Aromatase inhibitors (AIs) are widely used as a part of adjuvant hormonal therapy for postmenopausal women with hormone receptor-positive breast cancer. While AIs are effective in reducing the risk of cancer recurrence, a significant proportion of patients experience adverse effects, including arthralgia or joint pain. This side effect can negatively impact patients’ quality of life and lead to noncompliance with treatment. Mao et al. (2017) conducted a randomised trial to evaluate the efficacy of electro-acupuncture for reducing AI-related arthralgia, offering an alternative treatment option for this common side effect. This article discusses the clinical implementation of electro-acupuncture for AI-related arthralgia based on the findings of this study.
Study Overview
Mao et al.’s (2017) study was a randomised, sham-controlled trial involving 226 postmenopausal women with stage O-III hormone receptor-positive breast cancer who were experiencing AI-related arthralgia. Participants were randomised to receive either real electro-acupuncture, sham acupuncture (non-penetrating needles with no electrical stimulation), or waitlist control for eight weeks. Pain severity and interference were the primary outcome measures, with secondary outcomes including joint stiffness, physical function, and overall quality of life. The study found that real electro-acupuncture significantly reduced pain severity and interference compared to both sham acupuncture and waitlist control, with improvements sustained at 12 weeks.
Clinical Implementation
- Identifying Candidates for Electro-Acupuncture
Patients experiencing joint pain or stiffness while on AI therapy may be candidates for electro-acupuncture. It is essential to evaluate patients for other potential causes of joint pain and rule out contraindications for acupuncture before initiating treatment. Contraindications may include bleeding disorders, use of anticoagulant medications, or infection at the needle insertion site.
- Referral to a Qualified Acupuncturist
Healthcare providers should refer patients to licensed acupuncturists experienced in electro-acupuncture and familiar with AI-related arthralgia. Collaboration between the oncology team and the acupuncturist is crucial for coordinating care and monitoring patients’ progress.
- Electro-Acupuncture Treatment Protocol
Based on Mao et al.’s (2017) study, the recommended treatment protocol for AI-related arthralgia is twice-weekly electro-acupuncture sessions for a total of eight weeks. The study used the following acupuncture points: LI4, LI11, ST36, SP6, GB34, and two Ashi points (tender points) around the most painful joint. Low frequency and intensity adjusted to the patient’s comfort level. The acupuncturist should tailor the treatment plan to the individual patient’s needs and symptom severity.
- Monitoring and Assessing Patient Outcomes
Providers should closely monitor patients throughout the electro-acupuncture treatment period to assess response and adjust the treatment plan as needed. Pain severity, interference, joint stiffness, and physical function can be evaluated using patient-reported outcome measures.
- Long-Term Management and Follow-Up
Although Mao et al.’s (2017) study reported sustained improvements in pain severity and interference at 12 weeks, the long-term efficacy of electro-acupuncture for AI-related arthralgia remains unclear. Providers should continue to monitor patients for symptom recurrence or worsening and consider additional electro-acupuncture sessions or alternative treatments as needed.
- Patient Education and Support
Informing patients about the potential benefits of electro-acupuncture for AI-related arthralgia is essential. Healthcare providers should discuss the treatment process, possible side effects, and expectations with patients to ensure they are well-informed and can make educated decisions about their care. It is also crucial to address any concerns or misconceptions patients may have about acupuncture to alleviate anxiety and promote treatment adherence.
- Integrating Electro-Acupuncture into Multidisciplinary Care
Electro-acupuncture should be considered as a complementary therapy alongside conventional breast cancer management, including medical, surgical, and radiation treatments. Effective management of AI-related arthralgia may improve patients’ compliance with AI therapy, potentially reducing the risk of cancer recurrence. Collaboration and communication among healthcare providers, including oncologists, primary care physicians, and acupuncturists, are essential for coordinating care and ensuring patients receive comprehensive, patient-centered treatment.
- Further Research and Clinical Trials
Although Mao et al.’s (2017) study provides promising evidence for the use of electro-acupuncture in managing AI-related arthralgia, further research is needed to confirm and expand upon these findings. Larger, multicenter trials with longer follow-up periods can help establish the long-term efficacy and safety of electro-acupuncture for AI-related arthralgia. Additionally, studies comparing electro-acupuncture to other non-pharmacological interventions, such as physical therapy or cognitive-behavioral therapy, may help identify the most effective treatments for this common side effect.
Conclusion
The study by Mao et al. (2017) supports the use of electro-acupuncture as a viable treatment option for patients experiencing AI-related arthralgia. Implementing electro-acupuncture in clinical practice requires collaboration among healthcare providers, patient education, and close monitoring of treatment outcomes. By incorporating electro-acupuncture into multidisciplinary care plans, providers can help patients manage AI-related joint pain, potentially improving compliance with AI therapy and enhancing overall quality of life.
Reference:
Mao, J. J., Stricker, C., Bruner, D., Xie, S., Bowman, M. A., Farrar, J. T., & Greene, B. T. (2017). Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer, 123(4), 551-558. https://doi.org/10.1002/cncr.30343