Abstract
PurposeAromatase inhibitors (AIs) are widely prescribed for postmenopausal women with breast cancer and are known to cause musculoskeletal pain. This study aimed to identify factors associated with AI continuation intention among breast cancer survivors (BCS).MethodsA cross-sectional survey was conducted on 123 BCS (stages I–III), who had been taking AIs for at least 6 weeks. Participants were recruited from a cancer center in Goyang, Korea, from September to November 2019. Descriptive statistics, Welch analysis of variance, Pearson correlation coefficients, and simple linear regression were used for the analysis.ResultsBeliefs about endocrine therapy was a significant predictor of AI continuation intention (β=.66, p<.001). The majority of participants (87.0%) reported experiencing musculoskeletal pain since taking AIs and the score for the worst pain severity within 24 hours was 5.08±2.80 out of 10. Musculoskeletal pain, however, was not associated with AI continuation intention. Fear of cancer recurrence (FCR) was clinically significant (≥13) for 74.0% of the respondents (mean, 17.62±7.14). Musculoskeletal pain severity and pain interference were significantly associated with FCR (r=.21, p<.05; r=.35, p<.01, respectively). Pain interference was significantly associated with beliefs about endocrine therapy (r=–.18, p<.05). ConclusionAI continuation intention can be modified by reinforcing patients’ beliefs about endocrine therapy. Musculoskeletal pain may have a negative effect on beliefs about endocrine therapy and increase FCR among BCS. Thus, awareness of musculoskeletal pain during AI therapy should be raised and further research is required to develop multidisciplinary pain management strategies and clinical guidelines to reinforce beliefs about endocrine therapy.
Highlights
Aromatase inhibitors (AIs) have been used as the first choice of adjuvant endocrine therapy for postmenopausal women over the last 15 years since they are more effective than tamoxifen for postmenopausal breast cancer, and aromatase inhibitors (AIs) prescriptions account for 64% of endocrine therapy among women with invasive breast cancer [1]
Pain is known to amplify fear of cancer recurrence (FCR) in Breast cancer survivors (BCS) [13] and a study conducted with breast cancer patients undergoing AI therapy showed that FCR was higher in patients who experienced musculoskeletal pain than in those who did not [14]
Aromatase inhibitor continuation intention The mean score of AI continuation intention was 22.28 ± 4.34, which is interpreted as high (Table 2)
Summary
Aromatase inhibitors (AIs) have been used as the first choice of adjuvant endocrine therapy for postmenopausal women over the last 15 years since they are more effective than tamoxifen for postmenopausal breast cancer, and AI prescriptions account for 64% of endocrine therapy among women with invasive breast cancer [1]. Estrogen production by the ovaries terminates and estrogen is synthesized by aromatase in peripheral tissues. Suppression of estrogen is more effectively achieved by using AIs, as they primarily block most of the production of estrogen. To take full advantage of endocrine therapy, it is important to take the medication regularly throughout the recommended pe-
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