For non-hormonal anti-cancer drugs
- manage symptoms with analgesics
- provide reassurance that symptoms are usually transient.
For hormonal anti-cancer drugs
Early and rapid management of musculoskeletal side effects can improve treatment compliance of hormonal anti-cancer drugs.
The Arthralgia Working Group (AWG) has proposed a step wise approach to the management of joint pain in patients treated with aromatase inhibitors (AIs).r This can also be used as a guide for other hormonal anti-cancer drugs.
Mild arthralgia: recommendation of lifestyle changes (exercise and/or weight loss) or physiotherapy along with simple analgesics such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen), if no contraindication, may be successful.
Moderate to severe arthralgia: non-steroidal anti inflammatory drugs (NSAIDs), if no contraindication, should be initiated at a high dose and then titrated down to the minimum effective dose once adequate pain control is established. Paracetamol can be used as an adjunct to NSAIDs. In severe cases or where a contraindication to NSAIDs exists opiate analgesia may be considered.
For immune-checkpoint inhibitor therapy
Monitor patients for symptoms of arthralgia and myalgia. Management depends on the type of immune checkpoint inhibitor therapy and whether given in combination. Mild symptoms may be managed with analgesia such as paracetamol or non-steroidal anti-inflammatories (if not contraindicated). Moderate to severe symptoms may require corticosteroid therapy. Consultation with a rheumatologist is advised. Read more about the Management of immune-related adverse events here.
Other management strategies include:
- the application of warmth to affected areas
- lifestyle factors – weight loss and exercise
- consider a "drug holiday" (withholding treatment for ~ 2 weeks)
- for AIs, consider switching to a different AI. However, the evidence remains anecdotal, and there are currently no prospective trials to suggest that a different AI will result in less arthralgia
- referral of the patient to an Occupational Therapist for assistance in maintaining ADL.