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Preventing Aromatase Inhibitor-Associated Arthralgias Among Non-Hispanic Black Postmenopausal Women With Early-Stage Breast Cancer

NCT ID: NCT06534125Sponsor: Emory UniversityLast updated: 2026-01-29

Summary

This clinical trial evaluates if in-person acupuncture or virtual acupressure therapy prevents aromatase inhibitor-associated joint pain in Non-Hispanic Black postmenopausal women with stage I-III (early-stage) hormone receptor positive (HR+) breast cancer. Aromatase inhibitors (AI) are medications that prevent the formation of the hormone estrogen. They are used in the treatment of postmenopausal women who have hormone-dependent breast cancer. AI therapy prolongs life among patients with early-stage HR+ breast cancer. Many postmenopausal women stop AI therapy early due to debilitating joint pain (arthralgias). Non-Hispanic Black women are more likely to experience side effects and stop their hormonal therapy compared to Non-Hispanic white women. Acupuncture therapy involves inserting thin needles through the skin at specific points on the body to control pain. Acupressure therapy uses the application of pressure or localized massage to specific sites on the body to control symptoms such as pain. Acupuncture and acupressure are types of complementary and alternative medicine. Undergoing in-person acupuncture or participating in virtual acupressure may prevent AI-associated arthralgias (AIAA) in Non-Hispanic Black postmenopausal women with early-stage HR+ breast cancer.

Detailed description

PRIMARY OBJECTIVE: I. To determine if initiation of in-person acupuncture or virtual acupressure sessions within 2 weeks of starting aromatase inhibitors (AI) will reduce the severity and incidence of AI-associated arthralgias (AIAA) among non-Hispanic Black postmenopausal women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer at 6 months after starting adjuvant AI therapy. SECONDARY OBJECTIVES: I. To compare the efficacy of acupuncture to the efficacy of acupressure among the study population. II. To determine if acupuncture or acupressure will increase AI adherence (secondary endpoint) among the study population at 6 months after starting adjuvant AI therapy. III. To evaluate the acceptance, satisfaction, convenience, accessibility, and perceptions of in-person acupuncture and virtual acupressure. IV. To conduct 4 focus groups of 6-12 non-Hispanic Black women who receive 12 weeks of acupuncture or acupressure and collect and analyze qualitative data about barriers and facilitators to completing each intervention, transportation concerns, and ease or difficulty of completing each intervention. OUTLINE: Patients are randomized to 1 of 3 arms. ARM I: Patients undergo acupuncture therapy in-person over 1 hour twice weekly for the first 6 weeks and then once weekly for 6 weeks and receive standard of care (SOC) AI therapy. ARM II: Patients undergo self-administered acupressure therapy virtually over 1 hour twice weekly for the first 6 weeks and then once weekly for 6 weeks and receive SOC AI therapy. ARM III: Patients receive SOC AI therapy. After completion of study intervention, patients are followed up for 12 months or until the initiation of new antineoplastic or investigational therapy, whichever occurs first.

Arms & interventions

  • ProcedureAcupressure Therapy

    Undergo self-administered acupressure therapy to planned pressure points

  • DeviceAcupuncture Therapy

    Undergo acupuncture therapy with acupuncture needles applied to planned pressure points

  • DrugAromatase Inhibition Therapy

    Receive SOC AI therapy

  • OtherDiscussion

    Ancillary studies

  • OtherSurvey Administration

    Ancillary studies

Outcome measures

Primary

  • Brief pain inventory (BPI) pain severity score

    Pain will be assessed by the BPI-Short Form. Pain severity is rated from 0-10 with higher scores indicating worse pain. Will measure change in BPI severity score from baseline as an absolute value and a percentage. Will also measure pain as a dichotomous variable (increase in BPI score \>= 1 point versus (vs) \< 1 point increase in pain severity) in order to determine the incidence of aromatase inhibitor-associated arthralgias (AIAA) and compare the incidence between study arms at 24 weeks. Participants can also list all pain medications they are taking. Will verify this information in their medical records.

    Time frame: Baseline to 6 months after aromatase inhibitor (AI) start

  • Incidence of arthralgias

    Pain will be assessed by the BPI-Short Form. Pain severity is rated from 0-10 with higher scores indicating worse pain. Will measure change in BPI score from baseline as an absolute value and a percentage. Will also measure pain as a dichotomous variable (increase in BPI score \>= 1 point vs \< 1 point increase in pain severity) in order to determine the incidence of AIAA and compare the incidence between study arms at 24 weeks. Participants can also list all pain medications they are taking. Will verify this information in their medical records.

    Time frame: Baseline to 6 months after AI start

Secondary

  • Pain severity

    Time frame: Baseline to 6 months after starting study intervention

  • Incidence of arthralgias

    Time frame: Baseline to 6 months after starting study intervention

  • AI adherence

    Time frame: Baseline to 6 months after starting study intervention

  • Symptom burden

    Time frame: Baseline to 6 months after starting study intervention

  • Intervention completion rate

    Time frame: At 6 months after starting study intervention

  • Participant satisfaction rate

    Time frame: At 6 months after starting study intervention

  • Perceived difficulty of completing study intervention

    Time frame: At 6 months after starting study intervention

Eligibility criteria

Sex: FemaleAge: 18 Years and olderHealthy volunteers: No
Inclusion Criteria: * Age ≥ 18 years * Self-identified Non-Hispanic Black woman * Postmenopausal status (\>= 12 months since last menstrual period, history of bilateral salpingo-oophorectomy, or estradiol, follicle-stimulating hormone \[FSH\], and luteinizing hormone \[LH\] levels consistent with menopause) * Diagnosed with stage I-III HR+/HER2 negative (-) breast cancer * Completed all phases of active therapy (e.g. surgery, chemotherapy, and/or radiation) at least 14 days before study enrollment * Planned to start adjuvant AI Exclusion Criteria: * Diagnosed with metastatic breast cancer * Premenopausal status * History of allergic reactions attributed to compounds of similar chemical or biologic composition to acupuncture needles or other agents used in study * Diagnosis of rheumatoid arthritis, multiple sclerosis, or muscular dystrophy * A history of or current CDK 4/6 inhibitor use * A history of neoadjuvant AI use * Use of adjuvant AI \> 14 days * Received acupuncture within 60 days prior to start of study

Study locations (4)

Grady Health System

Atlanta, Georgia, 30303

Recruiting
Demetria Smith-Graziani, MD, MPH · Principal Investigator

Emory University Hospital Midtown

Atlanta, Georgia, 30308

Recruiting
Demetria Smith-Graziani, MD, MPH · Principal Investigator

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, 30322

Recruiting
Demetria Smith-Graziani, MD, MPH · Principal Investigator

Emory Saint Joseph's Hospital

Atlanta, Georgia, 30342

Recruiting
Demetria Smith-Graziani, MD, MPH · Principal Investigator