College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia.
School of Nursing, Southwest Medical University, 319 Zhongshan Rd 3rd Section, Luzhou, 646000, Sichuan, China.
Support Care Cancer. 2022 Nov;30(11):9279-9288. doi: 10.1007/s00520-022-07345-3. Epub 2022 Sep 6.
Aromatase inhibitor (AI)-induced joint pain is a common toxicity of AI treatment. Although many studies have been conducted to examine the occurrence and severity of AI-induced joint pain in breast cancer survivors, none of the studies focused on the Chinese population with breast cancer. Given that the differences in cultural background and the genetic structure between Asians and Caucasians may contribute to different phenotypes of joint pain, this cross-sectional study was therefore conducted to examine the prevalence of AI-induced joint pain among Chinese breast cancer survivors receiving AI treatment and the correlates of pain.
This cross-sectional study was conducted in a tertiary hospital in China. Breast cancer survivors undergoing AI treatment were recruited to complete the following questionnaires: a self-designed baseline data form, the Nordic Musculoskeletal Questionnaire (NMQ), the Brief Pain Inventory (BPI), the 36-Item Short Form Health Survey (SF-36), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Based on the assessment results of NMQ (if the participant indicated pain in specific body parts), participants were then invited to complete other questionnaires to specifically assess the joint symptoms, including the Oxford Knee Score (OKS), the Oxford Hip Score (OHS), the Michigan Hand Outcomes Questionnaire (MHQ), and the Manchester Foot Pain Disability Questionnaire (MFPDQ). Descriptive analysis was used to analyse participants' baseline data and the prevalence of pain. Stepwise multiple regression was used to identify the correlates of pain.
Four hundred and ten participants were analysed. According to the NMQ, 71.7% of the participants experienced joint symptoms in at least one joint, and the most frequently mentioned joint was knee (39.0%). The diagram in BPI indicated that 28.0% of the participants had the worst pain around knees. In patients with knee pain, the mean OKS score was 40.46 ± 6.19. The sub-scores of BPI for pain intensity and pain interference were 1.30 ± 1.63 and 1.24 ± 1.79, respectively. Patients' poorer physical well-being/functioning, previous use of AI treatment, presence of osteoarthritis, and receiving of physiotherapy were identified as four common correlates of greater severity of pain and pain interference (p < 0.05).
Chinese breast cancer survivors can experience joint pain at various locations, particularly knees. In addition to increasing the use of interventions for pain alleviation, a comprehensive assessment of survivors' conditions such as physical functioning, history of AI treatment, and presence of osteoarthritis should be emphasized to identify survivors who need more attention and tailored interventions.
芳香化酶抑制剂（AI）引起的关节痛是 AI 治疗的常见毒性。尽管许多研究已经研究了乳腺癌幸存者中 AI 诱导的关节痛的发生和严重程度，但没有一项研究专门针对中国的乳腺癌患者。鉴于亚洲人和高加索人在文化背景和遗传结构上的差异可能导致关节痛的表型不同，因此进行了这项横断面研究，以研究接受 AI 治疗的中国乳腺癌幸存者中 AI 诱导的关节痛的患病率以及疼痛的相关因素。
这项横断面研究在中国的一家三级医院进行。招募正在接受 AI 治疗的乳腺癌幸存者完成以下问卷：自我设计的基线数据表格、北欧肌肉骨骼问卷（NMQ）、简明疼痛量表（BPI）、36 项简短健康调查问卷（SF-36）和癌症治疗功能评估-乳房（FACT-B）。根据 NMQ 的评估结果（如果参与者表示在特定身体部位疼痛），然后邀请参与者完成其他问卷以专门评估关节症状，包括牛津膝关节评分（OKS）、牛津髋关节评分（OHS）、密歇根手功能问卷（MHQ）和曼彻斯特足部疼痛残疾问卷（MFPDQ）。描述性分析用于分析参与者的基线数据和疼痛的患病率。逐步多元回归用于确定疼痛的相关因素。
对 410 名参与者进行了分析。根据 NMQ，71.7%的参与者在至少一个关节处出现关节症状，最常提到的关节是膝盖（39.0%）。BPI 中的图表表明，28.0%的参与者膝盖周围疼痛最严重。在有膝关节疼痛的患者中，平均 OKS 评分为 40.46±6.19。BPI 的疼痛强度和疼痛干扰子量表评分为 1.30±1.63 和 1.24±1.79。患者较差的身体整体健康/功能、以前使用 AI 治疗、存在骨关节炎和接受物理治疗被确定为疼痛严重程度和疼痛干扰的四个常见相关因素（p<0.05）。
中国乳腺癌幸存者可能会在多个部位出现关节痛，尤其是膝盖。除了增加缓解疼痛的干预措施的使用外，还应强调全面评估幸存者的身体功能、AI 治疗史和骨关节炎的状况，以确定需要更多关注和个性化干预的幸存者。
