TY - JOUR
T1 - Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy
AU - Sheng, Jennifer Y.
AU - Blackford, Amanda L.
AU - Bardia, Aditya
AU - Venkat, Raghunandan
AU - Rosson, Gedge
AU - Giles, Jon
AU - Hayes, Daniel F.
AU - Jeter, Stacie C.
AU - Zhang, Zhe
AU - Hayden, Jill
AU - Nguyen, Anne
AU - Storniolo, Anna Maria
AU - Tarpinian, Karineh
AU - Henry, Norah Lynn
AU - Stearns, Vered
N1 - Funding Information:
Funding This study was funded by Pharmacogenetics Research Network Grant U-01 GM61373 (supports the Consortium on Breast Cancer Pharmacogenomics), investigator-initiated grants from Novartis and Pfizer, and Fashion Footwear Charitable Foundation of New York/ QVC Presents Shoes on Sale ™ (DFH). The study drug was provided by Novartis and Pfizer.
Funding Information:
grants from Biothernostics Inc, Immunomedics, Novartis, Genentech/ Roche, Merck, Radius Health, Spectrum Pharma, Innocrin, and Mer-sana Pharmaceuticals; consultant to Immunomedics, Novartis, Genen-tech/Roche, Merck, Radius Health, Spectrum Pharma, Taiho Pharma, Biothernostics Inc and Sanofi. GR has received grants from AxoGen and Allergan; patents US PCT/US2009/000,887, Europe 09710338.6-1222, Brazil PI0908087-2, licensed to Aegeria Soft Tissue; patent US 6 + 2/119,047 issued to Sonavex. DFH has received grants from Pfizer, Novartis and Astra Zeneca; Stock in Oncimmune LLC and Inbiomo-tion; Consultant/advisory panels with Cepheid, Freenome Inc, Arti-man Ventures (CellWorks), CVS Caremark, Agendia Inc.; Sponsored Research with Merrimack Pharmaceuticals, Eli Lilly, Menarini Silicon BioSystems, Puma Biotechnology, Pfizer, Astra Zeneca; Patents US 8790, 878 B2 licensed to Menarini Silicon BioSystems. NLH has received grants from NIH, Pfizer, Novartis, AbbVie, H3 Biomedicine, and Innocrin Pharmaceuticals. VS has received grants from Abbvie, Biocept, Pfizer, Novartis, Medimmune, and Puma Biotechnology; data safety monitoring board for Immunomedics; consultant to Iridium Therapeutics, Inc.
Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/8/15
Y1 - 2019/8/15
N2 - Purpose: Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. Methods: Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. Results: Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. Conclusion: For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
AB - Purpose: Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. Methods: Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. Results: Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. Conclusion: For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
KW - Aromatase inhibitor induced musculoskeletal symptoms
KW - Breast cancer survivor
KW - Carpal tunnel syndrome
KW - Early detection
KW - Endocrine therapy
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U2 - 10.1007/s10549-019-05270-4
DO - 10.1007/s10549-019-05270-4
M3 - Article
C2 - 31079282
AN - SCOPUS:85065667096
SN - 0167-6806
VL - 176
SP - 617
EP - 624
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 3
ER -