title: Joint pain severity predicts premature discontinuation of aromatase inhibitors in breast cancer survivors.
abstract: BACKGROUND
  Premature discontinuation of aromatase inhibitors (AIs) in breast cancer survivors compromises treatment outcomes. We aimed to evaluate whether patient-reported joint pain predicts premature discontinuation of AIs.
  
  
  METHODS
  We conducted a retrospective cohort study of postmenopausal women with breast cancer on AIs who had completed a survey about their symptom experience on AIs with specific measurements of joint pain. The primary outcome was premature discontinuation of AIs, defined as stopping the medication prior to the end of prescribed therapy. Multivariate Cox regression modeling was used to identify predictors of premature discontinuation.
  
  
  RESULTS
  Among 437 patients who met eligibility criteria, 47 (11%) prematurely discontinued AIs an average of 29 months after initiation of therapy. In multivariate analyses, patient-reported worst joint pain score of 4 or greater on the Brief Pain Inventory (BPI) (Hazard Ratio [HR] 2.09, 95% Confidence Interval [CI] 1.14-3.80, P = 0.016) and prior use of tamoxifen (HR 2.01, 95% CI 1.09-3.70, P = 0.026) were significant predictors of premature discontinuation of AIs. The most common reason for premature discontinuation was joint pain (57%) followed by other therapy-related side effects (30%). While providers documented joint pain in charts for 82% of patients with clinically important pain, no quantitative pain assessments were noted, and only 43% provided any plan for pain evaluation or management.
  
  
  CONCLUSIONS
  Worst joint pain of 4 or greater on the BPI predicts premature discontinuation of AI therapy. Clinicians should monitor pain severity with quantitative assessments and provide timely management to promote optimal adherence to AIs.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street - 2 Gates, Philadelphia, Pennsylvania 19104, USA. jun.mao@uphs.upenn.edu.
authors.forename: Kannie
authors.initials: K
authors.lastname: Chim
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Xie
authors.forename: Carrie T
authors.initials: CT
authors.lastname: Stricker
authors.forename: Qing S
authors.initials: QS
authors.lastname: Li
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.forename: John T
authors.initials: JT
authors.lastname: Farrar
authors.forename: Angela
authors.initials: A
authors.lastname: DeMichele
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D018771:Arthralgia / Q000209:etiology*; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors