Acupuncture May Relieve Breast Cancer Treatment Side Effects

Dealing with Aromatase Inhibitor Side Effects

Anti-estrogen or hormonal therapies are a mainstay of treatment for ER positive breast cancers. Most younger women are given Tamoxifen, and most post-menopausal women take one of the three available Aromatase Inhibitors or AIs (aromasin/exemestane, arimidex/anastrozole, and femara/letrozole). All three block the aromatase enzyme that would otherwise convert androgens to estrogen. None of these drugs can prevent the ovaries from making estrogen, so they are not useful in menstruating women. Since approximately 80% of all breast cancers are ER positive, many woman are taking these powerful drugs.

As you may know, the original plan was for woman to take an AI for five years after completing adjuvant chemotherapy — or, sometimes, to take an AI in lieu of chemotherapy. Over the years, the standard of care has changed. For a relatively brief period, many women took tamoxifen for two or three years and then switched to an AI for a total of five years of therapy. As the evidence accumulated that a longer duration of treatment is often helpful, women are staying on these drugs for 10 years or more.

The goal, obviously, is to prevent a recurrence of breast cancer, but there are trade offs and side effects that can be difficult. My experience has been that it is quite unusual for a women to experience really disabling or highly distressing side effects. When that does happen, the problem is usually solved by switching to one of the other AIs. They are alike, but different enough one from another that most women can find one that is tolerable. The take-home lesson here is that if you are feeling poorly on one of the AIs, talk to your doctor about the possibility of trying another. I have also known women who found that switching from the generic to the brand name pill solved any side effect issues. (In that case, you may have to talk with your insurance company, but a doctor's documentation of the problem will probably work.)

The most common complaint about all of the AIs is muscle and joint stiffness/discomfort/pain. There is a huge range of intensity. Many women feel stiff and awkward and 100 years old when they first get out of bed in the morning or out of the car after a long drive. Walking just a little loosens everything up. Some women feel more achy more of the time, and a few women experience real pain and difficulty in normal movement and activities. If you are in the middle group, an over the counter medication called Glucosamine Chondroitin may help. Regular exercise will almost certainly help. And now a recent study reported in JAMA, 'Can Acupuncture Keep Women on Their Breast Cancer Drugs?,' suggests that acupuncture can be useful.

Most insurance companies, unfortunately, do not cover acupuncture, but a few do, so it is worth asking. Staff at BIDMC's BreastCare Center can also make recommendations about treating side effects.

If you live elsewhere, ask your doctors and your friends for suggestions. There may also be less expensive options like Schools of Acupuncture that sometimes offer group sessions.