Women with Early Stage Breast Cancer Combat Joint Pain With Depression Drug

Women with Early Stage Breast Cancer Combat Joint Pain With Depression Drug

By Staff

A worldwide network of cancer researchers called SWOG, presented new research at the San Antonio Breast Cancer Symposium showing that a drug that is typically used to treat depression and anxiety can provide significant reductions in joint pain for women with early stage breast cancer.

The researchers conducted a randomized, placebo-controlled trial to test whether duloxetine, a depression and anxiety drug, could alleviate pain caused by aromatase inhibitors, a common breast cancer treatment that’s particularly effective with postmenopausal women.

Dr. N. Lynn Henry led the clinical trial, called S1202, because she wanted to conduct the study that addressed a common problem for women with breast cancer.  Tens of thousands of postmenopausal women each year are treated with aromatase inhibitors (AIs), pills that stop the production of estrogen and essentially starve hormone receptor-positive breast cancer cells.  As many as 50% of these women experience joint pain and stiffness as a side effect of AI therapy, and about 20% experience significant pain.  The impacted joints include, hips, knees, hands, and wrists, making many of life’s most simple tasks painful and difficult.

Henry said some women stop taking their medication to get relief. The pain is so common it has a name: AI-Associated Musculoskeletal Syndrome (AIMSS).

“A lot of 60-year-old women report feeling like they’re 80,” Henry said. “The pain can really interfere with daily life. And this is a big problem. The length of treatment with AIs can be five to 10 years, so we’re asking a lot of women to manage significant discomfort for a very long period of time.”

Henry and her team chose to test duloxetine (Cymbalta). The drug is primarily used to treat depression and anxiety, but is also used to treat fibromyalgia and diabetic nerve pain.

SWOG researchers enrolled 299 adult patients to S1202 at 43 institutions throughout the NCI’s National Cancer Trials Network (NCTN) and the NCI Community Oncology Research Program (NCORP). Those 299 patients were randomly assigned to either receive duloxetine or a placebo for 12 weeks. They filled out a questionnaire upon enrolling, and again at two, six, 12 and 24 weeks into the study. Questions focused on pain, rated on a 0-10 scale, and also on depression and quality of life.

Here are some of the results:

  • People taking duloxetine saw their average pain drop on the scale from 5.5 to about 3.
  • Improvement was rapid, and relief persisted through the end of the 12-week trial.
  • Improvement in pain was also seen in the placebo arm of the trial, suggesting a robust placebo effect.

“We’ve shown that this treatment is a potential option for women,” Dr. Henry said. “Taking this drug may help them tolerate their breast cancer treatment. And it’s important for their health that they stick with their treatment.”

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Authored by: Staff

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V. Wood

I had a five-year course of estrogen-suppressing drugs (four years of Tamoxifin and one year of an aromatase inhibitor) starting in 2006 for Stage 3A breast cancer. My regional cancer center’s physiatrist (pain management doctor) was primarily treating me for chemo-induced neuropathy (which continues to this day), but also treated me for what is now named AI-Associated Musculoskeletal Syndrome (AIMSS). (It didn’t have a name in 2006.) She treated me with Duloxetine/Cymbalta. Cymbalta reduced my muscle/joint pain and likely also helped with my depression/anxiety, which is common for a person going through significant surgical and medical procedures for breast cancer.

I just assumed that Cymbalta was the standard of care at the time I received it, and am surprised that it is just now being studied for efficacy against AIMSS.