MUSCULOSKELETAL COMPLAINTS

Neuropathy is common during and after treatment with taxanes or platinum agents. Permanent hearing loss can occur with cisplatin, and peripheral neuropathy is particularly frequent with taxane therapy. Treatment options are limited, although physical therapy can help improve function and there have been reports of some success with lessening neuropathy with glutamine and amitrip-tyline.47 Joint pains and generalized aches can continue after treatment with cytotoxic agents and are a tremendous problem for some women on hormonal therapies, especially aromatase inhibitors.48 Arthralgias due to aro-matase inhibitors are usually symmetric, often involve the hands, arms, knees, feet, pelvic bones, and back, and may be more severe in the morning. It is not known whether rates are higher with certain members of this drug class than others. Exercise and analgesics may improve arthralgias, and pain usually resolves within weeks of stopping an aromatase inhibitor.49 A recent cross-sectional survey of 200 women receiving adjuvant aromatase inhibitor therapy found that 47% reported joint pain and 44% reported joint stiffness. Body mass index of 25 to 30 kg/m2 and prior tamoxifen therapy were found to be associated with a reduced likelihood of joint symptoms. Patients who had previously received a taxane were four times as likely as those who had not to report joint symptoms.50

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