Acupuncture for the treatment of arthralgia related to adjuvant aromatase inhibitor therapy in postmenopausal breast cancer patients

Abstract

Purpose: Aromatase inhibitors (AIs) are the standard of care for adjuvant treatment of postmenopausal, hormone sensitive breast cancer. However, up to half of women on AIs therapy experience arthralgia which may lead to early discontinuation of this effective therapy or to reduction of quality of life. The management of arthralgia is not yet defined in clinical practice. We conduced a pilot study to evaluate the safety and efficacy of acupuncture for AIs-symptoms management. Patients and methods: Postmenopausal patients ( pts) with early breast cancer experiencing arthralgia attributable to AIs were enrolled to receive Yamamoto New Scalp Acupuncture (YNSA) twice weekly for 3 weeks and once for the next three weeks. We evaluated changes in Brief Pain Inventory-Short Form (BPI-SF), Health Assessment Questionnaire Disability Index (HAQ), Pain Visual Analog Scale (VAS) stiffness, Functional Assessment of Cancer Therapy-General (FACT-G) quality of life measure and after 3 and 6 weeks of acupuncture compared to baseline. We also evaluated the possible reduction in the use of anti-inflammatory medication the end of the treatment. Results: We enrolled 27 pts (26 evaluable). The median age was 61 (range 50-78) and the median time since menopause were 10,3. At the beginning of the treatment, 20 pts reported taking nonsteroidal anti-inflammatory drugs for pain relief. From baseline to the end of treatment, patients reported improvement in the mean BPI-SF worst pain score (7,26 to 3,85, p = 0,0001), pain severity (5,77 to 2,88, p = 0,0001), pain-related functional interference (4,82 to 2,82, p = 0,0001), in the mean HAQ score (0,95 to 0,62, p = 0,002), in the mean VAS score stiffness (71,52 to 30,59 p = 0,0001) and in the mean FACT-G physical (19,56 to 23,19, p = 0,03) and emotional well-being score (16,29 to 19, p = 0,031). Twenty pts (77%) reported the use of nonsteroidal anti-inflammatory drugs for pain relief at baseline. At the end of treatment only 11 of them (42%) continued to use pain relief. The acupuncture intervention was well-tolerated and no adverse events were reported. Conclusions: All pts had a significant improvement in AIs related join pain and stiffness. Our study suggests that acupuncture may be an effective intervention in treating AIs-related arthralgia and may play an important role in reducing discomfort from this common side effect. We will conduct a larger study with an adequate follow-up to confirm these results and to determine the duration of the benefit.