Jennifer Y Sheng1, Amanda L Blackford1, Aditya Bardia2, Raghunandan Venkat1, Gedge Rosson1, Jon Giles3, Daniel F Hayes4, Stacie C Jeter1, Zhe Zhang1,5, Jill Hayden4, Anne Nguyen6, Anna Maria Storniolo6, Karineh Tarpinian1,7, Norah Lynn Henry4,8, Vered Stearns9,10. 1. Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA. 2. Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA, USA. 3. Vagelos College of Physicians and Surgeons, Columbia University, New York, USA. 4. University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA. 5. Pfizer, San Diego, CA, USA. 6. Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA. 7. The Emmes Corporation, Rockville, MD, USA. 8. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 9. Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA. vstearn1@jhmi.edu. 10. Johns Hopkins School of Medicine, Breast Cancer Research Chair in Oncology, Sidney Kimmel Comprehensive Cancer Center, Under Armour Breast Health Innovation Center, Skip Viragh Building, 10-291, 201 North Broadway, Baltimore, MD, 21287, USA. vstearn1@jhmi.edu.
Abstract
PURPOSE:Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. METHODS:Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. RESULTS: Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. CONCLUSION: For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
RCT Entities:
PURPOSE:Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. METHODS: Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. RESULTS: Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. CONCLUSION: For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
Entities:
Keywords:
Aromatase inhibitor induced musculoskeletal symptoms; Breast cancer survivor; Carpal tunnel syndrome; Early detection; Endocrine therapy
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