Advertisement

Aromatase Inhibitor Symptom Management Practices: A Retrospective Study

      Abstract

      Purpose

      Aromatase inhibitor (AI)-associated symptoms contribute to early therapy discontinuation. Although guidelines exist for management of these symptoms, little is known about the degree to which physicians address symptoms and adhere to the guidelines for treatment.

      Patients and Methods

      In this retrospective chart review, women with hormone receptor–positive breast cancer who were prescribed an AI between October 15, 2012, and September 14, 2017, were randomly selected from the institution’s cancer registry. Patient medical records were reviewed to identify the prevalence of symptom documentation and management. Documented symptoms were categorized into musculoskeletal, vasomotor, and urogenital. Symptom treatment guidelines were compiled from the National Comprehensive Cancer Network (NCCN) and the American Cancer Society/American Society of Clinical Oncology (ACS/ASCO). Treatments were categorized as either meeting or not meeting the guidelines. Among patients with symptoms recorded, chi-square tests and time-to-event models were used to examine factors associated with treatment and factors associated with guideline-based treatment.

      Results

      Among 179 women prescribed an AI, 82% had at least one symptom and 46% had multiple symptoms. Of the 147 women with any documented symptom, 97 (66%) received some form of symptom-palliating treatment. Seventy-seven patients (52%) received guideline-based treatments or guideline-based treatments in combination with non–guideline-based treatments. There were no differences in receipt of treatment overall (ie, guideline based or non–guideline based) for either vasomotor or musculoskeletal symptoms by age, race, or stage.

      Conclusion

      Although 82% of patients had symptoms documented in their medical records, just over half of those patients received guideline-based treatment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Cancer Society
        Breast cancer facts and figures, 2019-2020.
        (Available at:)
        • US Centers for Disease Control and Prevention
        US cancer statistics data visualizations tool. Based on November 2018 submission data (1999-2016).
        (Available at:)
        • World Health Organization
        Adherence to long-term therapies: evidence for action.
        (Available at:)
        • Hershman D.L.
        • Shao T.
        • Kushi L.H.
        • et al.
        Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer.
        Breast Cancer Res Treat. 2011; 126: 529-537
        • Avvaru S.P.
        • Noolvi M.N.
        • Aminbhav T.M.
        • Chkraborty S.
        • Dash A.
        • Shukla S.S.
        Aromatase inhibitors evolution as potential class of drugs in the treatment of postmenopausal breast cancer women.
        Mini Rev Med Chem. 2018; 18: 609-621
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology: breast cancer, version 3.2017.
        (Available at:)
        • Partridge A.H.
        • LaFountain A.
        • Mayer E.
        • Taylor B.S.
        • Winer E.
        • Asnis-Alibozek A.
        Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer.
        J Clin Oncol. 2008; 26: 556-562
        • Hershman D.L.
        • Kushi L.H.
        • Shao T.
        • et al.
        Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients.
        J Clin Oncol. 2010; 28: 4120-4128
        • Cuzick J.
        • Sestak I.
        • Forbes J.F.
        • et al.
        Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial.
        Lancet. 2014; 383: 1041-1048
        • Goss P.E.
        • Ingle J.N.
        • Alés-Martínez J.E.
        • et al.
        Exemestane for breast-cancer prevention in postmenopausal women.
        N Engl J Med. 2011; 364: 2381-2391
        • Menas P.
        • Merkel D.
        • Hui W.
        • Lawton J.
        • Harper A.
        • Carro G.
        Incidence and management of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic.
        J Oncol Pharm Pract. 2012; 18: 387-393
        • Oberguggenberger A.
        • Hubalek M.
        • Sztankay M.
        • et al.
        Is the toxicity of adjuvant aromatase inhibitor therapy underestimated? Complementary information from patient-reported outcomes (PROs).
        Breast Cancer Res Treat. 2011; 128: 553-561
        • Baker A.
        Crossing the quality chasm: a new health system for the 21st century.
        BMJ. 2001; 323: 1192
        • Epstein R.M.
        • Fiscella K.
        • Lesser C.S.
        • Stange K.C.
        Why the nation needs a policy push on patient-centered health care.
        Health Aff (Millwood). 2010; 29: 1489-1495
        • Barry C.A.
        • Bradley C.P.
        • Britten N.
        • Stevenson F.A.
        • Barber N.
        Patients’ unvoiced agendas in general practice consultations: qualitative study.
        BMJ. 2000; 320: 1246-1250
      1. What is patient-centered care?.
        Catalyst Carryover. 2017; 3 (https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559)
        • Boonstra A.
        • van Zadelhoff J.
        • Timmer-Bonte A.
        • Ottevanger P.B.
        • Beurskens C.H.
        • van Laarhoven H.W.
        Arthralgia during aromatase inhibitor treatment in early breast cancer patients: prevalence, impact, and recognition by healthcare providers.
        Cancer Nurs. 2013; 36: 52-59
        • Beckwee D.
        • Leysen L.
        • Meuwis K.
        • Adriaenssens N.
        Prevalence of aromatase inhibitor–induced arthralgia in breast cancer: a systematic review and meta-analysis.
        Support Care Cancer. 2017; 25: 1673-1686
        • Denis J.L.
        • Hebert Y.
        • Langley A.
        • Lozeau D.
        • Trottier L.H.
        Explaining diffusion patterns for complex health care innovations.
        Health Care Manage Rev. 2002; 27: 60-73
        • Carpenter W.R.
        • Reeder-Hayes K.
        • Bainbridge J.
        • et al.
        The role of organizational affiliations and research networks in the diffusion of breast cancer treatment innovation.
        Med Care. 2011; 49: 172-179
        • Rogers E.
        Diffusion of Innovations.
        4th ed. Simon & Schuster, New York1995
        • Denlinger C.S.
        • Sanft T.
        • Baker K.S.
        • et al.
        Survivorship, version 2.2017, NCCN Clinical Practice Guidelines in Oncology.
        J Natl Compr Canc Netw. 2017; 15: 1140-1163
        • Hollowell K.
        • Olmsted C.L.
        • Richardson A.S.
        • et al.
        American Society of Clinical Oncology–recommended surveillance and physician specialty among long-term breast cancer survivors.
        Cancer. 2010; 116: 2090-2098
        • Sanft T.
        • Denlinger C.S.
        • Armenian S.
        • et al.
        NCCN Guidelines insights: survivorship, version 2.2019.
        J Natl Compr Canc Netw. 2019; 17: 784-794
        • Seow H.
        • Sussman J.
        • Martelli-Reid L.
        • Pond G.
        • Bainbridge D.
        Do high symptom scores trigger clinical actions? An audit after implementing electronic symptom screening.
        J Oncol Pract. 2012; 8: e142-e148
        • Sikorskii A.
        • Wyatt G.
        • Tamkus D.
        • Victorson D.
        • Rahbar M.H.
        • Ahn S.
        Concordance between patient reports of cancer-related symptoms and medical records documentation.
        J Pain Symptom Manage. 2012; 44: 362-372
        • Hershman D.L.
        • Unger J.M.
        • Greenlee H.
        • et al.
        Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: a randomized clinical trial.
        JAMA. 2018; 320: 167-176
        • Henry N.L.
        • Unger J.M.
        • Schott A.F.
        • et al.
        Randomized, multicenter, placebo-controlled clinical trial of duloxetine versus placebo for aromatase inhibitor–associated arthralgias in early-stage breast cancer: SWOG S1202.
        J Clin Oncol. 2018; 36: 326-332
        • Irwin M.L.
        • Cartmel B.
        • Gross C.P.
        • et al.
        Randomized exercise trial of aromatase inhibitor–induced arthralgia in breast cancer survivors.
        J Clin Oncol. 2015; 33: 1104-1111
        • Yen T.W.F.
        • Laud P.W.
        • McGinley E.L.
        • Pezzin L.E.
        • Nattinger A.B.
        Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer.
        Breast Cancer Res Treat. 2020; 179: 57-65
        • Briot K.
        • Tubiana-Hulin M.
        • Bastit L.
        • Kloos I.
        • Roux C.
        Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor–positive breast cancer: the ATOLL (articular tolerance of letrozole) study.
        Breast Cancer Res Treat. 2010; 120: 127-134
        • Henry N.L.
        • Azzouz F.
        • Desta Z.
        • et al.
        Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer.
        J Clin Oncol. 2012; 30: 936-942
        • Reese J.B.
        • Shelby R.A.
        • Keefe F.J.
        • Porter L.S.
        • Abernethy A.P.
        Sexual concerns in cancer patients: a comparison of GI and breast cancer patients.
        Support Care Cancer. 2010; 18: 1179-1189
        • Gilbert E.
        • Perz J.
        • Ussher J.M.
        Talking about sex with health professionals: the experience of people with cancer and their partners.
        Eur J Cancer Care. 2016; 25: 280-293
        • Schover L.R.
        • Baum G.P.
        • Fuson L.A.
        • Brewster A.
        • Melhem-Bertrandt A.
        Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors.
        J Sex Med. 2014; 11: 3102-3111
        • Dorfman C.S.
        • Arthur S.S.
        • Kimmick G.G.
        • et al.
        Partner status moderates the relationships between sexual problems and self-efficacy for managing sexual problems and psychosocial quality-of-life for postmenopausal breast cancer survivors taking adjuvant endocrine therapy.
        Menopause. 2019; 26: 823-832
        • Reese J.B.
        • Sorice K.
        • Beach M.C.
        • et al.
        Patient–provider communication about sexual concerns in cancer: a systematic review.
        J Cancer Surviv. 2017; 11: 175-188
        • Flynn K.E.
        • Whicker D.
        • Lin L.
        • Cusatis R.
        • Nyitray A.
        • Weinfurt K.P.
        Sexual orientation and patient-provider communication about sexual problems or concerns among US adults.
        J Gen Intern Med. 2019; 34: 2505-2511
        • Tran Q.
        • Warren J.L.
        • Barrett M.J.
        • et al.
        An evaluation of the utility of big data to supplement cancer treatment information: linkage between IQVIA pharmacy database and the Surveillance, Epidemiology, and End Results Program.
        JNCI Monogr. 2020; 2020: 72-81