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Symptom Map of Endocrine Therapy for Breast Cancer

A Scoping Review

Zhu, Yehui, PhD(c), MSN, BSN; Cohen, Susan M., PhD, CRNP, FAAN; Rosenzweig, Margaret Q., PhD, CRNP, AOCN, FAAN; Bender, Catherine M., PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000632
Article: PDF Only

Background Multiple symptoms associated with endocrine therapy have a detrimental impact on medication adherence and quality of life.

Objective The purpose of this scoping review is to map the symptoms during endocrine therapy for breast cancer to provide implications for current practice and suggestions for future research.

Methods The PubMed, CINAHL, and China Science Periodical Databases were searched to identify related studies published in English and Chinese languages. References of included articles were reviewed for additional eligible studies. Of the 2551 articles identified, 57 articles met inclusion criteria and were included in this scoping review.

Results Evidence for the 16 most studied symptoms and 15 most prevalent symptoms were synthesized. Five key symptoms associated with endocrine therapy were identified, including joint/muscle pain, hot flashes, low sexual interest/desire, joint/muscle stiffness, and fatigue/lack of energy. Rarely studied but highly prevalent symptoms and other gaps in the symptom science during endocrine therapy for breast cancer were identified.

Conclusion Nurses caring for women receiving endocrine therapy for breast cancer should assess the 5 key symptoms identified. There remain substantial gaps in the science related to the symptom experience during endocrine therapy for breast cancer. Future studies should focus on the domains of symptom intensity and distress, specific understudied symptoms, symptom clusters, and development of symptom assessment instruments specific to symptoms associated with endocrine therapy.

Implications for Practice This scoping review identified 5 well-studied and highly prevalent symptoms that should be assessed in women with breast cancer receiving endocrine therapy.

Author Affiliations: School of Nursing, University of Pittsburgh, Pennsylvania.

Y.Z. is supported by a Doctoral Degree Scholarship in Cancer Nursing, DSCN-17-073-01, from the American Cancer Society.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Correspondence: Yehui Zhu, PhD(c), MSN, BSN, School of Nursing, University of Pittsburgh, 415 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261 (;

Accepted for publication April 4, 2018.

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