Dear Dr. Roach: I am an 80-year-old woman. Three years ago, I had breast cancer surgery. After surgery, my oncologist said I should take medication for five years to prevent cancer recurrence. After three-and-a-half years on this medicine, I began having terrible shoulder, lower back and hip pain. I tried two other medications, but nothing changed. I was told that no other options were available for me.
What is your opinion on stopping my medication? I’ve had X-rays on the area that show arthritis. The pain can be very bad at times.
S.S.
It sounds like you were recommended a medication called an aromatase inhibitor, which does reduce your risk of cancer recurrence and reduces your risk of dying from breast cancer when taken for five years. The first few years are the most important, but even the last one to two years still give additional benefit. So, I recommend staying on the medicine.
However, I understand that side-effects can be so bad that even the benefit in reducing cancer and death may not seem worth it. In those cases, trying one of the other aromatase inhibitors is standard, but unfortunately, that didn’t work.
There are other ways to try to reduce these side-effects. Anti-inflammatory drugs, like ibuprofen (Advil) or naproxen (Aleve), and exercise are the first-line treatments. Many people worry about exercising due to the pain, but 20% of women who were recommended exercise and NSAIDs felt a significant improvement in their pain, compared to 1% of women who got the usual care.
Other medicines such as duloxetine have also been shown to reduce pain compared to the usual treatment or placebo.
A well-done trial involving acupuncture found that this treatment also led to a small improvement in pain.
When nothing works, many oncologists will switch their patients from an aromatase inhibitor to tamoxifen, which also reduces risk of recurrence, but not quite as well.
Dear Dr. Roach: Can we get the respiratory syncytial virus (RSV) vaccine, the new COVID vaccine and our annual flu shot all at the same time? Or should they be spread out? I am 69 and healthy.
L.C.
You can, but you will have an increased risk of “mild” side-effects. I say mild because they aren’t life-threatening and will go away in a few days, but they can make you feel pretty badly.
Personally, I separate the COVID vaccine and flu shot by a few days because I am in the hospital all the time and can attain those shots very easily. If it were difficult for me to get to the place where I receive the shots, I would definitely get them all at the same time.
The RSV vaccine is new, so I don’t have any personal experience with it. In trials, about 12% of people had local reactions, such as a sore muscle, from the RSV vaccine.
Most people can get these vaccines at their local pharmacy, so it’s up to you to spread them out or get them all together.
I have had patients who told me that when they were in the military, they got as many as 35 vaccines in the same day, so it’s certainly safe to get a few vaccines done on the same day.
Email questions to ToYourGoodHealth@med.cornell.edu
