Pharmacologic: aromatase inhibitors
Postmenopausal hormone receptor–positive or unknown, locally advanced, or metastatic breast cancer. Advanced postmenopausal breast cancer in with disease progression despite tamoxifen therapy.
Inhibits the enzyme aromatase, which is partially responsible for conversion of precursors to estrogen. Therapeutic Effects: Lowers levels of circulating estrogen, which may halt progression of estrogen-sensitive breast cancer.
Adverse Reactions/Side Effects
CNS: headache, weakness, dizziness. EENT: pharyngitis. Resp: dyspnea, increased cough. CV: peripheral edema. GI: nausea, abdominal pain, anorexia, constipation, diarrhea, dry mouth, vomiting. GU: pelvic pain, vaginal bleeding, vaginal dryness. Derm: rash, including mucocutaneous disorders, sweating. Metab: weight gain. MS: back pain, bone pain. Neuro: paresthesia. Misc: ALLERGIC REACTIONS, INCLUDING ANGIOEDEMA, URTICARIA, AND ANAPHYLAXIS, hot flashes, pain.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of allergic reactions (angioedema, anaphylaxis, urticaria), including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, tightness in the throat and chest, wheezing, dry cough, or difficult/labored breathing. Notify physician or nursing staff immediately if these reactions occur.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Assess any back pain, bone pain, or other musculoskeletal pain. Suggest additional tests (radiography, MRI) as needed to rule out fracture.
Be alert for signs of paresthesia (numbness, tingling). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain.
For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy, or to help restore function after chemotherapy.
Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.
Advise patient about the likelihood of GI reactions such as diarrhea, nausea, vomiting, constipation, abdominal pain, and loss of appetite. Instruct patient or family and caregivers to report severe or unexpected GI reactions.
Advise patient that rashes and other skin reactions (sweating, ...