Self-Care Measures for Patients on Long-Term Aromatase Inhibitors
Patients on long-term aromatase inhibitors should receive vitamin D and calcium supplements, undergo regular bone mineral density monitoring, and consider bisphosphonate or denosumab therapy if at risk for osteoporosis to manage bone health, while also implementing physical activity and acupuncture for musculoskeletal symptoms. 1
Bone Health Management
Aromatase inhibitors (AIs) cause significant bone loss that can lead to osteoporosis and increased fracture risk. Proper bone health management is essential:
- Baseline bone mineral density (BMD) assessment via bone densitometry is recommended before starting AI therapy, particularly for patients at risk of osteoporosis (e.g., age >65, family history, chronic steroid use) 1, 2
- Routine assessment of 25-hydroxy vitamin D levels prior to starting AI treatment due to high prevalence of vitamin D deficiency in women with early breast cancer 2
- Daily calcium and vitamin D supplementation for all patients on AIs 1
- Regular monitoring of bone density during AI therapy 1
- For patients with T-scores between -1.0 and -2.5 (osteopenia) or lower than -2.5 (osteoporosis), consider bone-directed therapy 1
Bone-Directed Therapy Options
- Oral bisphosphonates (risedronate, ibandronate) have shown favorable effects on BMD over 24 months in patients receiving anastrozole 1
- Intravenous zoledronic acid (4 mg IV every 6 months) has demonstrated preservation of BMD when used concurrently with letrozole 1
- Denosumab (60 mg subcutaneously every 6 months) has shown significant increases in lumbar spine BMD (7.6%) and hip BMD (4.7%) after 24 months in patients on AI therapy 1
Musculoskeletal Symptom Management
Up to 50% of women on AIs report arthralgias (joint pain) and myalgias (muscle pain), with 20% experiencing symptoms severe enough to lead to treatment discontinuation 1, 3:
- Regular assessment for musculoskeletal symptoms at each clinical encounter 1
- Physical activity and exercise programs have been shown to decrease AI-associated pain by up to 20% 1, 3
- Referral for physical therapy for stretching and targeted exercises to manage joint symptoms 1
- Acupuncture has demonstrated statistically significant improvement in AI-associated musculoskeletal symptoms 1, 3
- Consider acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) for pain management, though these may have limited efficacy for AI-related joint symptoms 1, 3
Cardiovascular Health Monitoring
Different AIs may have varying cardiovascular risk profiles:
- Monitor cardiovascular health during long-term AI therapy 1
- Exemestane and letrozole have shown early signs of cardiac side effects compared to tamoxifen, while anastrozole has not demonstrated significant increases in ischemic cardiovascular disease 1
- Regular assessment of lipid profiles may be warranted, though long-term effects of AIs on lipid metabolism remain unclear 4, 5
Other Side Effect Management
- Hot flushes and vaginal dryness are common endocrinological side effects 5
- For patients experiencing severe side effects that impact quality of life or treatment adherence, consider switching to a different AI or to tamoxifen if appropriate 1, 3
- Approximately 40% of patients who discontinue one AI due to side effects may tolerate a different AI or formulation 1
Importance of Adherence
- Poor compliance with AI therapy has been associated with increased risk of breast cancer recurrence 1
- Patient education about possible side effects and the importance of completing treatment is essential 3
- Regular follow-up visits every 3-6 months for the first 3 years, every 6-12 months for the next 3 years, then annually to monitor for side effects 1
By implementing these self-care measures, patients on long-term AI therapy can better manage side effects, improve quality of life, and maintain treatment adherence, ultimately optimizing their breast cancer outcomes.