Half of All Adults with Advanced Cancer Will Experience a Fall
(ChemotherapyAdvisor) – Regardless of age, 50.3% of adults with advanced cancer will experience a fall associated with high risk of physical injury, a study in the Journal of Clinical Oncology online May 14 has concluded.
“To our knowledge, this study is the first to investigate the incidence and risk factors of falls in patients with advanced cancer prospectively over a 6-month period and across a range of settings,” noted Carol A. Stone, MB, ChB, MSc, of Our Lady's Hospice and Care Services, Dublin, Ireland, and colleagues. While retrospective studies of inpatients with cancer suggest a diagnosis of cancer confers a high risk of falls, the cause remained unclear.
Their study had 3 objectives: in patients with advanced cancer, to determine incidence of falls over a maximum follow-up of 6 months; to determine whether falls occur predominantly in older persons; and to identify modifiable and non modifiable risk factors for falls.
They recruited 185 patients, 52.4% men, who were mobile without assistance and were admitted consecutively to community and inpatient palliative care services with metastatic or locoregionally advanced cancer. Mean age was 68 years. At the initial patient encounter, a risk factor assessment was conducted and all patients had weekly telephone contact follow-up for 6 months or until time of fall or death.
During the follow-up period, 50.3% of patients fell, 35 of 66 (53%) age <65 years and 58 of 119 (48.7%) age ≥65 years. A total of 61.3% of falls occurred in the community; 42% resulted in injury and 4% in fracture or dislocation. Median time to a fall was 96 days.
Independent risk factors associated with time to fall in multivariate analysis were primary brain tumor or brain metastasis (HR 2.5; P=0.002), number of falls in the preceding 3 months (HR, 1.27; P=0.005), severity of depression (HR, 1.12; P=0.012), benzodiazepine dose (HR, 1.05; P=0.004), and cancer-related pain (HR, 1.96; P=0.024).
“Screening for and correcting reversible risk factors, in combination with fall prevention education, are likely to be effective in reducing falls, but this should be tested in a randomized controlled trial,” the authors wrote. “In the meantime, we recommend that alternative options for the management of sleep disturbance and anxiety be considered, particularly for patients with brain metastases or primary brain tumors, a history of falls, or coexistent depression.”