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Background More than 80,000 postmenopausal breast cancer patients in the United States each year are estimated to begin a 5-year course of aromatase inhibitors (AIs) to prevent recurrence. AI-related arthralgia (joint pain and/or stiffness) may contribute to nonadherence, but longitudinal data are needed on arthralgia risk factors, trajectories, and background in postmenopause. This study sought to describe 1-year arthralgia trajectories and baseline covariates among patients with AI and a postmenopausal comparison group. Methods Patients initiating AIs (n = 91) were surveyed at the time of AI initiation and at 6 repeated assessments over 1 year. A comparison group of postmenopausal women without breast cancer (n = 177) completed concomitantly timed surveys. Numeric rating scales (0-10) were used to measure pain in 8 joint pair groups (bilateral fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes). Poisson regression models were used to analyze arthralgia trajectories and risk factors. Results By week 6, the AI-initiating group had more severe arthralgia than did the comparison group (ratio of means = 1.8, 95% confidence interval = 1.24-2.7, P = .002), adjusting for baseline characteristics. Arthralgia then worsened further over 1 year in the AI group. Menopausal symptom severity and existing joint-related comorbidity at baseline among women initiating AI were associated with more severe arthralgia over time. Conclusions Patients initiating AI should be told about the timing of arthralgia over the first year of therapy, and advised that it does not appear to resolve over the course of a year. Menopausal symptoms and joint-related comorbidity at AI initiation can help identify patients at risk for developing AI-related arthralgia.

Exercise is a common treatment for individuals with chronic low back or neck pain and is used to improve physical function and decrease symptoms (e.g., pain, stiffness). Exercise has also been used to minimize disability by decreasing individuals’ fears about pain during movement and by reshaping their attitudes and beliefs about their pain. The latter goal is common in cognitive behavioral and functional restoration programs that typically use a quota-based, non-pain contingent approach to exercise.1 In the past decade, a number of randomized trials, systematic reviews, and clinical practice guidelines have supported the use of exercise for the treatment of chronic low back pain (LBP) 2–14 and chronic neck pain.15–19 While there is still much to learn about the types and intensity of exercises that are most effective, recent meta-analyses by Hayden and colleagues suggest individually tailored, supervised exercise programs that include stretching and strengthening are associated with the best outcomes for individuals with chronic LBP.5, 6 Hayden et al. also found that exercise in combination with other conservative treatments and “high dose” exercise, defined as an exercise intervention with a total time of 20 hours or more, improved pain and function more than exercise alone or “low dose” exercise.6 The findings for chronic neck pain are similar, though somewhat less definitive, with data suggesting that certain types of exercise are most effective and supervised exercise is more effective than non-supervised exercise. According to evidence statements on the treatment of chronic neck pain published by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain, supervised and home exercise plus advice is marginally more effective than advice alone for chronic whiplash associated disorders; a neck exercise program alone or in combination with spinal manipulation is more effective than spinal manipulation alone, TENS, or usual care for chronic “non-specific” neck pain; and both endurance (repetitive, submaximal resistance exercises) and strengthening exercises (repetitive, maximal resistance exercises) are effective treatments for chronic “non-specific” neck pain.19 Data also suggest that aerobic exercise and stretching alone are less effective than endurance and strengthening exercises,20, 21 and that stretching exercises for the neck are as effective as manual therapy.22 Evidence on the additive effect of other conservative treatments in combination with exercise for the treatment of chronic neck pain is less clear. There are some data to suggest that multimodal approaches that include exercise may be more effective than single treatment approaches.23, 24 While the past decade has led to gains in our understanding of the efficacy of exercise for chronic low back and neck pain, less is known about exercise prescription in routine clinical practice. Who is prescribing it? Who is getting it? What is being prescribed? Such information would be useful in assessing the translation of research findings to clinical practice and in identifying areas to target for increased promotion of exercise as an effective treatment. We analyzed data from a population-based survey of healthcare provider and treatment use by individuals with chronic low back or neck pain to gain a better understanding of the use of exercise in the treatment of these conditions. Our specific objectives were: 1) to determine the extent to which exercise is prescribed by physicians, physical therapists (PTs), and chiropractors for the treatment of chronic low back and neck pain; 2) to identify demographic, insurance, work, and health-related characteristics associated with exercise prescription; 3) to describe the amount of supervision provided and types of exercises prescribed for each provider type; and 4) to determine the extent to which other conservative treatments are used in combination with exercise.

BACKGROUND. Longitudinal tumor-specific studies of cancer pain across the disease trajectory provide insight into the course of pain. Information on pain predictors refines our understanding of patients with greatest distress and need. METHODS. The authors studied 1124 women with metastatic breast cancer and bone metastases, all of whom received standard treatment in an international clinical trial conducted from October 1998 to January 2001. The Brief Pain Inventory (BPI) was administered repeatedly during the course of 1 year. Hazard models were fitted to identify baseline and time-dependent covariates as predictors of pain worsening within cumulative 80-day intervals during the year. RESULTS. Increased severe pain hazards were associated with non-Caucasian race (hazard ratio [HR] = 2.52; 95% CI, 1.69–3.76), restricted performance status (HR = 1.73; 95% CI, 1.13–2.64), and radiation therapy in a previous interval (HR = 2.86; 95% CI, 1.61-5.09). Estimated cumulative rates for not yet reaching a BPI score of 7 or above ranged from 0.79 (0.72–0.85) in the first interval to 0.64 (0.55–0.74) in the last interval for non-Caucasian women, whereas these rates ranged from 0.91 (0.89–0.93) to 0.84 (0.81–0.87) for Caucasian women. CONCLUSIONS. By using a time-to-event hazards analysis for cancer symptom data, the authors demonstrated that non-Caucasian race predicted poorer pain control among women with metastatic breast cancer. Disparity findings from cross-sectional studies were confirmed. Pain management strategies should take race into account as a risk factor for worsening pain outcomes, and further investigation should seek to uncover and resolve the reasons for this obvious disparity. Cancer 2008. © 2007 American Cancer Society.

BACKGROUND Patients in Phase I clinical trials sometimes report high expectations regarding the benefit of treatment. The authors examined a range of patient characteristics to determine which factors were associated with greater expectations of benefit from Phase I trials. METHODS Participants were adult patients with cancer who had been offered participation in Phase I studies and had decided to participate. Patients completed interviewer-administered surveys before initiation of treatment. Physicians assessed Eastern Cooperative Oncology Group performance status for each patient. Statistical analyses (Pearson product moment correlation and t tests) used multiple imputation to account for missing data. RESULTS Overall, 593 patients who were offered participation in Phase I trials were contacted, and 328 patients agreed to participate in a study of decision making by cancer patients. Of these, 260 patients (79%) enrolled in a Phase I trial. Patients' expectations regarding the chance that their disease would be controlled with experimental therapy were unrelated to age, gender, living situation, education level, or functional status. Expectations were correlated positively with beliefs about the benefit of standard therapy and the maximum benefit patients may experience from experimental therapy. Greater expectations of benefit were associated with better health-related quality of life, stronger religious faith, optimism, relative health stock, monetary risk seeking, and poorer numeracy. CONCLUSIONS Expectations expressed as beliefs in personal outcomes may be related more to quality of life and personality variables than to patients' knowledge or functional status. Whether such expectations are accurate reflections of knowledge has important implications for evaluating the informed consent process. Cancer 2003;98:166–75. © 2003 American Cancer Society. DOI 10.1002/cncr.11483