Effect of Aromatase Inhibitor Therapy on Sleep and Activity Patterns in Early-stage Breast Cancer

• Published in: Clinical breast cancer Vol. 18; no. 2; pp. 168 - 174.e2
• Main Authors: Bhave, Manali A., Speth, Kelly A., Kidwell, Kelley M., Lyden, Angela, Alsamarraie, Cindy, Murphy, Susan L., Henry, N. Lynn
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Actigraphy; Adjuvant endocrine therapy; Aged; Aged, 80 and over; AIs; Antineoplastic Agents, Hormonal - adverse effects; Aromatase Inhibitors - adverse effects; Breast - pathology; Breast - surgery; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Chemotherapy, Adjuvant - adverse effects; Chemotherapy, Adjuvant - methods; Fatigue - chemically induced; Fatigue - diagnosis; Female; Humans; Mastectomy; Medication Adherence; Middle Aged; Musculoskeletal Pain - chemically induced; Musculoskeletal Pain - diagnosis; Pain Measurement; Patient Reported Outcome Measures; Patient-reported outcomes; Pilot Projects; Postmenopause; Prospective Studies; Receptors, Estrogen; Receptors, Progesterone; Sleep Wake Disorders - chemically induced; Sleep Wake Disorders - diagnosis; Treatment discontinuation; Treatment Outcome; Actigraphy; Treatment discontinuation; AIs; Patient-reported outcomes; Adjuvant endocrine therapy
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2017.12.012

Treatment-emergent side effects often affect adherence to aromatase inhibitor (AI) therapy. In the present study, we examined the sleep patterns and daytime function both objectively using actigraphy and subjectively using validated questionnaires in women receiving AI therapy. Daytime function significantly decreased after 3 months of AI therapy and correlated with increased fatigue. Larger studies are necessary to understand why daytime function is affected by AI therapy and to identify interventions to improve daytime function, which could be helpful in improving adherence to AI therapy. Adherence to aromatase inhibitor (AI) therapy is poor, often because of treatment-emergent side effects, including musculoskeletal symptoms, fatigue, and insomnia. In the present analysis, we examined the sleep patterns and daytime function both objectively using actigraphy and subjectively using validated questionnaires in women initiating AI therapy. Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were initiating AI therapy were eligible. The patients wore actigraphy devices for 10 consecutive days and completed questionnaires at baseline before the initiation of AI and after 3 months of AI therapy. Associations between the baseline demographics and symptoms, changes in patient-reported outcomes and actigraphy measures from baseline to 3 months of AI therapy and discontinuation of AI therapy were examined using sign tests, logistic regression models, Spearman's correlation, and linear mixed models. Forty-two patients (86%) completed the baseline assessments and 23 patients (47%) completed both the baseline and the 3-month assessments. Objectively measured daytime function as measured by total daytime activity decreased during the 3 months after starting AI (232,566 activity count vs. 204,205 activity count; P = .023), and the decrease was more evident in women with higher baseline physical function. Reduced daytime activity correlated with increased fatigue (ρ = −0.49; P = .017). Daytime function decreased after initiation of AI therapy and correlated moderately with increased fatigue, although no association was identified with changes in pain or sleep quality. Additional studies are required to understand why function is reduced, which could have implications for interventions to improve patient tolerance of, and persistence with, AI therapy.