Arthralgia in breast cancer survivors: An integrative review of endocrine therapy

Problem Identification: Aromatase inhibitors (AIs) and the selective estrogen receptor modulator tamoxifen (Nolvadex®) are essential to extended survival for women with postmenopausal breast cancer. However, they can result in painful arthralgia. Literature Search: Databases searched for eligible articles were CINAHL®, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, MEDLINE®, PsycINFO®, PubMed, Scopus, and Sociological Abstracts (ProQuest). Data Evaluation: The final sample for this integrative review consisted of 16 studies. The total sample of women included across all studies was 11,511. Synthesis: Content analysis was used to summarize the study findings. Conclusions: AIs result in a higher incidence of arthralgia compared to tamoxifen. All breast cancer survivors commencing AI therapy should undergo a baseline assessment to identify any increased risk of arthralgia. All women on AIs should have their Vitamin D levels checked before beginning AIs and annually thereafter. Many women may need higher doses of Vitamin D supplementation than normally recommended. All women taking AIs should be advised on self-help strategies to alleviate pain, such as walking and yoga. Implications for Practice: Oncology nurses are ideally placed to undertake a baseline assessment before AI therapy. Nurses can also use this opportunity to educate women on their risk of developing AI-related arthralgia and provide advice on Vitamin D supplementation. In addition, nurses play an important role in educating women on self-help strategies.