Self-reported Wrist and Hand Pain and Disability in Breast Cancer Survivors Taking Aromatase Inhibitors

Abstract

Background: Aromatase inhibitors (AIs) are important medications that combat recurrence of hormone-positive breast cancer. Arthralgia is a common side effect of AIs, sometimes leading to discontinuation. Wrist or hand symptoms associated with so-called aromatase inhibitor musculoskeletal syndrome (AIMSS) can have particularly profound functional implications; however, little is known about the frequency, severity, and specific functional difficulties experienced by women taking AIs. Purpose: We sought to examine disability (eg, activity limitations and participation restrictions) in women with AIMSS in the wrist and hand and to determine if any demographic or cancer-treatment factors affected incidence of AIMSS, severity of symptoms, or self-reported disability in these women. Methods: A total of 198 women currently taking AIs were recruited to complete a researcher-designed questionnaire on demographic factors, presence and nature of wrist or hand symptoms, and any treatment sought. Those reporting symptoms in the previous week also completed the Patient Rated Wrist and Hand Evaluation (PRWHE) form. Questionnaires were returned by 102 women (mean age 60 yrs) for a 53% response rate. Results were calculated using frequency distributions and logistic regression analysis to predict factors indicative of disability as measured with the PRWHE. A p-value of 0.05 was set to indicate significance. Results: Wrist/hand symptoms at any point since taking AI were reported by 58% of the respondents. Pain was cited by 58% and rated as moderate to severe. There were no significant predictors of wrist or hand associated AIMSS identified from demographic or treatment-related factors. Of those who completed the PRWHE, carrying 10 lbs and performing housework were reported as being most difficult. Score on PRWHE was weakly associated with age (R2 = 0.13, p < 0.05). Conclusions: Wrist and hand symptoms of AIMSS are common, can be severe, and can lead to significant disability. Future studies aimed at identifying interventions to decrease AIMSS may allow breast cancer survivors to better adhere to these potentially life-saving medications.