Breast Cancer Research and Treatment

, Volume 172, Issue 3, pp 603–610 | Cite as

Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927)

  • Sherry Shen
  • Joseph M. Unger
  • Katherine D. Crew
  • Cathee Till
  • Heather Greenlee
  • Julie Gralow
  • Shaker R. Dakhil
  • Lori M. Minasian
  • James L. WadeIII
  • Michael J. Fisch
  • N. Lynn Henry
  • Dawn L. HershmanEmail author
Clinical trial



Although aromatase inhibitors (AIs) prolong survival in post-menopausal breast cancer (BC) patients, AI-associated arthralgia can lead to discontinuation. Obese patients have higher rates of AI arthralgia than non-obese patients, but treatment options are limited. Omega-3 fatty acid (O3-FA) treatment for AI arthralgia has produced mixed results.


We performed an exploratory analysis of SWOG S0927, a multicenter randomized placebo-controlled trial of O3-FA use for AI arthralgia. Post-menopausal women with stage I–III BC taking an AI were randomized to 24 weeks of O3-FAs or placebo. Brief Pain Inventory (BPI) questionnaires and fasting serum were collected at baseline, 12, and 24 weeks. The BPI assessment included worst pain, average pain, and pain interference scores (range 0–10).


Among the 249 participants, 139 had BMI < 30 kg/m2 (56%) and 110 had BMI ≥ 30 kg/m2 (44%). Among obese patients, O3-FA use was associated with significantly lower BPI worst pain scores at 24 weeks compared with placebo (4.36 vs. 5.70, p = 0.02), whereas among non-obese patients, there was no significant difference in scores between treatment arms (5.27 vs. 4.58, p = 0.28; interaction p = 0.05). Similarly, O3-FA use was associated with lower BPI average pain and pain interference scores at 24 weeks compared with placebo among obese patients, but no significant difference between treatment arms in non-obese patients (interaction p = 0.005 and p = 0.01, respectively).


In obese BC patients, O3-FA use was associated with significantly reduced AI arthralgia compared to placebo.


Breast cancer Omega-3 fatty acids Aromatase inhibitor Obesity Arthralgia 



This study was supported by BCRF, NCI, and SWOG.


This study was funded by the Breast Cancer Research Foundation; National Cancer Institute, Division of Cancer Prevention, NCORP Research Base grant 1UG1CA189974-01.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10549_2018_4946_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 33 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sherry Shen
    • 1
  • Joseph M. Unger
    • 2
    • 3
  • Katherine D. Crew
    • 1
  • Cathee Till
    • 2
  • Heather Greenlee
    • 1
  • Julie Gralow
    • 4
  • Shaker R. Dakhil
    • 5
  • Lori M. Minasian
    • 6
  • James L. WadeIII
    • 7
  • Michael J. Fisch
    • 8
  • N. Lynn Henry
    • 9
  • Dawn L. Hershman
    • 1
    Email author
  1. 1.Columbia University Medical CenterNew YorkUSA
  2. 2.SWOG Statistical CenterSeattleUSA
  3. 3.Fred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Seattle Cancer Care AllianceSeattleUSA
  5. 5.Cancer Center of KansasWichitaUSA
  6. 6.Community Oncology and Prevention Trials Research Group, Division of Cancer PreventionNational Cancer InstituteBethesdaUSA
  7. 7.Central Illinois CCOP/Cancer Care Specialists of Central IllinoisDecaturUSA
  8. 8.AIM Specialty HealthChicagoUSA
  9. 9.Hunstman Cancer InstituteSalt Lake CityUSA

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