Adaptation of an Evidence-Based Arthritis Program for Breast Cancer Survivors on Aromatase Inhibitor Therapy Who Experience Joint Pain
Adaptation of an Evidence-Based Arthritis Program for Breast Cancer Survivors on Aromatase Inhibitor Therapy Who Experience Joint Pain
SPECIAL TOPIC — Volume 12 — June 11, 2015
Kirsten A. Nyrop, PhD; Leigh F. Callahan, PhD; Christine Rini, PhD; Mary Altpeter, PhD; Betsy Hackney; Arielle Schecher; Anne Wilson; Hyman B. Muss, MD
Suggested citation for this article: Nyrop KA, Callahan LF, Rini C, Altpeter M, Hackney B, Schecher A, et al. Adaptation of an Evidence-Based Arthritis Program for Breast Cancer Survivors on Aromatase Inhibitor Therapy Who Experience Joint Pain. Prev Chronic Dis 2015;12:140535. DOI: http://dx.doi.org/10.5888/pcd12.140535.
PEER REVIEWED
Abstract
Adding aromatase inhibitors (AIs) to adjuvant treatment of postmenopausal women with hormone-receptor–positive breast cancer significantly reduces cancer recurrence. A common side effect of AIs is noninflammatory joint pain and stiffness (arthralgia) similar to arthritis symptoms. An evidence-based walking program developed by the Arthritis Foundation — Walk With Ease (WWE) — reduces arthritis-related joint symptoms. We hypothesized that WWE may also reduce AI-associated arthralgia. However, the potential for different barriers and facilitators to physical activity for these 2 patient populations suggested a need to adapt WWE before testing it with breast cancer survivors. We conducted qualitative research with 46 breast cancer survivors to explore program modification and inform the development of materials for an adapted program (Walk With Ease-Breast Cancer). Our process parallels the National Cancer Institute’s Research-Tested Intervention Programs (RTIPs) guidelines for adapting evidence-based programs for cancer populations. Findings resulted in a customized 8-page brochure to supplement existing WWE materials.
Introduction
In 2014, an estimated 232,670 women in the United States received a breast cancer diagnosis (1). Most cancers will be diagnosed in postmenopausal women at an early, highly treatable stage, and most tumors will be hormone receptor–positive (2,3). For women with this tumor type, standard adjuvant (postsurgery chemotherapy and/or radiation) treatment generally includes an aromatase inhibitor (AI) to reduce the chances for cancer recurrence (4,5). Third generation AIs — exemestane (Aromasin), letrozole (Femara), and anastrozole (Arimidex) — are pills taken daily for 5 years, with ongoing scientific consideration of additional years (4,5). Musculoskeletal symptoms — noninflammatory joint pain, stiffness, or achiness (arthralgia) — are common side effects of AIs, with an estimated 33% to 61% of women reporting these symptoms (6–9). When joint symptoms are moderate or severe, they interfere with engagement in physical activity, reduce overall quality of life, and can lead to AI discontinuation or not taking the AI dose as prescribed (7,9,10).
The number of women who are likely to experience these symptoms is substantial. In 2012, there were an estimated 2.97 million female breast cancer survivors, 75% of whom had tumors diagnosed as being hormone receptor–positive; most of these patients were likely to have been prescribed an AI (10). In an aging US population — and breast cancer being largely a disease of aging with 61 years the median age at diagnosis (1) — the number of survivors coping with AI-associated arthralgia will continue to grow. Their quality of life and ability to be physically active during adjuvant treatment may depend on the development of effective behavioral interventions to reduce these musculoskeletal symptoms.
Because AI-associated arthralgia symptoms are similar to those caused by arthritis, we hypothesized that a physical activity program developed by the Arthritis Foundation — Walk With Ease (WWE) (11–14) — could have similar benefits for women on AI therapy. However, the potential for unique psychosocial or medical concerns warranted an investigation of the need to adapt WWE for breast cancer survivors. We describe our process for developing and pilot testing materials to adapt WWE as a precursor to program testing in a randomized controlled trial (currently under way). Our adaptation process parallels guidelines developed by the National Cancer Institute’s (NCI’s) Research-Tested Intervention Programs (RTIPs) (15). We offer this description of our adaptation process as an example of how evidence-based physical activity interventions developed for 1 patient population can be adapted for a new patient population.
cknowledgments
This research is supported by NCI, National Institutes of Health, under award no. R21CA169492 and a pilot grant from the UNC Institute on Aging. We thank the Arthritis Foundation, UNC Thurston Arthritis Research Center, and the North Carolina Cancer Hospital oncology physicians and clinical staff for their interest and support throughout the study as well as the breast cancer survivors who participated in this study.
The research presented in this article is in full compliance with current laws of the United States of America.
The authors declare that they have no conflict of interest.
Author Information
Corresponding Author: Kirsten A. Nyrop, PhD, Division of Hematology/Oncology, CB 7305, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7305. Telephone: 919-962-5139. Email: kirsten_nyrop@med.unc.edu.
Author Affiliations: Leigh F. Callahan, Christine Rini, Mary Altpeter, Betsy Hackney, Hyman B. Muss, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Arielle Schecher, Anne Wilson, patient advisors, Chapel Hill, North Carolina.
References
- Surveillance Epidemiology and End Results (SEER). SEER stat fact sheets: breast cancer. National Cancer Institute. http://seer.cancer.gov/statfacts/html/breast/html. Accessed April 29, 2015.
- Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor–positive breast cancer. J Clin Oncol 2010;28(23):3784–96. CrossRef PubMed
- Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 2007;8(12):1101–15. CrossRef PubMed
- Dizdar O, Ozçakar L, Malas FU, Harputluoglu H, Bulut N, Aksoy S, et al. Sonographic and electrodiagnostic evaluations in patients with aromatase inhibitor-related arthralgia. J Clin Oncol 2009;27(30):4955–60. CrossRef PubMed
- Crew KD, Greenlee H, Capodice J, Raptis G, Brafman L, Fuentes D, et al. Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol 2007;25(25):3877–83. CrossRef PubMed
- Oberguggenberger A, Hubalek M, Sztankay M, Meraner V, Beer B, Oberacher H, et al. Is the toxicity of adjuvant aromatase inhibitor therapy underestimated? Complementary information from patient-reported outcomes (PROs). Breast Cancer Res Treat 2011;128(2):553–61. CrossRef PubMed
- Presant CA, Bosserman L, Young T, Vakil M, Horns R, Upadhyaya G, et al. Aromatase inhibitor–associated arthralgia and/or bone pain: frequency and characterization in non–clinical trial patients. Clin Breast Cancer 2007;7(10):775–8. CrossRef PubMed
- Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 2011;126(2):529–37. CrossRef PubMed
- Burstein HJ. Aromatase inhibitor-associated arthralgia syndrome. Breast 2007;16(3):223–34. CrossRef PubMed
- Khan QJ, O’Dea AP, Sharma P. Musculoskeletal adverse events associated with adjuvant aromatase inhibitors. J Oncol 2010;2010:654348. Published online 2010 Aug 24. CrossRefPubMed
- Arthritis Foundation. Walk With Ease: your guide to walking for better health, improved fitness and less pain (3rd edition). Atlanta (GA): Arthritis Foundation; 2010.
- Callahan LF, Shreffler JH, Altpeter M, Schoster B, Hootman J, Houenou LO, et al. Evaluation of group and self-directed formats of the Arthritis Foundation’s Walk With Ease program. Arthritis Care Res (Hoboken) 2011;63(8):1098–107. CrossRef PubMed
- Nyrop KA, Cleveland R, Callahan LF. Achievement of exercise objectives and satisfaction with the Walk With Ease program — group and self-directed participants. Am J Health Promot 2014;28(4):228–30. CrossRef PubMed
- Wyatt B, Mingo CA, Waterman MB, White P, Cleveland RJ, Callahan LF. Impact of the Arthritis Foundation’s Walk With Ease program on arthritis symptoms in African Americans. Prev Chronic Dis 2014;11:E199. PubMed
- National Cancer Institute and Substance Abuse and Mental Health Services Administration. Guidelines for choosing and adapting programs. http://rtips.cancer.gov/rtips/reference/adaptation_guidelines.pdf. Accessed February 5, 2014.
- Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84(2):191–215. CrossRef PubMed
- Keller C, Fleury J, Gregor-Holt N, Thompson T. Predictive ability of social cognitive theory in exercise research: an integrated literature review. Online J Knowl Synth Nurs 1999;6:2. PubMed
- Rogers LQ, Matevey C, Hopkins-Price P, Shah P, Dunnington G, Courneya KS. Exploring social cognitive theory constructs for promoting exercise among breast cancer patients. Cancer Nurs 2004;27(6):462–73. CrossRef PubMed
- Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol 2009;28(6):690–701.CrossRef PubMed
- Nyrop KA, Muss HB, Hackney B, Cleveland R, Altpeter M, Callahan LF. Feasibility and promise of a 6-week program to encourage physical activity and reduce joint symptoms among elderly breast cancer survivors on aromatase inhibitor therapy. J Geriatr Oncol 2014;5(2):148–55. CrossRef PubMed
- Schoster B, Altpeter M, Meier A, Callahan LF. Methodological tips for overcoming formative evaluation challenges: the case of the Arthritis Foundation Walk With Ease program. Health Promot Pract 2012;13(2):198–203. CrossRef PubMed
- Altundag K, Ibrahim NK. Aromatase inhibitors in breast cancer: an overview. Oncologist 2006;11(6):553–62. CrossRef PubMed
No hay comentarios:
Publicar un comentario