Postchemotherapy arthralgia
A single-institution chart review of breast cancer patients treated with adjuvant chemotherapy

Alison Haynes, BKin; Joy McCarthy, MD, FRCPC; Kara Laing, MD, FRCPC; Stewart Rorke, MD, FRCPC; Muhammad Zulfiqar, MD, FRCPC; Adnan Zaidi, MD, FRCPC; Michael LeBlanc, BSc Pharm

ABSTRACT
Rationale: Many of the immediate effects of chemotherapy are widely known, but the late effects postchemotherapy have not been extensively described. The purpose of this study was to determine the statistical occurrence of postchemotherapy arthralgia (PCA) in breast cancer patients in a single institution. The study further attempted to determine if certain chemotherapy regimes, comorbidities or menopausal status correlate with PCA symptoms.

Methods: This retrospective chart review included all patients from the Dr. H. Bliss Murphy Cancer Centre with Stage I, II or III breast cancer who received adjuvant chemotherapy during the 2005 calendar year. Information collected included the incidence of reported PCA and correlating factors.

Results: A total of 56 charts were eligible for the study, with 51 satisfying the inclusion criteria. Of the eligible charts, 18 (35.3%) reported PCA and 33 (64.7%) did not report PCA. Of the charts reporting PCA, 5 cases (27.8%) were recorded at </= 8 weeks postchemotherapy, and 10 (55.5%) between 8 weeks and 16 weeks, inclusive. The remaining 3 charts (16.7%) reported PCA at >/= 16 weeks. Within the PCA group, 5 patients (27.8%) were treated with fluorouracil + epirubicin + cyclophosphamide (FEC100) for a total of 6 cycles. Five patients (27.8%) were treated with 3 cycles of FEC100 plus 3 cycles of docetaxel. Four cases (22.2%) received 6 cycles of docetaxel + doxorubicin + cyclophosphamide (TAC) and 3 (16.7%) were given 4 cycles of doxorubicin + cyclophosphamide (AC). The remaining patient (5.5%) was treated with dose-dense epirubicin + cyclophosphamide (EC) for 6 cycles plus 4 cycles of paclitaxel. Of the 18 patients in the PCA group, 10 (55.5%) were premenopausal and 8 (44.5%) were postmenopausal prior to chemotherapy. Of the 10 premenopausal PCA patients, 6 (60%) were reported as having become postmenopausal following chemotherapy. Eleven patients (61.1%) in the PCA group were estrogen and/or progesterone receptor (ER/PR)-positive. Of these positive patients, 7 (63.6%) were treated with tamoxifen and 4 (36.4%) received an aromatase inhibitor (AI). Seven (38.9%) patients in the PCA group were ER/PR-negative.

Conclusions: Our findings have highlighted that PCA is a common, unpleasant postchemotherapy event for a large proportion of breast cancer patients. It would be beneficial for physicians to inquire about symptoms of PCA and document the details in the patient chart. Furthermore, prospective studies should include specific questions such as character, onset, severity and treatment to help define the typical pattern of PCA. Such information could be used to diagnose this side effect and potentially help differentiate between PCA and onset of metastatic disease.