The Acupuncture Answer: "[Joint pain] probably is the most-commonly cited reason breast cancer patients stop taking [aromatase inhibitors] medication.".

• Author: Mapes, Diane
• Position: Medicine & Health - Clinical report

EARLY-STAGE breast cancer patients dealing with painful side effects from powerful estrogen-squelching drugs known as aromatase inhibitors have received good news from a team of researchers who led a large and rigorous acupuncture study. It now has been scientifically proven that acupuncture relieves joint pain for these patients.

The results come from a blinded randomized multicenter trial conducted by SWOG (formerly the Southwest Oncology Group), a global network of researchers that designs and conducts cancer clinical trials. It is the latest in a series of studies to give breast cancer patients better tools--pharmaceutical and otherwise--to combat the debilitating joint and muscle pain commonly associated with aromatase inhibitors, or AIs.

Dawn Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University and lead author of the trial notes that joint pain "probably is the most-commonly cited reason breast cancer patients stop taking AI medication." This trial, she indicates, provides "a solution that doesn't include opioids or drugs that can be addictive or have serious side effects."

Coauthor Heather Greenlee, a Fred Hutchinson Cancer Research Center epidemiologist, naturopathic physician, and director of the Integrative Medicine Program at Seattle Cancer Care Alliance (SCCA) adds: "It is wonderful that we now have data from a large-scale, well-conducted trial showing that acupuncture works for managing a very specific type of pain.

"It's a milestone for SWOG to support this kind of trial, and it's really great for patients to have solid data to inform their treatment decisions. We're excited that a nonpharmacological agent like acupuncture has been shown to effectively reduce pain long term."

Aromatase inhibitors commonly are prescribed to early stage postmenopausal breast cancer patients with estrogen-receptor-positive disease following standard treatments like surgery, radiation, and chemotherapy. The daily pill further tamps down the body's ability to produce estrogen, essentially cutting off the cancer's food supply.

However, like some dark German fairy tale, there is a trade-off. The daily pill allows you to live longer (hopefully) but ages you before your time. As estrogen dwindles, patients experience all the side effects that come with advanced age: loss of bone density and libido, insomnia, hot flashes, night sweats, and, most especially, joint stiffness and pain in the feet, knees, hips, shoulders, wrists, and hands.

This ongoing pain makes it difficult for many patients to walk, sit, climb stairs, or perform simple tasks like typing or driving, let alone exercise, which often is prescribed to breast cancer patients to reduce their risk of recurrence. As a result, up to 50% of women stop taking AI before the recommended five years; fewer still are able to endure it for 10. Studies confirm that women who stop the drug have reduced disease-free survival.

"Patients tell me they feel much older. They say, 'I feel slower and my joints aren't moving the same. I feel like a creaky old lady.' That goes along with the vaginal dryness and all the other side effects," says Julie Gralow, a Fred Hutch clinical researcher and SCCA breast cancer oncologist who serves as vice-chair of SWOG's breast cancer committee.

"We need to help these women stay on these drugs and maintain a high quality of life. We need to do all we can. These are important drugs and staying on them for at least five years is optimal in terms of reducing recurrence and death."

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