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Arthralgia in Breast Cancer Survivors: An Integrative Review of Endocrine Therapy

Maura Dowling
Bernadette McDonagh
Elizabeth Meade
ONF 2017, 44(3), DOI: 10.1188/17.ONF.337-349

Problem Identification: Aromatase inhibitors (AIs) and the selective estrogen receptor modulator tamoxifen (Nolvadex®) are essential to extended survival for women with postmenopausal breast cancer. However, they can result in painful arthralgia.

Literature Search: Databases searched for eligible articles were CINAHL®, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, MEDLINE®, PsycINFO®, PubMed, Scopus, and Sociological Abstracts (ProQuest).

Data Evaluation: The final sample for this integrative review consisted of 16 studies. The total sample of women included across all studies was 11,511.

Synthesis: Content analysis was used to summarize the study findings.

Conclusions: AIs result in a higher incidence of arthralgia compared to tamoxifen. All breast cancer survivors commencing AI therapy should undergo a baseline assessment to identify any increased risk of arthralgia. All women on AIs should have their vitamin D levels checked before beginning AIs and annually thereafter. Many women may need higher doses of vitamin D supplementation than normally recommended. All women taking AIs should be advised on self-help strategies to alleviate pain, such as walking and yoga.

Implications for Practice: Oncology nurses are ideally placed to undertake a baseline assessment before AI therapy. Nurses can also use this opportunity to educate women on their risk of developing AI-related arthralgia and provide advice on vitamin D supplementation. In addition, nurses play an important role in educating women on self-help strategies.

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