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Breast Cancer Research and Treatment

, Volume 146, Issue 1, pp 109–116 | Cite as

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

  • A. Lintermans
  • K. Van Asten
  • H. Wildiers
  • A. Laenen
  • R. Paridaens
  • C. Weltens
  • J. Verhaeghe
  • D. Vanderschueren
  • A. Smeets
  • E. Van Limbergen
  • K. Leunen
  • M. R. Christiaens
  • P. Neven
Clinical Trial

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.

Keywords

Breast cancer Aromatase inhibitor Tamoxifen Arthralgia Grip strength BMI 

Notes

Funding

This work was supported by the Stichting Emmanuel van der Schueren, the scientific partner of the Vlaamse Liga tegen Kanker.

Conflict of interest

The authors have declared no conflicts of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • A. Lintermans
    • 1
  • K. Van Asten
    • 1
  • H. Wildiers
    • 1
    • 2
    • 3
  • A. Laenen
    • 4
  • R. Paridaens
    • 1
    • 2
    • 3
  • C. Weltens
    • 2
    • 5
  • J. Verhaeghe
    • 6
    • 7
  • D. Vanderschueren
    • 6
    • 8
  • A. Smeets
    • 1
    • 2
    • 9
  • E. Van Limbergen
    • 2
    • 5
  • K. Leunen
    • 1
    • 2
    • 7
  • M. R. Christiaens
    • 1
    • 2
    • 9
  • P. Neven
    • 1
    • 2
    • 7
  1. 1.Department of OncologyKU LeuvenLouvainBelgium
  2. 2.Multidisciplinary Breast CenterUniversity Hospitals LeuvenLouvainBelgium
  3. 3.General Medical OncologyUniversity Hospitals LeuvenLouvainBelgium
  4. 4.Electrical Engineering (ESAT-SISTA)KU LeuvenLouvainBelgium
  5. 5.RadiotherapyUniversity Hospitals LeuvenLouvainBelgium
  6. 6.Laboratory of Clinical and Experiment EndocrinologyKU LeuvenLouvainBelgium
  7. 7.GynecologyUniversity Hospitals LeuvenLouvainBelgium
  8. 8.Laboratory MedicineUniversity Hospitals LeuvenLouvainBelgium
  9. 9.Surgical OncologyUniversity Hospitals LeuvenLouvainBelgium

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