Skip to main content

Advertisement

Log in

Randomized phase II placebo-controlled study to evaluate the efficacy of topical pure emu oil for joint pain related to adjuvant aromatase inhibitor use in postmenopausal women with early breast cancer: JUST (Joints Under Study)

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Aromatase inhibitors are standard of care in women with hormone receptor-positive early breast cancer. Published evidence demonstrates that adverse effects may have an impact on drug compliance, with arthralgias being one of the most commonly reported adverse effects.

Methods

Eligible patients were postmenopausal women who had experienced arthralgia following initiation of an aromatase inhibitor. Patients who experienced arthralgias following a minimum of a 3-month treatment on the aromatase inhibitor were randomized to emu oil or placebo oil. The primary endpoint was to assess for a reduction in pain as measured by a visual analogue score after 8 weeks of treatment.

Results

Seventy-three patients comprised the intent-to-treat population, and there was no statistically significant benefit with use of EO. However, there was a statistically significant improvement in pain (visual analogue score was −1.28; p < 0.001) and Brief Pain Inventory severity score −0.88 (p < 0.001), as well as functional interference (Brief Pain Inventory interference −1.10 (p < 0.001) for the entire population following an 8-week administration of EO or placebo oil.

Conclusions

Arthralgias, as a result of aromatase inhibitor use, may be ameliorated by the use of topical oil massaged onto the joint. Further research into interventions for this common side effect is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. The Arimidex, Tamoxifen, alone or in combination Trialists’ Group, Buzdar A, Howell A, Cuzick J, Wale C, Distler W, Hoctin-Boes G, Houghton J, Locker G, Nabholtz J et al (2006) Comprehensive side effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol. 7(8):633–643

    Article  PubMed  Google Scholar 

  2. Goss P, Ingle J, Martino S et al (2003) A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N. Engl. J. Med. 349:1793–1802

    Article  CAS  PubMed  Google Scholar 

  3. Coombes R, Kilburn L, Snowdon C et al. (2007) Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomized controlled trial. Lancet 559–570

  4. The Breast International Group (Big) (2005) 1–98 Collaborative Group et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 2747–2757

  5. Sestak I, Cuzick J, Sapunar F et al (2008) Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol.:866–872

  6. Kaufmann M, Walter Jonat, Jörn Hilfrich, Holger Eidtmann, Günther Gademann, Ivan Zuna, Gunter Von Minckwitz et al (2007) Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95. Study J Clin Oncol 2664–2670

  7. Henry N, Azzouz F, Desta Z et al (2012) Predictors of AI discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J. Clin. Oncol. 30:936–942

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Burstein H And Eric P. (2007) Winer et al. Aromatase inhibitors and arthralgias: a new frontier in symptom management for breast cancer survivors. J Clin Oncol (Editorial) 25:3797–3799

    Article  Google Scholar 

  9. Crew K, Capodice J, Greenlee H et al (2010) Randomized, blinded, sham-controlled trial of acupuncture for the management of AI-associated joint symptoms in women with early-stage breast cancer. J. Clin. Oncol.:1154–1160

  10. Greenlee H, Crew KD, Shao T, Kranwinkel G, Kalinsky K, Maurer M, Phase II (2013 Apr) Study of glucosamine with chondroitin on AI-associated joint symptoms in women with breast cancer. Support Care Cancer 21(4):1077–1087

    Article  PubMed  Google Scholar 

  11. Irwin M, Cartmel B, Gross C et al (2015) Randomized exercise trial of AI-induced arthralgia in breast cancer survivors. J. Clin. Oncol. 33:1104–1111

    Article  PubMed  Google Scholar 

  12. Power R, Cameron M. Emu oil for osteoarthritic hand pain at http://www.emuindustry.asn.au/ RayPowerClinicalTrial.htm

  13. Lombard J, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes J, Chirgwin J et al (2016) AI induced musculoskeletal syndrome: a significant problem with limited treatment options. Support Care Cancer 24:2139–2146

    Article  PubMed  Google Scholar 

  14. Kadakia K, Snyder C, Kidwell K, Seewald N, Flockhart D, Skaar T, Desta Z, Rae J, Otte J, Carpenter J, Storniolo A, Hayes D, Stearns V, Henry N et al (2016) Patient-reported outcomes and early discontinuation in AI-treated postmenopausal women with early stage breast cancer. Oncologist 21:539–546

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Morales L, Pans S, Verschueren K, Van Calster B, Paridaens R, Westhovens R, Timmerman D, De Smet L, Vergote I, Christiaens Mr, Neven P. et al (2008) Prospective study to assess short-term intra-articular and tenosynovial changes in the AI-associated arthralgia syndrome. J Clin Oncol 26

  16. Lintermans A, Laenen A, Van Calster B, Van Hoydonck M, Pans S, Verhaeghe J, Westhovens R, Nl H, Wildiers H, Paridaens R, Dieudonné AS, Leunen K, Morales L, Verschueren K, Timmerman D, De Smet L, Vergote I, Christiaens M, Neven P et al (2013) Arthralgia and changes in serum levels of IGF-I, its binding protein and oestrogen in breast cancer patients on endocrine agents. Ann. Oncol. 24:350–355

    Article  CAS  PubMed  Google Scholar 

  17. Yoganathan S, Nicolosi R, Wilson T et al (2006) Antagonism of croton oil inflammation by topical emu oil in CD-1 mice. Lipids 38:603–607

    Article  Google Scholar 

  18. Qiu X, Wang J, Fang X et al (2005) Anti-inflammatory activity and healing-promoting effects of topical application of emu oil on wound in scalded rats. Di Yi Jun Yi Da Xue Xue Bao 25(4):407–410

    PubMed  Google Scholar 

  19. Perlman A, Ali A, Njike V, Hom D, Davidi A, Gould-Fogerite S, Milak C, Katz D et al (2012) Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One 7:e30246

    Article  Google Scholar 

  20. Tj C, Cy L, Yf C, Cj F, Hsu C et al (2015) Acupuncture for treating AI-related arthralgia in breast cancer: a systematic review and meta-analysis. J. Altern. Complement. Med. 21:251–260

    Article  Google Scholar 

  21. Hershman D, Unger J, Vrew K et al (2015) Randomized multicenter placebo-controlled trial of omega-3 fatty acids for the control of AI-induced musculoskeletal pain: SWOG S0927. J. Clin. Oncol. 33:1910–1917

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arlene Chan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, A., De Boer, R., Gan, A. et al. Randomized phase II placebo-controlled study to evaluate the efficacy of topical pure emu oil for joint pain related to adjuvant aromatase inhibitor use in postmenopausal women with early breast cancer: JUST (Joints Under Study). Support Care Cancer 25, 3785–3791 (2017). https://doi.org/10.1007/s00520-017-3810-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-017-3810-9

Keywords

Navigation