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Omega-3 fatty acid use improves symptoms among obese patients with breast cancer
CHICAGO — Aromatase inhibitor-associated arthralgia symptoms improved among women with breast cancer and a high BMI after treatment with omega-3 fatty acids, according to findings presented at ASCO Annual Meeting.
“In postmenopausal women with hormone receptor-positive breast cancer, aromatase inhibitors have been shown to improve outcomes and prolong survival but are associated with the adverse effect of arthralgia,” Sherry Shen, MD, resident in internal medicine at NewYork-Presbyterian Hospital, told HemOnc Today. “A significant proportion of women discontinue aromatase inhibitor therapy prematurely or have decreased adherence to their prescribed regimen due to this arthralgia, and as a result put themselves at higher risk for breast cancer recurrence and breast cancer-related mortality.”
Shen and colleagues assessed the association between omega-3 fatty acids and BMI in a cohort of 249 women with stage I to stage III breast cancer who were being treated with an aromatase inhibitor.
Researchers randomly assigned the patients — 110 who had a BMI of 30 mg/kg or higher and 139 with a BMI less than 30 mg/kg — to 24 weeks of omega-3 fatty acids or placebo.
Diabetes occurred among 19% of participants in the higher BMI group, compared with 8% in the lower BMI group (P = .009). Hypertension was also more likely in the higher BMI group (53% vs. 31%; P = .0005), along with having two or more cardiovascular risk factors (33% vs. 17%; P = .009), and lower HDL levels (49.9 vs. 60.3; P < .0001).
Results showed a significant reduction in triglyceride levels at 12 weeks in the omega-3 arm compared with placebo among patients in the higher BMI group (–22.42 vs. +1.59; P = .03). However, this outcome did not persist among patients with BMI less than 30 mg/kg.
Researchers observed a 2.89-point decrease in Brief Pain Inventory worst pain score after 24 weeks in the active treatment group, compared with a 1.49-point decrease for placebo (P = .02) among patients with a higher BMI. No significant change in this outcome occurred between the two treatment groups among patients with a BMI less than 30 mg/kg.
“We examined the data for a difference in effect by BMI, and found that obese patients taking omega-3 fatty acids had significantly lower pain scores after 24 weeks compared with obese patients taking placebo, but among nonobese patients there was no significant difference in pain scores between the treatment arms,” Shen said.
When the global change in joint pain was used as a parameter, a similar trend occurred. Among patients in the higher BMI group, omega-3 fatty acids yielded an improvement (+0.98 vs. +0.48; P = .05), but a similar improvement did not occur in the lower BMI group (+0.57 vs. +0.5).
“Given that this was a secondary analysis, our findings should be confirmed in other studies, but we hope that this offers obese patients with aromatase inhibitor-related arthralgia a potential treatment for their symptoms and ultimately promote increased adherence to aromatase inhibitors,” Shen said. “Omega-3 fatty acids are easily accessible at local pharmacies, low in cost, easy to take, and are associated with low rates of side effects, so obese patients experiencing aromatase inhibitor-related arthralgia should discuss potential treatment options with their oncologists.
“There are a few ongoing studies specifically evaluating omega-3 fatty acids for the prevention of aromatase inhibitor-related arthralgia,” Shen added. “It would be interesting to see if the same BMI-related treatment effect exists in their data.” – by Rob Volansky
Reference:
Shen S, et al. Abstract 10000. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Shen reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclsoures.
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This abstract is of great interest as we know that many patients are unable to tolerate the planned course of endocrine therapy due to aromatase inhibitor-related joint symptoms. The investigators found improvement in pain scores for patients with BMI at least 30 mg/kg following 24 weeks of omega-3 fatty acid supplementation compared with placebo, whereas those patients with BMI less than 30 mg/kg had no significant improvement in pain. I find these results intriguing, as omega-3 fatty acid supplementation is a fairly simple and cost-effective intervention that could result in better treatment adherence. It seems that there would be little downside to this intervention apart from increasing pill burden in a population that is likely already on multiple medications due to increased incidence of hypertension, diabetes and cardiovascular disease. These results suggest that there may be a greater inflammatory component to aromatase inhibitor-related arthralgia among patients with BMI of 30 mg/kg or higher, which may be worthy of study in the future.
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This is a very interesting study and particularly a problem in our breast cancer population. One of the biggest problems with compliance with aromatase inhibitors is joint pain, particularly among women who also have osteoarthritis. This study shows that omega-3 fatty acid can help this. As these are well tolerated and can have other benefits with cholesterol control, it is a very interesting study.