Abstract P5-13-05: Effect of aromatase inhibitor (AI) therapy on sleep and activity patterns in early stage breast cancer
Authors: Bhave MA , Kidwell K , Lyden AK , Alsamarraie C , Henry NL 
Published: March 2017

Background: AIs are commonly used for treatment of postmenopausal women with hormone receptor-positive breast cancer for 5-10 years. However, women often experience side effects including musculoskeletal pain and sleep disturbances that lead to treatment discontinuation and worse healthcare-related outcomes. There is a need to understand the impact of adjuvant AI therapy on sleep and activity patterns in treated patients and associations with treatment adherence. This study examines objective and subjective changes in sleep patterns and daytime function in patients starting AI therapy using actigraphy and questionnaires.

Methods: 49 postmenopausal women with hormone receptor-positive breast cancer who completed local surgery and chemotherapy and were planning to start AI therapy were enrolled. Patients completed 10 consecutive days of actigraphy and validated questionnaires to assess pain, sleep quality, fatigue and physical function at baseline and after three months of AI therapy. Changes in actigraphy parameters after 3 months of AI therapy were examined using paired T-tests and associations between actigraphy measures and patient-reported outcomes were examined using Pearson's correlations.

Results: 42 patients completed the baseline assessment and 22 patients completed the 3 month assessment. 20 patients were excluded due to incomplete actigraphy data (n=3), discontinuation of AI therapy (n=5) or withdrawal from the study per patient preference (n=12) prior to the 3 month assessment. Total 24 hour activity, average activity per minute and maximum activity over a 24 hour period worsened after 3 months of AI therapy (all p-values &lt;0.05). There was a trend towards worse sleep efficiency after 3 months. Patient-reported physical function also decreased after 3 months of AI therapy (p-value &lt;0.05), but pain severity remained unchanged. Worsening patient-reported fatigue after 3 months of AI treatment correlated to a decrease in average activity per minute (r=-0.55, p-value &lt;0.05) and maximum activity over a 24 hour period (r=-0.61, p-value &lt;0.05).

Changes in actigraphy variables and questionnaires after 3 months of AI therapyMean actigraphy sleep and activity variablesBaseline assessment3 month assessmentP-value*24 hour total activity2125901881040.01924 hour average activity per minute (AC)157.6141.00.03724 hour maximum activity (AC)10359030.012Total sleep time (min)456.1469.10.17Sleep efficiency (%)77.274.60.068Wake after sleep onset (min)72.982.00.52Total activity at night (AC)595367050.13PROMIS Physical Function52.148.30.001Brief Pain Inventory Severity0.601.10.10*p-value from t-test

Conclusions: Daytime activity and sleep patterns are negatively affected by AI therapy and are associated with worsening fatigue. Future research is needed to better understand the relationship between fatigue and daytime activity, which may lead to interventions to improve tolerance and adherence to AI therapy.

Citation Format: Bhave MA, Kidwell K, Lyden AK, Alsamarraie C, Henry NL. Effect of aromatase inhibitor (AI) therapy on sleep and activity patterns in early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-05.