Menas Pamela, Merkel Douglas, Hui Wendy, Lawton Jessica, Harper Abigail, Carro George
Kellogg Cancer Center, NorthShore University Health System, Evanston, IL 60201, USA.
J Oncol Pharm Pract. 2012 Dec;18(4):387-93. doi: 10.1177/1078155211434853. Epub 2012 Jan 25.
Aromatase inhibitors (AIs) are routinely used as first-line adjuvant treatment of breast cancer in postmenopausal women with hormone receptor positive tumors. The current recommended length of treatment with an AI is 5 years. Arthralgias have been frequently cited as the primary reason for discontinuation of AI therapy. Various treatment strategies are proposed in literature, but a standardized treatment algorithm has not been established. The initial purpose of this study was to describe the incidence and management of AI-induced arthralgias in patients treated at Kellogg Cancer Center (KCC). Further evaluation led to the development and the implementation of a treatment algorithm and electronic medical record (EMR) documentation tools.
The retrospective chart review included 206 adult patients with hormone receptor positive breast cancer who were receiving adjuvant therapy with an AI. A multidisciplinary treatment team consisting of pharmacists, collaborative practice nurses, and physicians met to develop a standardized treatment algorithm and corresponding EMR documentation tool. The treatment algorithm and documentation tool were developed after the study to better monitor and proactively treat patients with AI-induced arthralgias. RESULTS/ CONCLUSIONS: The overall incidence of arthralgias at KCC was 48% (n = 98/206). Of these patients, 32% were documented as having arthralgias within the first 6 months of therapy initiation. Patients who reported AI-induced arthralgias were younger than patients who did not report AI-induced arthralgias (61 vs. 65 years, p = 0.002). There was no statistical difference in the incidence of arthralgias in patients with a history of chemotherapy (including taxane therapy) compared to those who did not receive chemotherapy (p = 0.352). Of patients presenting with AI-induced arthralgias, 41% did not have physician-managed treatment documented in the EMR. A standardized treatment algorithm and electronic chart documentation tools were then developed by the multidisciplinary team.
芳香化酶抑制剂（AIs）通常用作激素受体阳性肿瘤的绝经后女性乳腺癌的一线辅助治疗。目前推荐的AI治疗时长为5年。关节痛经常被认为是停用AI治疗的主要原因。文献中提出了各种治疗策略，但尚未建立标准化的治疗算法。本研究的最初目的是描述在凯洛格癌症中心（KCC）接受治疗的患者中AI诱导的关节痛的发生率及管理情况。进一步评估促使了一种治疗算法和电子病历（EMR）文档工具的开发与实施。
回顾性病历审查纳入了206例接受AI辅助治疗的激素受体阳性乳腺癌成年患者。由药剂师、协作执业护士和医生组成的多学科治疗团队开会制定了标准化的治疗算法和相应的EMR文档工具。该治疗算法和文档工具是在研究之后开发的，以便更好地监测和积极治疗AI诱导的关节痛患者。结果/结论：KCC关节痛的总体发生率为48%（n = 98/206）。在这些患者中，32%在治疗开始的前6个月内被记录为有关节痛。报告有AI诱导关节痛的患者比未报告AI诱导关节痛的患者更年轻（61岁对65岁，p = 0.002）。有化疗史（包括紫杉烷治疗）的患者与未接受化疗的患者相比，关节痛发生率无统计学差异（p = 0.352）。在出现AI诱导关节痛的患者中，41%在EMR中没有医生管理治疗的记录。然后多学科团队开发了标准化的治疗算法和电子病历文档工具。
