title: Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy.
abstract: BACKGROUND
  Aromatase inhibitor (AI) therapy results in substantial survival benefits for patients with hormone receptor-positive breast cancer. The rates of poor adherence and discontinuation of AI therapy are high, primarily because of treatment-related toxicities like musculoskeletal pain. Although pain-related symptoms may worsen during AI therapy, the authors hypothesized that nonpersistence with AI therapy was associated with symptoms that were present before treatment initiation.
  
  
  METHODS
  Postmenopausal women initiating AI therapy who were enrolled in a prospective clinical trial completed questionnaires at baseline to assess sleep, fatigue, mood, and pain. Reasons for treatment discontinuation during the first year of treatment were recorded. Associations between baseline patient-reported symptoms and treatment discontinuation because of toxicity were identified using logistic regression.
  
  
  RESULTS
  Four hundred forty-nine patients were evaluable. The odds of treatment discontinuation were higher in patients who reported a greater number of symptoms before AI initiation. Baseline poor sleep quality was associated with early treatment discontinuation, with an odds ratio (OR) of 1.91 (95% confidence interval [CI], 1.26-2.89; P = .002). Baseline presence of tired feeling and forgetfulness had similar ORs for discontinuation (tired feeling: OR, 1.76; 95% CI, 1.15-2.67; P = .009; forgetfulness: OR, 1.66; 95% CI, 1.11-2.48; P = .015). An increasing total number of baseline symptoms was associated with an increased likelihood of treatment discontinuation, with an OR of 1.89 (95% CI, 1.20-2.96; P = .006) for 3 to 5 symptoms versus 0 to 2 symptoms.
  
  
  CONCLUSIONS
  Symptom clusters in breast cancer survivors that are present before the initiation of adjuvant AI therapy may have a negative impact on a patient's persistence with therapy. Interventions to manage these symptoms may improve breast cancer outcomes and quality of life.
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Kidwell
authors.forename: Steven E
authors.initials: SE
authors.lastname: Harte
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hayes
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Storniolo
authors.forename: Janet
authors.initials: J
authors.lastname: Carpenter
authors.forename: David A
authors.initials: DA
authors.lastname: Flockhart
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.forename: David A
authors.initials: DA
authors.lastname: Williams
authors.forename: N Lynn
authors.initials: NL
authors.lastname: Henry
mesh_terms: D000730:Androstadienes / Q000009:adverse effects / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077289:Letrozole; C056516:exemestane
keywords: aromatase inhibitor; breast cancer; nonpersistence; patient-reported outcomes; symptoms