title: A prospective assessment of musculoskeletal toxicity and loss of grip strength in breast cancer patients receiving adjuvant aromatase inhibitors and tamoxifen, and relation with BMI.
abstract: Aromatase inhibitor (AI) therapy for estrogen receptor-positive breast cancer is known to induce or enhance musculoskeletal problems. We have previously reported that loss of grip strength is more pronounced in AI-users with extremes in BMI. We here report results from a larger prospective study. Postmenopausal early breast cancer patients scheduled to start AI or tamoxifen therapy were recruited. A functional assessment grip strength test was performed at baseline, 3, 6, and 12 months of therapy. BMI was assessed, and a rheumatologic questionnaire was completed at each visit. 188 patients on an AI and 104 patients on tamoxifen were enrolled. 74 % of AI-users reported new/worsened musculoskeletal complaints compared with 37 % in the tamoxifen group. This was translated in a larger grip strength decrease in patients experiencing AI-induced pain opposed to patients without new/worsened complaints (p = 0.0002). 15 % of AI-users discontinued therapy due to musculoskeletal symptoms, who were characterized by a larger grip strength reduction versus adherent patients (p = 0.0107). Young age (p = 0.0135), taxane-based chemotherapy (p = 0.0223), and baseline VAS score >4 (p = 0.0155) were predictors for AI-related musculoskeletal pain. In addition, a quadratic trend of BMI with grip strength change (p = 0.0090) and probability of discontinuation was observed (p = 0.0424). Musculoskeletal events were a substantial problem in AI-treated patients and an important reason for treatment discontinuation. The decrease in grip strength was larger in AI- than in tamoxifen-users, with a more pronounced change in symptomatic patients. The inverse relationship between BMI extremes and grip strength change was confirmed in this large group of AI-patients.
authors.affiliation: Department of Oncology, KU Leuven, Herestraat 49, 3000, Louvain, Belgium, anneleen.lintermans@uzleuven.be.
authors.forename: A
authors.initials: A
authors.lastname: Lintermans
authors.forename: K
authors.initials: K
authors.lastname: Van Asten
authors.forename: H
authors.initials: H
authors.lastname: Wildiers
authors.forename: A
authors.initials: A
authors.lastname: Laenen
authors.forename: R
authors.initials: R
authors.lastname: Paridaens
authors.forename: C
authors.initials: C
authors.lastname: Weltens
authors.forename: J
authors.initials: J
authors.lastname: Verhaeghe
authors.forename: D
authors.initials: D
authors.lastname: Vanderschueren
authors.forename: A
authors.initials: A
authors.lastname: Smeets
authors.forename: E
authors.initials: E
authors.lastname: Van Limbergen
authors.forename: K
authors.initials: K
authors.lastname: Leunen
authors.forename: M R
authors.initials: MR
authors.lastname: Christiaens
authors.forename: P
authors.initials: P
authors.lastname: Neven
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D018737:Hand Strength; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D059352:Musculoskeletal Pain / Q000209:etiology; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D017698:Postmenopause; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen