Arthralgia in breast cancer survivors: an integrative review of of aromatase inhibitors (AIs) tamoxifen

Problem Identification: Aromatase inhibitors (AIs) and the selective estrogen receptor modulators (SERM) tamoxifen are an essential aspect of extended survival for women with postmenopausal breast cancer. However, they can result in painful arthralgia. Literature Search: Databases searched for eligible papers were CINAHL, SCOPUS, Pubmed, EmBase, PsycInfo, Sociological Abstracts (ProQuest), Medline (Ovid), Cochrane and Google Scholar. Data Evaluation: The final sample for this integrative review included 16 studies. The total sample of women included across all 16 studies was 11,511 (the smallest study had a sample of 10 women and the largest a sample of 9,366). Synthesis: Content analysis was used summarise the study findings. Conclusions: AIs result in a higher incidence of arthralgia when compared to tamoxifen. All breast cancer survivors commencing on 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 commencing 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 that can help alleviate pain, such as walking and yoga. Implications for nursing 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 (AIA), and provide advice on vitamin D supplementation. Nurses also play an important role in educating women on self-help strategies, such as walking and yoga.