Finding the ‘Right Fit’ for ER+ Breast Cancer After Aromatase Inhibitor AEs

"I think, regardless if you're a nurse versus the APN or APP, you're just listening, hearing them out, documenting it, reporting it," said Valerie Shander, FNP, AOCNP, MSN, BSB, CGRA.

To manage aromatase inhibitor-associated joint pain among patients with estrogen receptor-positive breast cancer, oncology nurses and advanced practice providers (APPs) must work collaboratively with the multidisciplinary team, explained Valerie Shander, FNP, AOCNP, MSN, BSB, CGRA.

This may be particularly true when symptoms lead to a necessary change in treatment. “Everyone has their right fit … we start with letrozole [Femara] oftentimes with the practice I work with, but that might not be the right fit for [another patient who] may do better with something else,” Shander, a nurse practitioner at Rutgers Cancer Institute, said in an interview with Oncology Nursing News. “[It’s important] working with a patient to find the right fit. And sometimes it takes 3 or 4 medications to find the right fit.”

READ MORE: ASCO/SIO Panel Recommends Acupuncture For Adults With Aromatase Inhibitor–Related Joint Pain

To manage joint pain—and other adverse events from aromatase inhibitors, such as hot flashes, sleep disturbances, and libido change—nurses must work closely with physicians, orthopedic specialists, and other members of the clinical team, Shander said.

Is there anything that can be done before treatment to prevent or decrease the chance of aromatase inhibitor-associated joint pain?

Usually your body kind of gets reacclimated to being at a lower amount of estrogen in your body. Usually about the first 3 months is the worst period, and if you can push through that, most people will reacclimate and feel better.

There is nothing really to do preventatively, other than it is recommended to exercise. So the more you exercise, the more you use those joints, the better. People who [have a higher body mass index] will have more joint pain. So you exercise, you decrease some of that weight, it sometimes can help with some of the joint pains.

Also, it does seem to aggravate those joints that we already know are aggravated. So those people who already have knee issues will notice a resurgence in their knee pain. So [patients should see] an orthopedist to help minimize pain and maximize benefits that they can get from different agents.

We don't want to give chronic narcotics. So sometimes it's also feeling out, is there another aromatase inhibitor that might be better? Some people are just better with one than the other. And even though we [typically] start with one drug, sometimes we have to switch around a little bit to find the agent that's best for that individual, and sometimes just aromatase inhibitors are not the right agent for them. They may need to go on tamoxifen, which does not cause the joint pain as much. So it's figuring out what's right for that particular patient.

In order to appropriately switch treatment, if need be, patients should be upfront with their care team about side effects they are experiencing. How can nurses and APPs build these trusting relationships?

I don't think there's any specific way other than listening to what their concerns are, dialoguing that: “Yes, it is a valid concern. Yes, that can be a legitimate issue complaint, but we need to figure out how to best manage it so that we also still treat your breast cancer.” So again, having open dialogue, communication, validating their feelings, is pretty much the way I handle it.

I think, regardless if you're a nurse versus the APN or APP, you're just listening, hearing them out, documenting it, reporting it…validating the patient's feelings, communicating with the providers who can change the medications, and having that dialogue [is important].