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Management Strategies for Aromatase Inhibitor-Associated Musculoskeletal Symptoms and Their Impact on Treatment
Meizhen Liang1, Shaofei Yuan2, Yuxiang Xue1
1Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325200, People's Republic of China.
Background:
Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) frequently lead to discontinuation of adjuvant endocrine therapy in postmenopausal breast cancer (BC) patients. This retrospective study assessed the impact of initial combined versus monotherapy management on aromatase inhibitor (AI) treatment persistence and explored whether baseline pain interference moderates this effect.
Methods:
In this single-center, retrospective cohort study of 253 postmenopausal hormone receptor-positive BC patients with AIMSS, Patients were categorized into the monotherapy group (n = 182) or the combined therapy group (n = 71) based on initial management. Combined therapy was defined as the simultaneous use of ≥2 different categories of management interventions initiated at the time of AIMSS diagnosis (eg, analgesics, physical therapy, or AI regimen adjustment). The primary outcome was treatment interruption-free survival. Kaplan-Meier and Cox regression analyses were conducted to test for an interaction between management strategy and baseline Brief Pain Inventory (BPI) interference score (high: ≥ 7; low: < 7).
Results:
Treatment interruptions occurred in 68 (26.9%) patients. Combined therapy was associated with superior interruption-free survival (Log-rank P = 0.037). A significant interaction was found between management strategy and baseline pain interference (interaction HR = 0.192, 95% CI: 0.051-0.722, P = 0.015). Subgroup analysis revealed combination therapy significantly reduced interruption risk only in the high interference group (HR = 0.125, 95% CI: 0.042-0.378, P < 0.001), not in the low interference group (HR = 0.731, P = 0.454). Combination therapy also yielded greater pain reduction at 3 months (P < 0.001).
Conclusion:
Initiating multimodal combination management for AIMSS patients with severe baseline pain interference significantly improves AI treatment persistence and provides greater short-term symptom relief, supporting stratified management based on symptom severity.