Breast cancer is the most frequently diagnosed cancer (231 841 estimated cases in 2015) and ranks _______________ as a cause of cancer death among women in the United States
second
Aromatase inhibitors play a critical role in decreasing the estrogen that primarily stimulates breast cancer progression by 90% via_________________or___________________, thereby aiding in preventing breast cancer recurrence.
covalent (eg, exemestane)
or
noncovalent (eg, letrozole, anastrozole) binding
Nearly half of women who take AIs report AI-related joint pain or stiffness, and ________to__________% discontinue the treatment because of joint pain
20 to 30%
-Patients report symmetrical joint pain or stiffness in hands, knees, feet, hip, and back, with a mild thickening of the soft tissues. Neuropathic, diffused, mixed, or persistent joint pain is the most common characteristic of this condition.
Characteristics and Quality of the Included Studies
PHARMACOLOGICAL APPROACHES
Characteristics and Quality of the Included Studies
PHARMACOLOGICAL APPROACHES
Four cohort 1-group pretest-posttest studies examined the effects of pharmacological interventions in a total of 251 participants with AIA. Pharmacological approaches include taking
duloxetine (Cymbalta) as a serotonin and norepinephrine reuptake inhibitor, prednisolone, zadaxin (Thymalfasin) as immunotherapy and switching between AI drugs
Discussion
Discussion
We found that the overall effect size of AIA interventions for pain improvement across the studies was large. In particular, _____________________and__________________________ showed a large effect on pain, and relaxation techniques had a moderate effect,
pharmacological approaches
and
acupuncture
In the _______________ trial (30 mg daily for 1 week and then 60 mg daily for 7 weeks), 72.4% of participants experienced at least 30% reduction in the average pain level compared with baseline (P < .001), and approximately 80% completed the protocol.
duloxetine
A short course of ______________________________ provided immediate relief in joint pain in nearly 70% of participants, with 63% still reporting improvement at 1 month
prednisolone (5 mg of oral prednisolone once a day in the morning for 1 week)
Also, the participants who started _______1_______ after a 1-month washout period of anastrozole reported improvement in pain (P < .001) and physical and mental quality of life (P < .001 and P = .01, respectively), indicating that _______1_______was bette
1. letrozole
However, 74% of participants still complain of arthralgia at 6 months of letrozole therapy.
Lastly,__________________________________ had evidence of improvement in pain severity (P = .014), pain-related functional interference (P = .001), and physical well-being (P = .001) compared with baseline
Zadaxin therapy (subcutaneous injection of thymosin ?1 1.6 mg twice a week for 4 weeks)
Studies using duloxetine, immunotherapy, and switching between AIs were evaluated as having _________________ quality, whereas the prednisolone study was weak because of lack of blinding and no use of valid and reliable measurement tools.
moderate
Discussion
Discussion
This systematic review was the first to evaluate the effects of current pain management on AIA in breast cancer survivors and to identify the quality and strength of the studies. We found that the overall effect size of AIA interventions for pain improvem
large
Relaxation techniques had a _________________ effect
moderate
Whereas effects of nutritional supplementation and physical exercise were shown to be ____________________
insignificant