Abstract PD08-05: Longitudinal Change of Pain and Other Symptoms in Breast Cancer Patients with Anastrozole Treatment
Authors: Shi Q , Giordano SH , Lu H , Cleeland CS. 
Published: April 2011

Background About one in three breast cancer patients undergoing treated with aromatase inhibitors report problems with joint pain, some times interfering with work and other activities. We conducted a longitudinal study to characterize the course and impact of arthralgia and other symptoms during anastozole therapy by following how pain and other symptoms change during anastrozole treatment, and the impact of symptoms on patient's functioning, health-related quality of life (HRQoL), and work productivity.

Methods Two cohorts of patients were included: Cohort I recruited patients at the start of anastrozole therapy: Cohort II recruited patients at the beginning of their third year of treatment. Brief Pain Inventory and MD Anderson Symptom Inventory were used to monthly assess patients’ pain, multiple symptoms, and functioning. A single item of quality of life question and the Work Productivity and Activity Impairment Questionnaire: General Health V2.0 were used to measure patient's HRQoL and impairment of working productivity every 6 months. A joint pain self-assessment kit was used to locate the affected joints. Statistical analyses were based on the one-year follow-up data and t-test, mixed effects models, linear regression models, and correlation coefficients were used.

Results At this point in the study, thirty-eight patients have finished the one year assessment in cohort I and 37 patients in cohort II. Cohort I patients reported no or mild pain and symptoms before they started therapy. Compared to baseline, pain ratings on 0 to 10 scales significantly increased at the 5th month (4.17±3.66 vs. 1.52±2.38, p=.015) and then decreased to baseline levels at the 9th month. Similarly, patients reported higher level of distress (3.5±3.63 vs. 1.00±2.07, p=.014) and hot flashes (4.0±4.57 vs. 1.45±2.36, p=.039) at month 5 and decreased to baselines levels at month 9. Mixed effects model with the total symptom interference as the dependent variable identified that among all symptoms, pain had the greatest impact on patient functioning (p&lt;.0001). Patients with 4 or greater pain at month 5 reported poorer HRQoL at month 6 than those reported 3 or lower pain level (5.40±1.82 vs. 8.25±2.14, p=.020). Severity of pain at month 5 was positively correlated with working productivity: impairment at work (r=.80, p=.010), overall work productivity loss (r=.81, p=.014), and activity impairment (r=.84, p=.005). During the third year of anastrozole treatment, no symptom reaches the peak level at month 5 and no significant change was found over time, as well their HRQoL and working productivity. For cohort I patients, right knee was the most affected joint and right wrist as the most affected one for cohort II patients.

Conclusion Breast cancer patients beginning analstrozole therapy reported increased pain, distress, and hot flashes at the first year of treatment, worsening around the 5th month. Increased pain negatively impacted functioning, HRQoL, and work productivity. This study indicates that symptoms related to starting anastrozole develop over the first several months of therapy and have a functional impact on patients. Symptoms emerge when patients may be less actively followed clinically. Methods of managing these symptoms need to be investigated.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-05.