Article

Identification of Tools to Measure Changes in Musculoskeletal Symptoms and Physical Functioning in Women With Breast Cancer Receiving Aromatase Inhibitors

Karen K. Swenson

Mary Jo Nissen

Susan J. Henly

Laura Maybon

Jean Pupkes

Karen Zwicky

Michaela L. Tsai

Alice C. Shapiro

physical activity, aromatase inhibitors, women, breast cancer, measurements
ONF 2013, 40(6), 549-557. DOI: 10.1188/13.ONF.549-557

Purpose/Objectives: To estimate and compare responsiveness of standardized self-reported measures of musculoskeletal symptoms (MSSs) and physical functioning (PF) during treatment with aromatase inhibitors (AIs).

Design: Prospective, longitudinal study.

Setting: Park Nicollet Institute and North Memorial Cancer Center, both in Minneapolis, MN.

Sample: 122 postmenopausal women with hormone receptor-positive breast cancer.

Methods: MSSs and PF were assessed before starting AIs and at one, three, and six months using six self-reported MSSs measures and two PF tests.

Main Research Variables: MSSs and PF changes from baseline to six months.

Findings: Using the Breast Cancer Prevention Trial-Musculoskeletal Symptom (BCPT-MS) subscale, 54% of participants reported MSSs by six months. Scores from the BCPT-MS subscale and the physical function subscales of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) were most responsive to changes over six months.

Conclusions: BCPT-MS, AUSCAN, and WOMAC were the most responsive instruments for measuring AI-associated MSSs.

Implications for Nursing: Assessment and management of MSSs are important aspects of oncology care because MSSs can affect functional ability and AI adherence.

Knowledge Translation: The three measures with the greatest sensitivity were the BCPT-MS, AUSCAN, and WOMAC questionnaires. These measures will be useful when conducting research on change in MSSs associated with AI treatment in women with breast cancer.

Jump to a section

    References

    Allen, K.D., DeVellis, R.F., Renner, J.B., Kraus, V.B., & Jordan, J.M. (2007). Validity and factor structure of the AUSCAN Osteoarthritis Hand Index in a community-based sample. Osteoarthritis and Cartilage, 15, 830-836.
    American Cancer Society. (2013). Cancer facts and figures, 2013. Atlanta, GA: Author.
    Anderson, W.F., Katki, H.A., & Rosenberg, P.S. (2011). Incidence of breast cancer in the United States: Current and future trends. Journal of the National Cancer Institute, 103, 1397-1402.
    Bellamy, N. (2005). The WOMAC Knee and Hip Osteoarthritis Indices: Development, validation, globalization, and influence on the development of the AUSCAN Hand Osteoarthritis Indices. Clinical and Experimental Rheumatology, 23(5, Suppl. 39), S148-S153.
    Bellamy, N., Sothern, R.B., Campbell, J., & Buchanan, W.W. (2002). Rhythmic variations in pain, stiffness, and manual dexterity in hand osteoarthritis. Annals of the Rheumatic Diseases, 61, 1075-1080.
    Briot, K., Tubiana-Hulin, M., Bastit, L., Kloos, I., & Roux, C. (2010). 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 Research and Treatment, 120, 127-134.
    Broderick, J.E., Schneider, S., Junghaenel, D.U., Schwartz, J.E., & Stone, A.A. (2013). Validity and reliability of patient-reported outcomes measurement information system instruments in osteoarthritis. Arthritis Care Research, 65, 1623-1633. doi:10.1002/acr.22025
    Carlson, R.W., Allred, D.C., Anderson, B.O., Burstein, H.J., Carter, W.B., Edge, S.B., … Zellars, R. (2011). Invasive breast cancer. Journal of the National Comprehensive Cancer Network, 9, 136-222.
    Coates, A., Keshaviah, A., Thurlimann, B., Mouridsen, H., Mauriac, L., Forbes, J., … Goldhirsch, A. (2007). Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: Update of study BIG 1-98. Journal of Clinical Oncology, 25, 486-492.
    Cohen, J. (1977). Statistical power analysis for the behavioral sciences (revised ed.). New York, NY: Academic Press.
    Coleman, R.E., Bolten, W.W., Lansdown, M., Dale, S., Jackisch, C., Merkel, D., … Hadji, P. (2008). Aromatase inhibitor-induced arthralgia: Clinical experience and treatment recommendations. Cancer Treatment Reviews, 34, 275-282. doi:10.1016/j.ctrv.2007.10.004
    Coombes, R.C., Hall, E., Gibson, L.J., Paridaens, R., Jassem, J., Delozier, T., … van de Velde, C. (2004). A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. New England Journal of Medicine, 350, 1081-1092.
    Crew, K.D., Capodice, J.L., Greenlee, H., Brafman, L., Fuentes, D., Awad, D., … Hershman, D.L. (2010). Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Journal of Clinical Oncology, 28, 1154-1160.
    Crew, K.D., Greenlee, H., Capodice, J., Raptis, G., Brafman, L., Fuentes, D., … Hershman, D.L. (2007). Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. Journal of Clinical Oncology, 25, 3877-3883.
    Cuzick, J., Sestak, I., Baum, M., Buzdar, A., Howell, A., Dowsett, M., & Forbes, J.F. (2010). Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncology, 11, 1135-1141.
    Davidson, B., Vogel, V., & Wickerham, L. (2007). Oncologist-patient discussion of adjuvant hormonal therapy in breast cancer: Results of a linguistic study focusing on adherence and persistence to therapy. Journal of Supportive Oncology, 5, 139-143.
    Day, R., Ganz, P.A., Costantino, J.P., Cronin, W.M., Wickerham, D.L., & Fisher, B. (1999). Health-related quality of life and tamoxifen in breast cancer prevention: A report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. Journal of Clinical Oncology, 17, 2659-2669.
    Dodd, M., Janson, S., Facione, N., Faucett, J., Froelicher, E.S., Humphreys, J., … Taylor, D. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33, 668-676.
    Early Breast Cancer Trialists' Collaborative Group. (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet, 365, 1687-1717. doi:10.1016/S0140-6736(05)66544-0
    Fallowfield, L., Atkins, L., Catt, S., Cox, A., Coxon, C., Langridge, C., … Price, M. (2006). Patients' preference for administration of endocrine treatments by injection or tablets: Results from a study of women with breast cancer. Annals of Oncology, 17, 205-210.
    Fries, J.F., Cella, D., Rose, M., Krishnan, E., & Bruce, B. (2009). Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing. Journal of Rheumatology, 36, 2061-2066.
    Gaillard, S., & Stearns, V. (2011). Aromatase inhibitor-associated bone and musculoskeletal effects: New evidence defining etiology and strategies for management. Breast Cancer Research, 13, 205.
    Gallicchio, L., Macdonald, R., Wood, B., Rushovich, E., & Helzlsouer, K. (2011). Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy. Breast Cancer Research and Treatment, 130, 569-577. doi:10.1007/s10549-011-1611-2
    Ganz, P.A., Greendale, G.A., Petersen, L., Zibecchi, L., Kahn, B., & Belin, T.R. (2000). Managing menopausal symptoms in breast cancer survivors: Results of a randomized controlled trial. Journal of the National Cancer Institute, 92, 1054-1064. doi:10.1093/jnci/92.13.1054
    Glass, A.G., Lacey, J.V., Jr., Carreon, J.D., & Hoover, R.N. (2007). Breast cancer incidence, 1980-2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. Journal of the National Cancer Institute, 99, 1152-1161.
    Gummesson, C., Ward, M., & Atroshi, I. (2006). The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH. BMC Musculoskeletal Disorders, 7, 44.
    Henry, N.L., Azzouz, F., Desta, Z., Li, L., Nguyen, A.T., Lemler, S., … Storniolo, A.M. (2012). Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. Journal of Clinical Oncology, 30, 936-942.
    Henry, N.L., Banerjee, M., Wicha, M., Van Poznak, C., Smerage, J.B., Schott, A.F., … Hayes, D.F. (2011). Pilot study of duloxetine for treatment of aromatase inhibitor-associated musculoskeletal symptoms. Cancer, 117, 5469-5475. doi:10.1002/cncr.26230
    Henry, N.L., Giles, J.T., & Stearns, V. (2008). Aromatase inhibitor-associated musculoskeletal symptoms: Etiology and strategies for management. Oncology, 22, 1401-1408.
    Hudak, P.L., Amadio, P.C., & Bombardier, C. (1996). Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). American Journal of Industrial Medicine, 29, 602-608.
    Husted, J.A., Cook, R.J., Farewell, V.T., & Gladman, D.D. (2000). Methods for assessing responsiveness: A critical review and recommendations. Journal of Clinical Epidemiology, 53, 459-468.
    Kanematsu, M., Morimoto, M., Honda, J., Nagao, T., Nakagawa, M., Takahashi, M., … Sasa, M. (2011). The time since last menstrual period is important as a clinical predictor for non-steroidal aromatase inhibitor-related arthralgia. BMC Cancer, 11, 436.
    Khan, Q.J., O'Dea, A.P., & Sharma, P. (2010). Musculoskeletal adverse events associated with adjuvant aromatase inhibitors. Journal of Oncology, 2010, 654348. doi:10.1155/2010/654348
    Khan, Q.J., Reddy, P.S., Kimler, B.F., Sharma, P., Baxa, S.E., O'Dea, A.P., … Fabian, C.J. (2010). Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer. Breast Cancer Research and Treatment, 119, 111-118.
    Kubo, M., Onishi, H., Kuroki, S., Okido, M., Shimada, K., Yokohata, K., … Katano, M. (2012). Short-term and low-dose prednisolone administration reduces aromatase inhibitor-induced arthralgia in patients with breast cancer. Anticancer Research, 32, 2331-2336.
    Leblanc, M., Mao, J.J., Stineman, M. Demichele, A., & Stricker, C. (2013). Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Archives of Physical Medication and Rehabilitation. Advance online exclusive.
    Liang, M.H. (2000). Longitudinal construct validity: Establishment of clinical meaning in patient evaluative instruments. Medical Care, 38(9, Suppl.), II84-II90. doi:10.1097/00005650-200009002-00013
    Liang, M.H., Fossel, A.H., & Larson, M.G. (1990). Comparisons of five health status instruments for orthopedic evaluation. Medical Care, 28, 632-642. doi:10.1097/00005650-199007000-00008
    Lintermans, A., Van Calster, B., Van Hoydonck, M., Pans, S., Verhaeghe, J., Westhovens, R., … Neven, P. (2011). Aromatase inhibitor-induced loss of grip strength is body mass index dependent: Hypothesis-generating findings for its pathogenesis. Annals of Oncology, 22, 1763-1769. doi:10.1093/annonc/mdq699
    Love, S.M. (2005). Dr. Susan Love's breast cancer book (4th ed.). Cambridge, MA: Da Capo Lifelong Press.
    Mao, J.J., Stricker, C., Bruner, D., Xie, S., Bowman, M.A., Farrar, J.T., … DeMichele, A. (2009). Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer, 115, 3631-3639. doi:10.1002/cncr.24419
    Mathias, S., Nayak, U.S., & Isaacs, B. (1986). Balance in elderly patients: The "get up and go" test. Archives of Physical Medicine and Rehabilitation, 67, 387-389.
    Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: Normative data for adults. Archives of Physical Medicine and Rehabilitation, 66(2), 69-74.
    Mathiowetz, V., Weber, K., Volland, G., & Kashman, N. (1984). Reliability and validity of grip and pinch strength evaluations. Journal of Hand Surgery, 9, 222-226.
    Morales, L., Pans, S., Verschueren, K., Van Calster, B., Paridaens, R., Westhovens, R., … Neven, P. (2008). Prospective study to assess short-term intra-articular and tenosynovial changes in the aromatase inhibitor-associated arthralgia syndrome. Journal of Clinical Oncology, 26, 3147-3152. doi:10.1200/JCO.2007.15.4005
    Muslimani, A.A., Spiro, T.P., Chaudhry, A.A., Taylor, H.C., Jaiyesimi, I., & Daw, H.A. (2009). Aromatase inhibitor-related musculoskeletal symptoms: Is preventing osteoporosis the key to eliminating these symptoms? Clinical Breast Cancer, 9(1), 34-38.
    National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines in Oncology: Breast cancer [v.3.2013]. Retrieved from www.nccn.org/professionals/physician_gls/pdf/breast.pdf
    Podsiadlo, D., & Richardson, S. (1991). The timed "Up & Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148.
    Presant, C.A., Bosserman, L., Young, T., Vakil, M., Horns, R., Upadhyaya, G., … Howard, F. (2007). Aromatase inhibitor-associated arthralgia and/or bone pain: Frequency and characterization in non-clinical trial patients. Clinical Breast Cancer, 7, 775-778.
    Rajotte, E.J., Yi, J.C., Baker, K.S., Gregerson, L., Leiserowitz, A., & Syrjala, K.L. (2012). Community-based exercise program effectiveness and safety for cancer survivors. Journal of Cancer Survivorship, 6, 219-228. doi:10.1007/s11764-011-0213-7
    Serlin, R.C., Mendoza, T.R., Nakamura, Y., Edwards, K.R., & Cleeland, C.S. (1995). When is cancer pain mild, moderate, or severe? Grading pain severity by its interference with function. Pain, 61, 277-284.
    Stanton, A.L., Bernaards, C.A., & Ganz, P.A. (2005). The BCPT symptom scales: A measure of physical symptoms for women diagnosed with or at risk for breast cancer. Journal of the National Cancer Institute, 97, 448-456. doi:10.1093/jnci/dji069
    Terwee, C.B., Dekker, F.W., Wiersinga, W.M., Prummel, M.F., & Bossuyt, P.M.M. (2003). On assessing responsiveness of health-related quality-of-life instruments: Guidelines for instrument evaluation. Quality of Life Research, 12, 349-362. doi:10.1023/A:1023499322593
    Winters-Stone, K.M., Schwartz, A.L., Hayes, S.C., Fabian, C.J., & Campbell, K.L. (2012). A prospective model of care for breast cancer rehabilitation: Bone health and arthralgias. Cancer, 118(8, Suppl.), 2288-2299.
    Zhang, Q., Tang, D., & Zhao, H. (2010). Immunological therapies can relieve aromatase inhibitor-related joint symptoms in breast cancer survivors. American Journal of Clinical Oncology, 33, 557-560.