Joint pain and falls among women with breast cancer on aromatase inhibitors
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Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls.
We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up.
Among 667 participants (median age 63 years, interquartile range 57–69 years), 232 (35%, 95% CI 31 to 39%) reported falls 12–24 months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12 months by their primary care physician (44%) or oncologist (36%).
Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.
KeywordsBreast cancer Aromatase inhibitors Fall risk Arthralgia Joint pain Falls
Coby Basal, BA: conceptualization, data curation, investigation, methodology, writing—original draft, and writing—review and editing. Emily Vertosick, MPH: data curation, methodology, formal analysis, visualization, writing—original draft, and writing—review and editing. Theresa A. Gillis, MD: conceptualization, investigation, writing—original draft, and writing—review and editing. Qing Li, MS: conceptualization, data curation, formal analysis, methodology, writing—original draft, and writing—review and editing. Ting Bao, MD, DABMA, MS: conceptualization, investigation, writing—original draft, and writing—review and editing. Andrew Vickers, PhD: conceptualization, data curation, methodology formal analysis, investigation, visualization, writing—original draft, and writing—review and editing. Jun J. Mao, MD, MSCE: conceptualization, data curation, funding acquisition, investigation, methodology, writing—original draft, and writing—review and editing.
This work was supported in part by grants from the National Cancer Institute at the National Institutes of Health (grant numbers R01 CA158243, P30-CA008748) and by the Byrne Fund and the Translational Research and Integrative Medicine Fund, both at Memorial Sloan Kettering Cancer Center.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Research involving human participants and/or animals
The Institutional Review Board of the University of Pennsylvania approved the study protocol. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
- 1.Society AC. Breast Cancer Facts & Figures 2015-2016. Atlanta2015Google Scholar
- 3.Coombes R, Kilburn L, Snowdon C, Paridaens R, Coleman RE, Jones SE, Jassem J, van de Velde C, Delozier T, Alvarez I, del Mastro L, Ortmann O, Diedrich K, Coates AS, Bajetta E, Holmberg SB, Dodwell D, Mickiewicz E, Andersen J, Lønning PE, Cocconi G, Forbes J, Castiglione M, Stuart N, Stewart A, Fallowfield LJ, Bertelli G, Hall E, Bogle RG, Carpentieri M, Colajori E, Subar M, Ireland E, Bliss JM (2007) Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 369(9561):559–570CrossRefPubMedGoogle Scholar
- 15.Spoelstra SL, Given BA, Schutte DL, Sikorskii A, You M, Given CW. Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer. Paper presented at: Oncology nursing forum 2013Google Scholar
- 17.Cleeland CS, Ryan K (1994) The Brief Pain Inventory. Available onli ne: https://www.mdanderson.org/education-andresearch/departments-programs-and-labs/departments-and-divisions/symptom-research/symptomassessment-tools/BPI_UserGuide.pdf. Accessed 1 Mar 2016
- 26.Patel KV, Phelan EA, Leveille SG, Lamb SE, Missikpode C, Wallace RB, Guralnik JM, Turk DC (2014) High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study. J Am Geriatr Soc 62(10):1844–1852CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Choksi P, Williams M, Kidwel K, Stella J, Soyster M (2016) Adjuvant aromatase inhibitors in early breast cancer may not increase the risk of falls. J Bone Rep Recomm 2(2)Google Scholar
- 32.Munch T, Harrison SL, Barrett-Connor E et al. Pain and falls and fractures in community-dwelling older men. Age Ageing. 2015;afv125Google Scholar
- 35.Borrie AE, Kim RB. Molecular basis of aromatase inhibitor associated arthralgia: known and potential candidate genes and associated biomarkers. Expert Opin Drug Metab Toxicol. 2016;1–8Google Scholar