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Naz I, Turgut B, Gunay Ucurum S, Komurcuoglu B, Ozer Kaya D. Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01492-0. [PMID: 37964048 DOI: 10.1007/s11764-023-01492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS. METHODS Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale. RESULTS LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05). CONCLUSION LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters. IMPLICATIONS FOR CANCER SURVIVORS Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.
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Affiliation(s)
- Ilknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey.
| | - Büsra Turgut
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
| | - Sevtap Gunay Ucurum
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
| | - Berna Komurcuoglu
- Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, Yenisehir Mah. Gaziler Cad. No:331 Konak, 35170, Izmir, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
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Gupta E, Tennison JM, Shin KY, Fu JB, Rozman de Moraes A, Naqvi SMA, Fellman B, Bruera E. Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit. JCO Oncol Pract 2023; 19:741-749. [PMID: 37339393 PMCID: PMC10538936 DOI: 10.1200/op.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. METHODS A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. RESULTS There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). CONCLUSION The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.
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Affiliation(s)
- Ekta Gupta
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jegy M. Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ki Y. Shin
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aline Rozman de Moraes
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bryan Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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3
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Galliardt M, Betz U, Birklein F, Drees P, Geber C. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies - (lessons learned from) a prospective study. Open Med (Wars) 2023; 18:20230696. [PMID: 37251538 PMCID: PMC10224621 DOI: 10.1515/med-2023-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
This prospective cohort study aimed to characterise the impact of oxaliplatin-based chemotherapy and its neurotoxic side effects (i.e., chemotherapy-induced neuropathy) on functional fall-risk and falls. Twenty chemotherapy-naïve participants (mean age, 59 years; 16 males) were consecutively included. A multimodal fall risk assessment was performed at four time points within 6 months. Polyneuropathy was assessed using the Neurologic Disability Scale; the fall risk was assessed by functional tests (Tinetti Test, Chair-Rising Test, and Timed up and Go Test). Patient-reported outcomes comprised the Hospitality Anxiety and Depression Scale (HADS), the Falls Efficacy Scale - International (FES-I) to assess the fear of falling, and the Physical Activity for the Elderly (PASE) questionnaire. Three falls occurred during the study. All fallen participants had a high fall risk-index (≥4 more risk factors) compared to only 30% of the non-fallen participants (p = 0.03) and suffered more frequently from pre-existing mild polyneuropathy (p = 0.049). Study discontinuation (n = 12) was associated with a higher rate of polypharmacy (p = 0.045), anxiety (HADS-A, p = 0.03), and specific fear of falling (FES-I, p = 0.025). In contrast, study completers (n = 8) reported an improvement in physical activity (PASE) (p = 0.018). In summary, pre-existing fall-risk factors impacted more falls than chemotherapy. A fall risk index offers a time-efficient screening option in an outpatient oncological setting.
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Affiliation(s)
- Melanie Galliardt
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- DRK Schmerz-Zentrum, Auf der Steig 14-16, Mainz, 55131, Germany
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4
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Kenis C, Decoster L, Flamaing J, Debruyne PR, De Groof I, Focan C, Cornélis F, Verschaeve V, Bachmann C, Bron D, Van den Bulck H, Schrijvers D, Langenaeken C, Specenier P, Jerusalem G, Praet JP, De Cock J, Lobelle JP, Wildiers H, Milisen K. Incidence of falls and fall-related injuries and their predictive factors in frail older persons with cancer: a multicenter study. BMC Geriatr 2022; 22:877. [PMCID: PMC9675153 DOI: 10.1186/s12877-022-03574-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 10/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Falls and fall-related injuries are a major public health problem. Data on falls in older persons with cancer is limited and robust data on falls within those with a frailty profile are missing. The aim of this study is to investigate the incidence and predictive factors for falls and fall-related injuries in frail older persons with cancer. Methods This study is a secondary data analysis from data previously collected in a large prospective multicenter observational cohort study in older persons with cancer in 22 Belgian hospitals (November 2012–February 2015). Patients ≥70 years with a malignant tumor and a frailty profile based on an abnormal G8 score were included upon treatment decision and evaluated with a Geriatric Assessment (GA). At follow-up, data on falls and fall-related injuries were documented. Results At baseline 2141 (37.2%) of 5759 included patients reported at least one fall in the past 12 months, 1427 patients (66.7%) sustained an injury. Fall-related data of 3681 patients were available at follow-up and at least one fall was reported by 769 patients (20.9%) at follow-up, of whom 289 (37.6%) fell more than once and a fall-related injury was reported by 484 patients (62.9%). Fear of falling was reported in 47.4% of the patients at baseline and in 55.6% of the patients at follow-up. In multivariable analysis, sex and falls history in the past 12 months were predictive factors for both falls and fall-related injuries at follow-up. Other predictive factors for falls, were risk for depression, cognitive impairment, dependency in activities of daily living, fear of falling, and use of professional home care. Conclusion Given the high number of falls and fall-related injuries and high prevalence of fear of falling, multifactorial falls risk assessment and management programs should be integrated in the care of frail older persons with cancer. Further studies with long-term follow-up, subsequent impact on cancer treatment and interventions for fall prevention, and integration of other important topics like medication and circumstances of a fall, are warranted. Trial registration B322201215495.
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Affiliation(s)
- Cindy Kenis
- grid.410569.f0000 0004 0626 3338Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lore Decoster
- grid.8767.e0000 0001 2290 8069Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Flamaing
- grid.410569.f0000 0004 0626 3338Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven – University of Leuven, Leuven, Belgium
| | - Philip R. Debruyne
- grid.5115.00000 0001 2299 5510Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium & Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Inge De Groof
- Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
| | - Christian Focan
- grid.433083.f0000 0004 0608 8015Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
| | - Frank Cornélis
- grid.48769.340000 0004 0461 6320Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Vincent Verschaeve
- grid.490655.bDepartment of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Dominique Bron
- grid.418119.40000 0001 0684 291XDepartment of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
| | - Heidi Van den Bulck
- grid.414579.a0000 0004 0608 8744Department of Medical Oncology, Imelda hospital, Bonheiden, Belgium
| | - Dirk Schrijvers
- grid.417406.00000 0004 0594 3542Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Christine Langenaeken
- grid.420031.40000 0004 0604 7221Department Medical Oncology, AZ Klina, Brasschaat, Belgium
| | - Pol Specenier
- grid.411414.50000 0004 0626 3418Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
| | - Guy Jerusalem
- grid.411374.40000 0000 8607 6858Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman and Liege University, Liege, Belgium
| | - Jean-Philippe Praet
- grid.50545.310000000406089296Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
| | - Jessie De Cock
- grid.8767.e0000 0001 2290 8069Department of Geriatric Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean-Pierre Lobelle
- grid.5596.f0000 0001 0668 7884Department of Oncology, Laboratory of Experimental Oncology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Hans Wildiers
- grid.410569.f0000 0004 0626 3338Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Oncology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Koen Milisen
- grid.410569.f0000 0004 0626 3338Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
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Saberi N, Darvishpoor Kakhki A, Ilkhani M, Khan HTA. Falls in older ambulatory care patients with cancer in Iran: Implications for clinical practice. J Eval Clin Pract 2022; 28:624-630. [PMID: 34854180 DOI: 10.1111/jep.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
RATIONALE/AIM Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls. METHOD A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls. RESULTS A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035). CONCLUSIONS The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor.
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Affiliation(s)
- Najmeh Saberi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Ilkhani
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hafiz T A Khan
- Public Health Group, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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Sattar S, Haase KR, Alibhai SM, Penz K, Szafron M, Harenberg S, Amir E, Kuster S, Pitters E, Campbell D, McNeely ML. Feasibility and efficacy of a remotely delivered fall prevention exercise program for community-dwelling older adults with cancer: Protocol for the STABLE trial. J Geriatr Oncol 2022; 13:1273-1280. [DOI: 10.1016/j.jgo.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
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Rattanakrong N, Siriphorn A, Boonyong S. Incidence density and factors associated with peripheral neuropathy among women with breast cancer during taxane-based chemotherapy. Sci Rep 2022; 12:10632. [PMID: 35739233 PMCID: PMC9226074 DOI: 10.1038/s41598-022-14870-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
This work aimed to determine the incidence density of taxane-induced peripheral neuropathy (TIPN) and its risk factors among women with breast cancer. One hundred and forty-one women with breast cancer participated in this cohort study. TIPN symptoms were evaluated with the European Organization for Research and Treatment of Cancer CIPN specific self-report questionnaire (EORTC QOL-CIPN20) at five-time points throughout chemotherapy treatment. Over three months, 125 (89%) and 59 (44.03%) women with breast cancer were identified with sensory and motor neuropathy, respectively. The sensory neuropathy incidence density was 21 per 1000 person-days. The motor neuropathy incidence density was 6 per 1000 person-days. This study discovered a significant link between age and the incidence density of sensory neuropathy (HR = 1.02; 95% CI: 1.01-1.05) as well as motor neuropathy (HR = 1.05; 95% CI: 1.01-1.08). These findings imply that screening may be necessary to detect early TIPN symptoms and provide appropriate rehabilitation programs, particularly for elderly persons.
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Affiliation(s)
- Nida Rattanakrong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand
- Department of Rehabilitation Medicine, Physical Therapy Unit, Chulabhorn Hospital, Bangkok, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand
| | - Sujitra Boonyong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand.
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Fall predictors in hospitalized patients living with cancer: a case-control study. Support Care Cancer 2022; 30:7835-7843. [PMID: 35705752 DOI: 10.1007/s00520-022-07208-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify fall predictors and develop an assessment tool to be used for screening hospitalized cancer patients at risk for fall. METHODS A retrospective case-control study was conducted in 2018 at a cancer center in Northern Italy. The study participants were 448 adult cancer patients admitted to the oncology ward from 2009 to 2013. The case group consisted of 112 patients presenting at least one fall, while controls were randomly chosen by matching each case for age, sex, and admission period with three patients who did not fall. Data for the fall predictors were extracted from the electronic medical records. Conditional logistic regression was used to evaluate the association between patient's characteristics and fall risk. RESULTS The overall prevalence of patients having at least one candidate fall predictor was high (98%). Seven of the studied variables showed an independent association with fall risk at multivariate analysis. These were tumor site, the presence of neurologic diseases, gait imbalance disorders, fatigue, and the assumption of certain medications such as diuretics, hypnotics, and opioids (odds ratios and 95% confidence intervals in brackets were 3.78 (1.78-8.13), 2.26 (1.08-4.77), 4.22 (1.87-9.52), 2.76 (1.45-5.26), 2.66 (1.52-4.66), 2.41 (1.20-4.85), and 3.03 (1.68-5.45), respectively). CONCLUSIONS In this study, we identified falling risk factors in an Italian population of hospitalized cancer patients and developed a new risk assessment tool. An external validation is necessary before implementing our screening tool in clinical practice.
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Spanolios A, Rogers L, Hartranft S, Reich RR, Trudeau J, Utaegbulam E, Smith K, Lile W. Characteristics of Inpatients With Blood Cancers Who Experience a Fall: A Retrospective Study. Clin J Oncol Nurs 2022; 26:204-209. [PMID: 35302556 DOI: 10.1188/22.cjon.204-209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inpatients with cancer are at the greatest risk for falling. Although studies have identified the characteristics of patients with cancer who fall, few studies have focused on the characteristics of patients with blood cancers who fall. OBJECTIVES The objectives of this study are to identify characteristics of inpatients with blood cancers who fall and implement fall-mitigation efforts through an enhanced assessment of chemotherapy-induced peripheral neuropathy. METHODS Descriptive design and retrospective review of 51 patient falls were used to identify characteristics of inpatients with cancer who fell. FINDINGS The majority of patients who fell were male (n = 33), and most falls occurred during the day shift (n = 24). Few patients were listed on the Morse Fall Risk Scale for mental status and forgetting limitations (n = 7), and most were not identified as a high fall risk (n = 30). The majority of falls were associated with toileting needs (n = 32). Patients spent a mean of 12.73 days in the hospital before falling. Thirty-two patients received chemotherapy prior to their fall, 25 of whom received neurotoxic chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Wayne Lile
- H. Lee Moffitt Cancer Center and Research Institute
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10
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Couderc AL, Tomasini P, Greillier L, Nouguerède E, Rey D, Montegut C, Thomas PA, Barlesi F, Villani P. Functional status in older patients with lung cancer: an observational cohort study. Support Care Cancer 2022; 30:3817-3827. [PMID: 35031829 DOI: 10.1007/s00520-021-06752-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE An assessment of the impact of functional status (FS) evaluated using a combination of Activities of Daily Living (ADL) and the short version of the Instrumental Activities of Daily Living (IADL), on 3- and 6- month mortality and on 3-month unplanned hospitalizations in older patients treated for lung cancers. METHOD AND OBJECTIVES This observational retrospective study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients aged 70 years or older referred for a comprehensive geriatric assessment (CGA) before the initiation of lung cancer treatment were enrolled. RESULTS Two hundred twenty-seven patients were analyzed: the median age was 78.7 years and 74.0% were male. Almost half of the patients were metastatic (45.4%). Concerning FS, 41.9% of patients had no ADL-IADL impairment, 30.0% had either IADL or ADL impairment, and both ADL-IADL were impaired for 28.1%. Impaired ADL-IADL was associated with poor nutritional status, depression, mobility, and cognitive disorders. In a logistic regression model, ADL or IADL impairment (aOR = 2.1; 95% CI [1.0-4.2]; p = 0.037) and impaired ADL-IADL (aOR = 2.6; 95% CI [1.2-5.3]; p = 0.012) were independently associated with a higher risk of unplanned hospitalizations within 3 months. In the multivariate Cox model, 6-month mortality risk was independently associated with impaired ADL-IADL (aHR = 2.3; 95% CI [1.3-4.4]; p = 0.008). CONCLUSION The combination of ADL and IADL scales to assess FS is a prognostic marker of the mortality risk at 6 months in older patients with lung cancer and should be more largely used by oncologists in treatment decision making.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France. .,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France. .,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France.
| | - Pascale Tomasini
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France.,Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France.,Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Emilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Pascal-Alexandre Thomas
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Thoracic Surgery Unit, AP-HM, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Gustave Roussy Cancer Campus, Villejuif, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
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11
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Schoenbeck KL, Fiala MA, Wildes TM. Bortezomib in first-line therapy is associated with falls in older adults with multiple myeloma. J Geriatr Oncol 2021; 12:1005-1009. [PMID: 33750674 PMCID: PMC8419206 DOI: 10.1016/j.jgo.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bortezomib is a common multiple myeloma therapy that can cause treatment-related peripheral neuropathy, a risk factor for falls. The relationship between bortezomib and falls in older patients with multiple myeloma is unknown. METHODS We analyzed the SEER-Medicare database for patients aged 65 or older diagnosed with multiple myeloma between 2007 and 2013. Claims were analyzed for myeloma treatments, falls, and covariates of interest. We evaluated accidental falls occurring within 12 months after starting first-line multiple myeloma treatment with bortezomib. RESULTS Bortezomib was used in first-line therapy for 2052 older adults with new diagnoses of multiple myeloma. Claims for falls were reported in 157 (8%) patients within 12 months after starting bortezomib, compared to 102 (5%) patients not receiving bortezomib (p < 0.001). Bortezomib was associated with a 36% increased risk of falls after controlling for covariates (aHR 1.36; 95% CI 1.05-1.75; p = 0.018). In a landmark analysis of those who survived 12 months after starting treatment, the median overall survival of those with a fall was 35.7 months compared to 49.1 months for those without (p < 0.0001). A fall in the first year after diagnosis was associated with a 26% increased risk in hazard for death (aHR 1.26; 95% CI 1.02-1.56; p = 0.033). CONCLUSION In older adults with multiple myeloma, bortezomib was associated with an increased risk of having a diagnostic code for falls. Decreased overall survival was seen in those who fell within the year of starting therapy. Prospective trials involving fall assessments and fall-prevention interventions are needed in this population.
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Affiliation(s)
- Kelly L Schoenbeck
- University of California San Francisco, San Francisco, CA, United States of America.
| | - Mark A Fiala
- Washington University School of Medicine, St Louis, MO, United States of America; Saint Louis University, St Louis, MO, United States of America
| | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, United States of America
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12
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Yonenaga Y, Naito T, Okayama T, Kitagawa M, Mitsuhashi N, Ishii T, Fuseya H, Inano T, Morikawa A, Sugiyama M, Mori K, Notsu A, Kawabata T, Ono A, Kenmotsu H, Murakami H, Tanuma A, Takahashi T. Impact of Physical Inactivity on the Risk of Disability and Hospitalization in Older Patients with Advanced Lung Cancer. J Multidiscip Healthc 2021; 14:1521-1532. [PMID: 34188479 PMCID: PMC8232865 DOI: 10.2147/jmdh.s311225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose This prospective observational study aimed to explore the influence of physical inactivity during initial chemotherapy on the risk of disability and hospitalization in later life among older patients with advanced non-small-cell lung cancer (NSCLC). Patients and Methods Patients aged 70 or above who were scheduled to receive first-line chemotherapy for newly diagnosed advanced NSCLC were recruited for the study. An electronic pedometer was used to measure daily steps; based on the change rate (cutoff: −12.5%) from pretreatment to 12 ± 4 weeks after enrolment, patients were classified as active or inactive. The Barthel Index estimated activities of daily living. We compared disability-free survival time, mean cumulative functions of hospital stays, and medical costs, between the active and inactive groups. Results Among the 29 patients enrolled, 21 were evaluable. Compared with active patients (n = 11), inactive patients (n = 10) showed shorter disability-free survival (6.4 vs 19.9 months, p < 0.05) and tended to have longer hospital stays (23.7 vs 6.3 days/person) and higher inpatient care cost (¥1.6 vs ¥0.3 million/person [US$16,000 vs US$3000/person]) during the first year. Conclusion Physical inactivity during initial chemotherapy may be a risk factor for developing disability and requiring hospitalization in later life for older patients with advanced NSCLC. Our findings may indicate the need for lifestyle interventions with multidisciplinary teams, which include physicians, nurses, and physiotherapists, for older patients with advanced lung cancer during an active cancer treatment. A large-sample-sized study is needed to validate our findings.
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Affiliation(s)
- Yusuke Yonenaga
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Midori Kitagawa
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Noriko Mitsuhashi
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Takeshi Ishii
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Hiroshi Fuseya
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Toshimi Inano
- Division of Nutrition, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Ayumu Morikawa
- Division of Nursing, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Miwa Sugiyama
- Division of Nursing, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Izunokuni-shi, Shizuoka, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan
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13
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Tennison JM, Ng AH, Rianon NJ, Liu DD, Bruera E. Patient-Reported Continuity of Care and Functional Safety Concerns After Inpatient Cancer Rehabilitation. Oncologist 2021; 26:887-896. [PMID: 34080755 DOI: 10.1002/onco.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with cancer have been noted to have inadequate continuity of care after discharge from hospital. We sought to assess patient-reported continuity of care and functional safety concerns after acute inpatient rehabilitation. METHODS This was a prospective study that used cross-sectional surveys at a National Cancer Institute Comprehensive Cancer Center. All patients who were admitted to acute inpatient rehabilitation from September 5, 2018, to February 7, 2020, met the inclusion criteria, and completed two surveys (assessing continuity of care and functional safety concerns) upon discharge and 1 month after discharge were included in the study. RESULTS A total of 198 patients completed the study, and no major concerns were reported by the patients. The greatest concern was a lack of adequate communication management among different providers, reported by only 10 (5.0%) patients. The combined fall and near-fall rate within 1 month after discharge was (25/198) 13%. Brain metastasis, a comorbidity of depression, and a history of falls were significantly associated with a higher risk of falls or near falls within 1 month after discharge. CONCLUSION Although overall patients with cancer reported adequate continuity of care and feeling safe to function at home after acute inpatient rehabilitation, it is important to be aware that fall or near-fall events within 1 month after acute inpatient rehabilitation are associated with brain metastasis, comorbidity of depression, and a history of falls. Thus, patients with these risk factors may benefit from including more focused fall prevention education and interventions. IMPLICATIONS FOR PRACTICE Patients with cancer often have extensive problems that require care from multiple health care providers simultaneously, and a high level of coordination is needed for adequate transition of care from the inpatient to the outpatient setting. This transition of care period is prone to inadequate continuity of care and, for older adults, a particular risk for falls. Assessment for risk of fall is also an important factor to consider when evaluating patients to continue oncology treatments. There is a gap in knowledge regarding patient-reported continuity of care and functional safety concerns after acute inpatient cancer rehabilitation.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy H Ng
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nahid J Rianon
- Department of Family & Community Medicine and Joan & Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Houston Health Science Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Nightingale G, Mohamed MR, Holmes HM, Sharma M, Ramsdale E, Lu-Yao G, Chapman A. Research priorities to address polypharmacy in older adults with cancer. J Geriatr Oncol 2021; 12:964-970. [PMID: 33589379 DOI: 10.1016/j.jgo.2021.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/31/2021] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Abstract
Polypharmacy poses a significant public health problem that disproportionately affects older adults (≥65 years) since this population represents the largest consumers of medications. Clinicians caring for older adults with cancer must rely on evidence to understand polypharmacy and its implications, not only to communicate with patients and other healthcare providers, but also because of the significant interplay between polypharmacy, cancer, cancer-related treatment, and clinical outcomes. Interest in polypharmacy is rising because of its prevalence, the origins and facilitating factors behind it, and the direct and indirect clinical outcomes associated with it. The growing body of publications focused on polypharmacy in older adults with cancer demonstrates that this is a significant area of research; however, limited evidence exists to guide medication use (e.g., prescribing, administration) in this population. Currently, research priorities aimed at polypharmacy in the field of geriatric oncology lack clarity. We identified current gaps in the literature in order to establish research priorities for polypharmacy in older adults with cancer. The five research priorities-Polypharmacy Methodology and Definitions, Suboptimal Medication Use, Comorbidities and Geriatric Syndromes, Underrepresented Groups, and Polypharmacy Interventions-highlight critical areas for future research to improve outcomes for older adults with cancer.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mostafa R Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Holly M Holmes
- McGovern Medical School, University of Texas Health Science Center of Houston, Houston, TX, USA
| | - Manvi Sharma
- Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Grace Lu-Yao
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA; Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Andrew Chapman
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
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15
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“Life Isn't as Carefree as It Used to Be”: A Mixed-Methods Evaluation of the Experiences of Women With Fear of Falling During Cancer Survivorship. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Jespersen E, Winther SB, Minet LR, Möller S, Pfeiffer P. Frailty screening for predicting rapid functional decline, rapid progressive disease, and shorter overall survival in older patients with gastrointestinal cancer receiving palliative chemotherapy - a prospective, clinical study. J Geriatr Oncol 2020; 12:578-584. [PMID: 33830020 DOI: 10.1016/j.jgo.2020.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A growing number of older patients with cancer require well-founded clinical decision-making. Frailty screening is suggested as a service to improve outcomes in vulnerable older patients with cancer. This prospective study examined the value of frailty screening to predict rapid functional decline, rapid progressive disease (PD) and shorter overall survival (OS) in older patients with gastrointestinal cancer receiving palliative chemotherapy. MATERIALS AND METHODS Patients aged ≥70 years were screened for frailty in an oncologic department after clinical decision but before starting palliative chemotherapy. Screening was repeated at first response evaluation after approximately two months of chemotherapy. Frailty screening tools included performance status (PS), Charlson Comorbidity Index, G-8 using two different cut-offs (G814,G811), VES-13, Timed-Up-and-Go, Handgrip strength and falls. RESULTS A total of 170 patients were included, median age was 75.5 (70-88) years and 65.9% were male. The frequency of frailty varied from 14% to 74% according to the chosen frailty tool. In multivariate analysis G814 predicted OS (HR 1.5; 95%CI 1.0-2.4), whereas G811 predicted PD (OR 2.4; 1.1-5.6) and OS (HR 2.1; 1.4-2.9). VES-13 predicted functional decline (OR 3.5; 1.0-11.6), PD (OR 3.5; 1.5-8.4) and OS (HR 1.7; 1.2-2.4). Timed-Up-and-Go predicted OS (HR 1.8; 1.1-2.7). Handgrip strength and falls predicted functional decline (OR 4.5; 1.1-19 and OR 6.1; 1.4-25.8, respectively). PS predicted PD (OR 6.2; 2.6-14.7) and OS (HR 2.2; 1.5-3.2). CONCLUSION VES-13 was useful for predicting all three endpoints of interest. Frailty tools covering domains of functioning and nutrition are suggested for older patients with advanced gastrointestinal cancer.
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Affiliation(s)
- Eva Jespersen
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Stine Braendegaard Winther
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Rosenbek Minet
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Health Science Research Centre, UCL University College, Odense, Denmark
| | - Sören Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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17
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Sattar S, Haase K, Kuster S, Puts M, Spoelstra S, Bradley C, Wildes TM, Alibhai S. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2020; 29:21-33. [PMID: 32671565 DOI: 10.1007/s00520-020-05619-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? METHODS MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. RESULTS A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. CONCLUSION This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Room 108, Regina, Saskatchewan, S4T 0H8, Canada.
| | - K Haase
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - S Kuster
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, Canada
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - S Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - C Bradley
- Library, University of Regina, Regina, Canada
| | - T M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - S Alibhai
- Department of Medicine, Institute of Health Policy, Management, and Evaluations, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
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18
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Wasilewski A, Alam A, Mohile N. Chemotherapy toxicities and geriatric syndromes in older patients with malignant gliomas. J Geriatr Oncol 2020; 12:134-138. [PMID: 32674977 DOI: 10.1016/j.jgo.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe treatment toxicities and polypharmacy in older patients with malignant gliomas (MG). BACKGROUND Advanced age in cancer patients is associated with increased treatment-related toxicities, acute care utilization and functional decline. Most patients with MG are over age 65, yet treatment patterns and toxicities are poorly defined. METHODS A retrospective chart review of 125 patients with MG age 65 or older at the University of Rochester from January 2012 to December 2018. RESULTS 115 patients with glioblastoma and 10 with anaplastic astrocytoma had a median age of 71 (range 65-89) at diagnosis and median overall survival (OS) of 10.3 months. Radiotherapy (RT) was offered and completed in 79% (fractionated, n = 69, hypofractionated, n = 30). 24% of the 98 patients treated with concurrent temozolomide (TMZ) experienced treatment delays (n = 24). Median of 4 cycles of adjuvant TMZ were taken by 61% (n = 76). Delays and dose reductions occurred in 55% during treatment with adjuvant TMZ, most commonly due to thrombocytopenia (n = 29) and fatigue (n = 15). 16/98 patients required transfusions during treatment with concurrent or adjuvant TMZ. At baseline, patients were prescribed a median of 11 medications. OS was longer in patients prescribed less than 8 medications vs. 8 or more (14 vs. 8.6 months, p = .0738). 96% experienced a non-elective hospital admission and 64% reported at least one fall. CONCLUSION Older patients with MG experience significant polypharmacy, treatment toxicities and falls. Studies incorporating geriatric assessment tools may better determine associations between geriatric syndromes and survival. Clinical trials in older patients should also include non-survival outcomes.
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19
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Tomczak U, Sattar S, Schoenbeck KL, Cordner T, Wildes TM. Circumstances around falls in older adults with Cancer. J Geriatr Oncol 2020; 12:91-95. [PMID: 32576521 DOI: 10.1016/j.jgo.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Falls are increasingly worrisome to older adults with cancer due to the side effects of cancer and its treatments. Understanding the circumstances of falls is important in the development of fall prevention strategies. The aim of this study is to understand the circumstances of falls in older patients with cancer. MATERIALS AND METHODS This study is a secondary analysis of a prospective cohort study in which adults aged ≥65 years with cancer receiving systemic cancer therapy were followed for fall outcomes for six months. Falls were assessed by monthly fall calendars; 51 participants who reported a fall were interviewed regarding the fall. RESULTS The cohort had an average age of 72.2 ± 5.2 years; 37% were female and 90% were white. Half (25/51) had experienced falls in the six months prior to enrollment. During the follow-up period, 78 falls occurred in 51 individuals over 6 months: 36 patients had 1 fall, 9 patients had 2 falls, 3 had 3 falls, and 1 each had 4, 5, or 6 falls. Nearly half of falls (51%) took place in the home and 38 (49%) occurred outside of the home. CONCLUSIONS Falls occurred at similar rates both inside the home and outside the home, indicating that familiarity with the person's surroundings does not protect against falls. Symptoms of cancer treatments were not mentioned during fall assessment, which may indicate a need for more awareness of the side effects of cancer medications and future developments of fall prevention methods.
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Affiliation(s)
| | | | | | | | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, USA.
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20
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Childs DS, Yoon HH, Eiring RA, Jin Z, Jochum JA, Pitot HC, Jatoi A. Falls: descriptive rates and circumstances in age-unspecified patients with locally advanced esophageal cancer. Support Care Cancer 2020; 29:733-739. [PMID: 32447502 DOI: 10.1007/s00520-020-05511-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Falls can occur in older cancer patients, but few studies have examined falls in an age-unspecified group of patients with locally advanced esophageal cancer. Because these patients are often administered neuropathy-inducing agents, are weak, and can develop orthostatic symptoms, examining falls appears relevant. METHODS Electronic medical records were used to examine falls and their circumstances in locally advanced esophageal cancer patients treated with chemotherapy and radiation and often surgery. RESULTS Among 300 patients, 62 (21%) suffered a fall, yielding 6 falls per 100 patient years. The median age at first fall was 64 years (range 31 to 83). The median time from cancer diagnosis to first fall was 11 months (range 0 to 107). Forty-two patients (68%) who fell had active cancer; 20 (32%) were cancer-free. Fall-related injuries occurred in 42 patients and included fractures, hematomas, and other musculoskeletal events. Eighteen patients (29%) fell repeatedly. Neuropathy, general weakness, and orthostatic symptoms were associated with falls ("He does state his neuropathy is more bothersome…. He did have a fall last week…." "He has been increasingly weak to the point where he fell down last week…." "Upon rising… [he] felt like somebody had put a sheet over his eyes, felt very lightheaded, and fell to the floor…."). At times, falls occurred under commonplace circumstances, such as slipping on ice or tripping on an underfoot pet. CONCLUSION Regardless of patient age, clinicians should remain vigilant for fall risk in adult patients with locally advanced esophageal cancer.
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Affiliation(s)
- Daniel S Childs
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Harry H Yoon
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rachel A Eiring
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jacob A Jochum
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Henry C Pitot
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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21
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Yamamoto S, Fujikawa N, Asano K, Toki M, Takao A, Arao H. Assessment of Fall-Related Self-Efficacy: Characteristics that Influence the Perception of Patients with Chemotherapy-Induced Peripheral Neuropathy. Asia Pac J Oncol Nurs 2020; 7:190-195. [PMID: 32478137 PMCID: PMC7233563 DOI: 10.4103/apjon.apjon_54_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/09/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. METHODS A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. RESULTS A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI; P = 0.026), and the CAS-CIPN score (P < 0.001). CONCLUSIONS Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.
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Affiliation(s)
- Sena Yamamoto
- Department of Nursing, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Naomi Fujikawa
- Department of Nursing, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Kota Asano
- Department of Nursing, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Masayo Toki
- Department of Nursing, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Ayumi Takao
- Department of Nursing, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Covington KR, Atler KE, Schmid AA, Pergolotti M. Understanding fall risk for older adults with cancer: An evaluation of experts' perceptions. J Geriatr Oncol 2020; 11:263-269. [DOI: 10.1016/j.jgo.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/12/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
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Integrating Nurses and Allied Health Professionals in the care of older adults with cancer: A report from the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2020; 11:187-190. [DOI: 10.1016/j.jgo.2019.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/30/2019] [Accepted: 06/19/2019] [Indexed: 12/24/2022]
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Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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Abstract
Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.
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Basal C, Vertosick E, Gillis TA, Li Q, Bao T, Vickers A, Mao JJ. Joint pain and falls among women with breast cancer on aromatase inhibitors. Support Care Cancer 2019; 27:2195-2202. [PMID: 30306326 PMCID: PMC6758909 DOI: 10.1007/s00520-018-4495-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls. METHODS We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up. RESULTS Among 667 participants (median age 63 years, interquartile range 57-69 years), 232 (35%, 95% CI 31 to 39%) reported falls 12-24 months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12 months by their primary care physician (44%) or oncologist (36%). CONCLUSION Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.
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Affiliation(s)
- Coby Basal
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Emily Vertosick
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Theresa A Gillis
- Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Qing Li
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ting Bao
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Andrew Vickers
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Jun J Mao
- Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
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Magnuson A, Sattar S, Nightingale G, Saracino R, Skonecki E, Trevino KM. A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression. Am Soc Clin Oncol Educ Book 2019; 39:e96-e109. [PMID: 31099668 DOI: 10.1200/edbk_237641] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.
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Affiliation(s)
- Allison Magnuson
- 1 Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
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Naito T, Mitsunaga S, Miura S, Tatematsu N, Inano T, Mouri T, Tsuji T, Higashiguchi T, Inui A, Okayama T, Yamaguchi T, Morikawa A, Mori N, Takahashi T, Strasser F, Omae K, Mori K, Takayama K. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. J Cachexia Sarcopenia Muscle 2019; 10:73-83. [PMID: 30334618 PMCID: PMC6438328 DOI: 10.1002/jcsm.12351] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. METHODS This was a multicentre prospective single-arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first-line chemotherapy for newly diagnosed, advanced pancreatic, or non-small-cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder® , Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home-based low-intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched-chain amino acids (Inner Power® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. RESULTS The median patient age was 75 years (range, 70-84). Twelve patients (40%) were cachectic at baseline. Twenty-nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). CONCLUSIONS The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.
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Affiliation(s)
- Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shuichi Mitsunaga
- Department of Hepatobilliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Noriatsu Tatematsu
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Chiba, Japan
| | - Toshimi Inano
- Division of Nutrition, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takako Mouri
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Tsuji
- Division of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Akio Inui
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Teiko Yamaguchi
- Division of Nutrition, Kyushu University Hospital, Kyushu, Japan
| | - Ayumu Morikawa
- Division of Nursing, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoharu Mori
- Palliative Care Center, Aichi Medical University, Aichi, Japan
| | | | - Florian Strasser
- Oncological Palliative Medicine, Clinic Oncology and Hematology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland
| | - Katsuhiro Omae
- Department of Clinical Biostatistics, Kyoto University, Kyoto, Japan
| | - Keita Mori
- Division of Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Zahiri M, Chen KM, Zhou H, Nguyen H, Workeneh BT, Yellapragada SV, Sada YH, Schwenk M, Najafi B. Using wearables to screen motor performance deterioration because of cancer and chemotherapy-induced peripheral neuropathy (CIPN) in adults - Toward an early diagnosis of CIPN. J Geriatr Oncol 2019; 10:960-967. [PMID: 30665876 DOI: 10.1016/j.jgo.2019.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE An essential component for optimizing quality of life in adults with cancer is determining the degree to which therapy may negatively impact motor-performance, so that patients can maintain their quality of life and independence. This study examined whether instrumented gait and balance could determine the magnitude of deterioration in motor-performance from chemotherapy-induced peripheral neuropathy (CIPN). METHODS We recruited 84 adults with cancer (age = 71.1 ± 9.7 years old, BMI = 26.8 ± 6.2 kg/m2, gender = 56%female) and 57 age-matched non-cancer patients (age = 69.5 ± 9.8 years old, BMI = 27.1 ± 6.0 kg/m2, gender = 79%female). Based on clinical screening, the group with cancer was classified into two groups: participants with CIPN (CIPN+) and without CIPN (CIPN-). Gait and balance were quantified using validated wearables. The Vibration Perception Threshold (VPT) test was used to stratify the CIPN+ group into mild (Mild-CIPN) and severe (Severe-CIPN) subgroups. RESULTS All gait and balance parameters were deteriorated in the group with cancer compared to non-cancer group with the largest effects observed for stride-time (11%, Cohen's effect size d = 1.00, p < 0.001) and eyes-closed ankle sway (94%, d = 0.49, p = 0.001). The same trend was observed when the Severe-CIPN subgroup was compared to the Mild-CIPN. VPT correlates significantly with motor deterioration, with the largest correlation found in stride-time (Rho = 0.37, p = 0.007). Severe-CIPN subjects were significantly older and overall had more deterioration in the majority of motor-performance parameters after adjusting for age (p < 0.050). CONCLUSION These results confirmed the negative impact of CIPN on motor-performance with the largest effects on ankle stability and stride-time. VPT is a predictor of motor deterioration and may be used to determine the severity of CIPN symptom.
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Affiliation(s)
- Mohsen Zahiri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kevin M Chen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Hung Nguyen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Biruh T Workeneh
- Department of Nephrology, Division of Internal Medicine, MD Anderson, Houston, TX, USA
| | - Sarvari V Yellapragada
- Department of Medicine, Section of Hematology and Oncology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Hematology and Oncology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Yvonne H Sada
- Department of Medicine, Section of Hematology and Oncology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Hematology and Oncology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany; Department of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Huang MH, Blackwood J, Godoshian M, Pfalzer L. Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: Results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage. PLoS One 2018; 13:e0208573. [PMID: 30566443 PMCID: PMC6300321 DOI: 10.1371/journal.pone.0208573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background Cancer and its treatment affect body systems that are important in preventing falls and controlling balance/walking. This study examined factors associated with self-reported falls and balance/walking difficulty in the past 12 months in older survivors of four major cancers. Methods This was a cross-sectional study analyzing population-based data from Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey (SEER-MHOS). Data from cohorts 9 to 14 (January 2006 to December 2013) were extracted. Inclusion criteria were: age ≥65 years at cancer diagnosis, first MHOS completed during years 1–5 post-cancer diagnosis, first primary breast (n = 2725), colorectal (n = 1646), lung (n = 752), and prostate (n = 4245) cancer, and availability of cancer staging information. Primary outcomes were self-reported falls and balance/walking difficulty in the past 12 months. Multivariable logistic regression was constructed for each cancer type to examine independent factors associated with falls and balance/walking difficulty. Results In all cancer types, advancing age at cancer diagnosis and dependence in activities of daily living were significant independent factors associated with increased odds of reporting falls and balance/walking difficulty in the past 12 months. Additionally, depression was independently associated with falls and sensory impairment in feet was independently linked to balance/walking difficulty in all cancer types. Other independent factors of falls and balance/walking difficulty varied across cancer types. In breast cancer only, localized or regional cancer stage was significantly associated with increased odds of reporting falls and balance/walking difficulty, whereas treatment with radiation decreased the odds of falling. No association between falls and balance/walking difficulty with time since cancer diagnosis, cancer stage, or cancer treatment was found in colorectal, lung, and prostate cancer. Conclusion There exists some heterogeneity in factors associated with self-reported falls and balance/walking difficulty between different cancer types. Future research is necessary to ascertain factors predictive of falls and balance/walking difficulty in older cancer survivors, particularly factors related to cancer diagnosis and treatment.
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Affiliation(s)
- Min H. Huang
- Physical Therapy Department, College of Health Sciences, University of Michigan–Flint, Flint, MI, United States of America
- * E-mail:
| | - Jennifer Blackwood
- Physical Therapy Department, College of Health Sciences, University of Michigan–Flint, Flint, MI, United States of America
| | - Monica Godoshian
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Lucinda Pfalzer
- Physical Therapy Department, College of Health Sciences, University of Michigan–Flint, Flint, MI, United States of America
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Morishita S, Mitobe Y, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T. Differences in Balance Function Between Cancer Survivors and Healthy Subjects: A Pilot Study. Integr Cancer Ther 2018; 17:1144-1149. [PMID: 30043664 PMCID: PMC6247543 DOI: 10.1177/1534735418790387] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Older adults who have survived cancer experience significantly more falls
compared with healthy adults. Adult cancer survivors may also have a lower
balance function than healthy adults. We examined muscle strength and balance
function among 19 cancer survivors and 14 healthy subjects. The mean age of the
cancer survivors was 51.5 ± 11.2 years; 6 men and 13 women. Cancer diagnoses
included breast cancer, retroperitoneal sarcoma, acute leukemia, lung cancer,
colorectal cancer, thyroid cancer, Ewing’s sarcoma, and tongue cancer. The mean
age of healthy subjects was 47.4 ± 14 years; 3 men, 11 women. Muscle strength
was assessed using hand grip and knee extensor strength tests. Balance function
was evaluated using the Timed Up and Go (TUG) test, and body sway was tested
using a force platform. No significant differences were found with respect to
right and left grip strength or right and left knee extension strength between
the 2 groups. A significantly higher TUG time was observed in cancer survivors
than in healthy subjects (P < .05). With eyes open, the area
of the center of pressure was significantly larger in cancer survivors than in
healthy subjects (P < .05). Similarly, the length per area
was significantly lower both with eyes open and closed for cancer survivors than
for healthy subjects (P < .05). TUG was significantly
correlated with muscle strength in both groups (P < .05).
However, no body sway parameters were related to muscle strength in either
group. Cancer survivors had lower balance function that might not have been
related to muscle strength. Cancer survivors should be evaluated for balance
function as there is a potential for impairment. The findings of this study will
be relevant for planning the prevention of falls for cancer survivors.
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Affiliation(s)
| | - Yuta Mitobe
- 1 Niigata University of Health and Welfare, Niigata, Japan
| | | | - Osamu Aoki
- 2 Shijonawate Gakuen University, Osaka, Japan
| | - Jack B Fu
- 3 University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hideaki Onishi
- 1 Niigata University of Health and Welfare, Niigata, Japan
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Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol 2018; 19:e305-e316. [DOI: 10.1016/s1470-2045(18)30348-6] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/28/2016] [Accepted: 12/22/2016] [Indexed: 01/14/2023]
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Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage. J Geriatr Oncol 2018; 10:89-97. [PMID: 29752141 DOI: 10.1016/j.jgo.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/03/2018] [Accepted: 04/25/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To identify predictors of falls in older breast and prostate cancer survivors. METHODS This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC). RESULTS At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers. CONCLUSIONS Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.
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Factors associated with falls in older adults with cancer: a validated model from the Cancer and Aging Research Group. Support Care Cancer 2018; 26:3563-3570. [PMID: 29705872 DOI: 10.1007/s00520-018-4212-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Falls in older adults with cancer are common, yet factors associated with fall-risk are not well-defined and may differ from the general geriatric population. This study aims to develop and validate a model of factors associated with prior falls among older adults with cancer. METHODS In this cross-sectional secondary analysis, two cohorts of patients aged ≥ 65 with cancer were examined to develop and validate a model of factors associated with falls in the prior 6 months. Potential independent variables, including demographic and laboratory data and a geriatric assessment (encompassing comorbidities, functional status, physical performance, medications, and psychosocial status), were identified. A multivariate model was developed in the derivation cohort using an exhaustive modeling approach. The model selected for validation offered a low Akaike Information Criteria value and included dichotomized variables for ease of clinical use. This model was then applied in the validation cohort. RESULTS The development cohort (N = 498) had a mean age of 73 (range 65-91). Nearly one-fifth (18.2%) reported a fall in the prior 6 months. The selected model comprised nine variables involving functional status, objective physical performance, depression, medications, and renal function. The AUC of the model was 0.72 (95% confidence intervals 0.65-0.78). In the validation cohort (N = 250), the prevalence of prior falls was 23.6%. The AUC of the model in the validation cohort was 0.62 (95% confidence intervals 0.51-0.71). CONCLUSION In this study, we developed and validated a model of factors associated with prior falls in older adults with cancer. Future study is needed to examine the utility of such a model in prospectively predicting incident falls.
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Abstract
OBJECTIVE To examine the prevalence of falls, factors associated with falls and the relationship between falls and survival in older adults with multiple myeloma. METHODS In an analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS)-linked database, we examined 405 older adults with multiple myeloma (MM) and 513 matched non-cancer controls. The primary outcome was self-reported within the past 12 months. Age, race, gender, symptoms, and comorbidities were self-reported in the MHOS. Survival was calculated from SEER data. RESULTS Of the patients with MM, 171 were within 1 year of diagnosis (cohort 1) and 234 were ≥1 year postdiagnosis (cohort 2). Patients in cohorts 1 and 2 were more likely to have fallen than controls (26% and 33% vs 23%, P = .012). On multivariate analysis, among patients with myeloma (combined cohorts 1 and 2), factors associated with falls included self-report of fatigue (aOR 2.52 [95% CI 1.34-4.93]), depression (aOR 1.90 [95% CI 1.14-3.18]), or poorer general health (aOR 1.86 [95% CI 1.05-3.36]). Falls were not associated with survival. CONCLUSIONS Older adults with MM have a greater prevalence of falls than matched controls. Self-reported fatigue, depression, and poorer general health are associated with greater odds of falls.
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Affiliation(s)
- Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis MO
| | - Mark A. Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis MO
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Droz JP, Boyle H, Albrand G, Mottet N, Puts M. Role of Geriatric Oncologists in Optimizing Care of Urological Oncology Patients. Eur Urol Focus 2017; 3:385-394. [DOI: 10.1016/j.euf.2017.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/06/2017] [Accepted: 10/21/2017] [Indexed: 12/27/2022]
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Zhang X, Sun M, Liu S, Leung CH, Pang L, Popat UR, Champlin R, Holmes HM, Valero V, Dinney CP, Tripathy D, Edwards BJ. Risk factors for falls in older patients with cancer. BMJ Support Palliat Care 2017; 8:34-37. [DOI: 10.1136/bmjspcare-2017-001388] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 02/05/2023]
Abstract
ObjectivesA rising number of patients with cancer are older adults (65 years of age and older), and this proportion will increase to 70% by the year 2020. Falls are a common condition in older adults. We sought to assess the prevalence and risk factors for falls in older patients with cancer.MethodsThis is a single-site, retrospective cohort study. Patients who were receiving cancer care underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, falls in the prior 6 months and comorbidity assessment. Vitamin D and bone densitometry were performed.AnalysisDescriptive statistics and multivariable logistic regression.ResultsA total of 304 patients aged 65 or above were enrolled in this study. The mean age was 78.4±6.9 years. They had haematological, gastrointestinal, urological, breast, lung and gynaecological cancers. A total of 215 patients with available information about falls within the past 6 months were included for final analysis. Seventy-seven (35.8%) patients had at least one fall in the preceding 6 months. Functional impairment (p=0.048), frailty (p<0.001), dementia (p=0.021), major depression (p=0.010) and low social support (p=0.045) were significantly associated with the fall status in the univariate analysis. Multivariate logistic regression analysis identified frailty and functional impairment to be independent risk factors for falls.ConclusionsFalls are common in older patients with cancer and lead to adverse clinical outcomes. Major depression, functional impairment, frailty, dementia and low social support were risk factors for falls. Heightened awareness and targeted interventions can prevent falls in older patients with cancer.
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Miwa Y, Yamagishi Y, Konuma T, Sato T, Narita H, Kobayashi K, Takahashi S, Tojo A. Risk factors and characteristics of falls among hospitalized adult patients with hematologic diseases. J Geriatr Oncol 2017; 8:363-367. [PMID: 28743506 DOI: 10.1016/j.jgo.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/10/2017] [Accepted: 07/06/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are major problems in hospitals. In hematologic patients, both disease and its treatment, including chemotherapy and allogeneic hematopoietic cell transplantation (allo-HCT), can cause anemia, febrile neutropenia, and bleeding tendency, which may result in falls and fall-related injuries. MATERIALS AND METHODS We retrospectively analyzed 397 consecutive admissions to the hematology unit at our institute which included 201 adult patients with hematologic disease. RESULTS AND CONCLUSIONS A total of 56 fall events were observed in 43 patients, and the incidence of falls was 2.49 per 1000 person-days. The median hemoglobin, platelet, and serum albumin levels prior to fall events were 8.65g/dl (range, 6.3-12.7), 38×109/l (range, 7-454), and 2.85g/dl (range, 1.6-4.3), respectively. Despite the presence of thrombocytopenia among the majority of patients who fell, no serious injury was observed. Multiple variable logistic regression analysis demonstrated that age older than 65years (hazard ratio [HR], 2.86; 95% confidence interval [CI], 1.17-6.99, P=0.02), admission for allo-HCT (HR, 9.48; 95% CI, 3.35-26.80, P<0.001), hypnotic medication (HR, 3.57; 95% CI, 1.56-8.20, P=0.002), urinary or intravenous catheter placement (HR, 2.34; 95% CI, 1.08-5.09, P=0.03), and hypoalbuminemia (HR, 2.30; 95% CI, 1.07-4.96, P=0.03) were significantly associated with increased fall risk. These findings indicated that special attention should be paid to patients with such risk factors during their treatment.
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Affiliation(s)
- Yoriko Miwa
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuko Yamagishi
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Tomoko Sato
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hatsuko Narita
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koji Kobayashi
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Huang MH, Blackwood J, Godoshian M, Pfalzer L. Prevalence of self-reported falls, balance or walking problems in older cancer survivors from Surveillance, Epidemiology and End Results—Medicare Health Outcomes Survey. J Geriatr Oncol 2017; 8:255-261. [DOI: 10.1016/j.jgo.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/28/2017] [Accepted: 05/27/2017] [Indexed: 01/31/2023]
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Tsai MS, Lai CH, Lee CP, Yang YH, Chen PC, Kang CJ, Chang GH, Tsai YT, Lu CH, Chien CY, Young CK, Fang KH, Liu CJ, Yeh RMA, Chen WC. Mortality in tongue cancer patients treated by curative surgery: a retrospective cohort study from CGRD. PeerJ 2016; 4:e2794. [PMID: 27994985 PMCID: PMC5162395 DOI: 10.7717/peerj.2794] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Our study aimed to compare the outcomes of surgical treatment of tongue cancer patients in three different age groups. METHODS From 2004 to 2013, we retrospectively analyzed the clinical data of 1,712 patients who were treated in the four institutions constituting the Chang Gung Memorial Hospitals (CGMH). We divided and studied the patients in three age groups: Group 1, younger (<65 years); Group 2, young old (65 to <75); and Group 3, older old patients (≥75 years). RESULTS Multivariate analyses determined the unfavorable, independent prognostic factors of overall survival to be male sex, older age, advanced stage, advanced T, N classifications, and surgery plus chemotherapy. No significant differences were found in adjusted hazard ratios (HR) of death in early-stage disease (stage I-II) among Group 1 (HR 1.0), Group 2 (HR 1.43, 95% confidence interval (CI) [0.87-2.34], p = 0.158), and Group 3 (HR 1.22, 95% CI [0.49-3.03], p = 0.664) patients. However, amongst advanced-stage patients (stage (III-IV)), Group 3 (HR 2.53, 95% CI [1.46-4.38], p = 0.001) showed significantly worse survival than the other two groups after other variables were adjusted for. Fourteen out of 21 older old, advanced-staged patients finally died, and most of the mortalities were non-cancerogenic (9/14, 64.3%), and mostly occurred within one year (12/14, 85%) after cancer diagnosis. These non-cancer cause of death included underlying diseases in combination with infection, pneumonia, poor nutrition status, and trauma. CONCLUSIONS Our study showed that advanced T classification (T3-4), positive nodal metastasis (N1-3) and poorly differentiated tumor predicted poor survival for all patients. Outcome of early-stage patients (stage I-II) among three age groups were not significantly different. However, for advanced-stage patients (stage III-IV), the older old patients (≥75) had significantly worse survival than the other two patient groups. Therefore, for early-stage patients, age should not deny them to receive optimal treatments. However, older old patients (≥75) with advanced cancer should be comprehensively assessed by geriatric tools before surgical treatment and combined with intensive postoperative care to improve outcome, especially the unfavorable non-cancerogenic mortalities within one year after cancer diagnosis.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Hsuan Lai
- Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chang-Hsien Lu
- Department of Medical Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chi-Kuang Young
- Department of Otolaryngology -Head and Neck Surgery, Keelung Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Ku-Hao Fang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Chin-Jui Liu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Re-Ming A Yeh
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Wen-Cheng Chen
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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