited by 245
Assessment of Quality of Life in MA.17: A Randomized, Placebo-Controlled Trial of Letrozole After 5 Years of Tamoxifen in Postmenopausal Women
Whelan, T. J., Goss, P. E., Ingle, J. N., Pater, J. L., Tu, D., Pritchard, K. I., Liu, S., Shepherd, L. E., Palmer, M. K., Robert, N. J., et al. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.11.181 · Cited by 239 · cited 2×
“17 trial [25]; PLA = placebo; OR = odds ratio.”
BackgroundMethod
Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition? A pilot study
Jenkins, V. A., Shilling, V. M., Fallowfield, L. J., Howell, A., & Hutton, S. B. (2003) · Psycho-Oncology · doi:10.1002/pon.709 · Cited by 227 · cited 1×
“A pilot crosssectional ATAC substudy reported impairments in verbal memory and processing speed in EBC patients receiving either anastrozole or tamoxifen, compared with healthy controls [75].”
BackgroundSelf-citation
A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors.
Stearns, V., Isaacs, C., Rowland, J., Crawford, J., Ellis, M. J., Kramer, R., Lawrence, W., Hanfelt, J. J., & Hayes, D. F. (2000) · Annals of Oncology · doi:10.1023/a:1008382706068 · Cited by 224
Estrogen- and tamoxifen-associated effects on brain structure and function
Eberling, J. L., Wu, C. C., Tong-Turnbeaugh, R., & Jagust, W. (2003) · NeuroImage · doi:10.1016/j.neuroimage.2003.08.037 · Cited by 214 · cited 2×
“compared with healthy postmenopausal women, exhibited hypometabolism in the inferior and dorsal lateral frontal lobes, smaller hippocampal volumes, and significantly lower semantic memory scores [76].”
BackgroundResult
The influence of letrozole on serum lipid concentrations in postmenopausal women with primary breast cancer who have completed 5 years of adjuvant tamoxifen (NCIC CTG MA.17L)
Wasan, K. M., Goss, P. E., Pritchard, P. H., Shepherd, L. E., Palmer, M., Liu, S., Tu, D., Ingle, J. N., Heath, M., DeAngelis, D., et al. (2005) · Annals of Oncology · doi:10.1093/annonc/mdi158 · Cited by 179 · cited 1×
“17 trial (with placebo as the comparator) [3, 18].”
Background
Breast Cancer Chemotherapy-Related Cognitive Dysfunction
Ahles, T. A., & Saykin, A. J. (2002) · Clinical Breast Cancer · doi:10.3816/cbc.2002.s.018 · Cited by 177 · cited 1×
“In retrospective studies of breast cancer survivors, some investigators found cognitive decline (especially in verbal learning, visuospatial functioning, and visual memory) to be greater in patients who received tamoxifen plus chemotherapy (compared with chemotherapy alone or surgery alone), while others reported that…”
Background
Quality of Life in the Intergroup Exemestane Study: A Randomized Trial of Exemestane Versus Continued Tamoxifen After 2 to 3 Years of Tamoxifen in Postmenopausal Women With Primary Breast Cancer
Fallowfield, L. J., Bliss, J. M., Porter, L., Price, M. H., Snowdon, C. F., Jones, S. E., Coombes, R. C., & Hall, E. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.03.3654 · Cited by 177 · cited 14×
“Dyspareunia and diminished libido were also reported in the IES, but without a significant difference in incidence between the AI and tamoxifen groups [24].”
BackgroundInfluentialSelf-citation
Patients' preference for administration of endocrine treatments by injection or tablets: results from a study of women with breast cancer
Fallowfield, L. J., Atkins, L., Catt, S., Cox, A., Coxon, C. R., Langridge, C., Morris, R., & Price, M. H. (2005) · Annals of Oncology · doi:10.1093/annonc/mdj044 · Cited by 173 · cited 2×
“Although 63% of women preferred daily oral medication over a monthly intramuscular (im) injection, the primary reason given for the im preference was to ensure adherence [14].”
BackgroundSelf-citation
Pre‐treatment factors related to cognitive functioning in women newly diagnosed with breast cancer
Cimprich, B., So, H., Ronis, D. L., & Trask, C. L. (2004) · Psycho-Oncology · doi:10.1002/pon.821 · Cited by 172 · cited 2×
“A chronic health problem and menopausal status are secondary predictors [79].”
Background
Aromatase inhibitors and the syndrome of arthralgias with estrogen deprivation
Felson, D. T., & Cummings, S. R. (2005) · Arthritis & Rheumatism · doi:10.1002/art.21364 · Cited by 163 · cited 2×
“Increased pain sensitivity due to estrogen deficiency might also be a factor in arthralgia, as estrogen is known to modulate neural processing of nociceptive input at the level of the central nervous system [46].”
Background
The clinical significance of quality of life assessments in oncology: a summary for clinicians
Sloan, J. A., Frost, M. H., Berzon, R., Dueck, A., Guyatt, G., Moinpour, C., Sprangers, M., Ferrans, C., Cella, D., & Clinical Significance Consensus Meeting Group (2006) · Supportive Care in Cancer · doi:10.1007/s00520-006-0085-y · Cited by 149 · cited 1×
“In addition to clinician-reported AEs recorded for safety monitoring in clinical trials, data captured via patient selfreport on validated QoL instruments may provide important complementary information about a drug’s tolerability [19].”
Self-citation
ATAC trial update
Mastro, L. D., & Venturini, M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)74802-9 · Cited by 133
Preoperative Twice-Weekly Paclitaxel With Concurrent Radiation Therapy Followed by Surgery and Postoperative Doxorubicin-Based Chemotherapy in Locally Advanced Breast Cancer: A Phase I/II Trial
Formenti, S. C., Volm, M. D., Skinner, K. A., SPICER, D. V., Cohen, D., Perez, E. A., Bettini, A., Groshen, S. G., Gee, C., Florentine, B. D., et al. (2003) · Journal of Clinical Oncology · doi:10.1200/jco.2003.06.132 · Cited by 127
Extended adjuvant treatment with anastrozole: Results from the Austrian Breast and Colorectal Cancer Study Group Trial 6a (ABCSG-6a)
Jakesz, R., Samonigg, H., Greil, R., Gnant, M., Schmid, M., Kwasny, W., Kubista, E., Mlineritsch, B., Tausch, C., & Stierer, M. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.23.16_suppl.527 · Cited by 120 · cited 2×
“As shown in Table 1, these trials have explored the use of AIs as initial adjuvant treatment compared with tamoxifen [1–3], as sequential therapy following 2–3 years of tamoxifen [4–6], and as extended therapy following 5 years of tamoxifen [7, 8].”
MethodInfluential
Phase III Comparison of Depomedroxyprogesterone Acetate to Venlafaxine for Managing Hot Flashes: North Central Cancer Treatment Group Trial N99C7
Loprinzi, C. L., Levitt, R., Barton, D. L., Sloan, J. A., Dakhil, S. R., Nikcevich, D. A., Bearden, J. D., Mailliard, J. A., Tschetter, L. K., Fitch, T. R., et al. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.04.7324 · Cited by 119 · cited 1×
“acupuncture have shown efficacy in reducing hot flashes [50, 51, 57, 61].”
Background
Nodal Metastasis Is Highly Consistent in Squamous Cell Carcinoma of the Vulva
Penson, R. T., Fuller, A. F., de Hullu, J. A., & van der Zee, A. G. J. (2001) · Journal of Clinical Oncology · doi:10.1200/jco.2001.19.10.2767 · Cited by 118
Feasibility of Quantifying the Effects of Epoetin Alfa Therapy on Cognitive Function in Women with Breast Cancer Undergoing Adjuvant or Neoadjuvant Chemotherapy
O’Shaughnessy, J., Vukelja, S. J., Holmes, F. A., Savin, M. A., Jones, M., Royall, D. R., George, M. J., & Hoff, D. D. V. (2005) · Clinical Breast Cancer · doi:10.3816/cbc.2005.n.002 · Cited by 114 · cited 1×
“Patients randomized to epoetin alfa, compared with placebo, exhibited higher mean hemoglobin levels, better executive control function, and less fatigue at 12 weeks of adjuvant anthracycline-based chemotherapy, though group differences were not significant at 6 months [83].”
Background
Tolerability of hormone therapies for breast cancer: How informative are documented symptom profiles in medical notes for ‘well-tolerated’ treatments?
Fellowes, D., Fallowfield, L. J., Saunders, C. M., & Houghton, J. (2001) · Breast Cancer Research and Treatment · doi:10.1023/a:1010684903199 · Cited by 100 · cited 1×
“In one assessment, treatment-related symptoms documented by clinicians in medical notes were compared to those that patients reported in an interview, and it was found that only 89% of women receiving hormonal therapy had side effects in their medical notes, compared with 99% who reported side effects in an interview…”
ResultSelf-citation
Switching to anastrozole (ANA) vs continued tamoxifen (TAM) treatment of early breast cancer (EBC). Updated results of the Italian tamoxifen anastrozole (ITA) trial
Boccardo, F., RUBAGOTTI, A., Puntoni, M., Guglielmini, P., Porpiglia, M., Mesiti, M., Rinaldini, M., Paladini, G., Distante, V., & Franchi, R. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.23.16_suppl.526 · Cited by 100
Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: a randomized study
Bertelli, G., Venturini, M., Mastro, L. D., Bergaglio, M., Sismondi, P., Biglia, N., Venturini, S., Porcile, G., Pronzato, P., Costantini, M., et al. (2002) · Annals of Oncology · doi:10.1093/annonc/mdf151 · Cited by 98 · cited 3×
“acupuncture have shown efficacy in reducing hot flashes [50, 51, 57, 61].”
Background
The Effects of Tamoxifen and Estrogen on Brain Metabolism in Elderly Women
Ernst, T. (2002) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/94.8.592 · Cited by 93
Pilot evaluation of citalopram for the relief of hot flashes.
Barton, D. L., Loprinzi, C. L., Novotny, P., Shanafelt, T. D., Sloan, J. A., Wahner‐Roedler, D. L., Rummans, T. A., Christensen, B. J., Dakhil, S. R., & Martin, L. (2003) · PubMed · Cited by 90
Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm
Filshie, J., Bolton, T., Browne, D. R. G., & Ashley, S. E. (2005) · Acupuncture in Medicine · doi:10.1136/aim.23.4.171 · Cited by 87
Effects of third-generation aromatase inhibitors on bone
McCloskey, E. V. (2006) · European Journal of Cancer · doi:10.1016/j.ejca.2005.10.028 · Cited by 78 · cited 1×
“Arthralgia is considered a class effect of AIs, with a reported incidence 2–8% higher in patients treated with AIs versus those treated with tamoxifen [44, 45].”
Background
Hot flushes in breast cancer patients
Mom, C. H., Buijs, C., Willemse, P. H. B., Mourits, M. J. E., & de Vries, E. G. E. (2005) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2005.04.009 · Cited by 68 · cited 3×
“Norepinephrine and serotonin are the primary neurotransmitters involved in thermoregulation [48].”
BackgroundInfluential
Inhibition of RANKL as a treatment for osteoporosis: Preclinical and early clinical studies
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See all 286

Authors: Cella, D., & Fallowfield, L. J.
Affiliations: Northwestern University (US)
Brighton and Sussex Medical School (GB)
Corresponding author: Cella, David
ORCID: Cella, David
Fallowfield, Lesley J.
Venue: Breast Cancer Research and Treatment
Publisher: Springer Science and Business Media LLC
Published: 2007-09-18
Volume: 107
Issue: 2
Pages: 167-180
ISSN: 0167-6806 (ISSN-L)
1573-7217
DOI: 10.1007/s10549-007-9548-1
OpenAlex: W2034100757
Cited by: 286
References: 83
Citations by year: 2026: 9 · 2025: 17 · 2024: 16 · 2023: 22 · 2022: 20 · 2021: 17 · 2020: 14 · 2019: 16 · 2018: 15 · 2017: 19 · 2016: 17 · 2015: 15 · 2014: 9 · 2013: 14 · 2012: 17
FWCI: 0.88
Type: journal article
Language: en
Open access: green
figshare.com
Licence: cc-by
www.springer.com/tdm (tdm)
Locations: Breast Cancer Research and Treatment (publishedVersion)
PubMed (publishedVersion)
Sussex Research Online (University of Sussex) (submittedVersion)
Figshare (submittedVersion, cc-by)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords: breast cancer, adjuvant endocrine therapy, aromatase inhibitors, tamoxifen, treatment-related adverse events, medication adherence, health-related quality of life, vasomotor symptoms, hot flashes, vaginal dryness, dyspareunia, joint pain, adverse event management, hormone receptor-positive breast cancer
MeSH terms: Aromatase, Breast Neoplasms, Clinical Trials as Topic, Endocrine System, Female, Humans, Medical Oncology, Patient Compliance, Quality of Life, Surveys and Questionnaires, Tamoxifen, Treatment Outcome, Chemotherapy, Adjuvant, Antineoplastic Agents, Hormonal, Aromatase Inhibitors

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Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy

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