Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study
Abstract
Aromatase
inhibitors (AI) are the first-line treatment in women with breast
cancer for total estrogen depletion. Half the treated women may develop
pain and this condition may therefore be seen as a clinical model of
pain related to estrogen deprivation. In this prospective multicenter
study, we classified AI-related pain syndromes and identified their
predictors.
A one-year, prospective, multicenter cohort study,
with six visits, was carried out on 135 women with early-stage breast
cancer and no pain at the start of AI treatment.
At initial assessment,
we investigated clinical (demographic and psychosocial, cancer
characteristics and treatment, sleep, quality of life), biological (sex
hormones, vitamin D, bone biomarkers, oxidative stress, immunological
and inflammatory markers), environmental and genetic (polymorphism for
pain mechanisms) risk factors for pain.
During one year of
follow-up, 77 women (57%) developed pain, leading to AI discontinuation
in 12 cases.
Five pain syndromes were identified: joint pain (36%),
diffuse pain (22%), tendinitis (22%), neuropathic pain (9%) and mixed
pain (11%), mostly persistent (57%), with diffuse and joint pains the
most intense.
Risk factors for the development of pain included
higher levels of anxiety and impaired quality of life at the initial
assessment, whereas cancer characteristics, genetic background,
inflammation, immunological and hormonal status at baseline were not
significant predictors.
Key words: Breast cancer, pain, estrogen deprivation, aromatase inhibitors, arthritis
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