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Visovsky C, Wodzinski PT, Haladay D, Ji M, Coury J. Fall Risk Associated with Taxanes: Focus on Chemotherapy-Induced Peripheral Neuropathy. Semin Oncol Nurs 2024:151687. [PMID: 39013733 DOI: 10.1016/j.soncn.2024.151687] [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: 03/22/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Chemotherapy-induced peripheral neuropathy (CIPN) remains a significant toxicity for women with breast cancer receiving taxane-based treatment. This analysis has been done within the context of an ongoing 16-week randomized clinical trial consisting of a gait, balance, and strength training exercise intervention for the lower extremities in women with persistent CIPN who received taxane-based chemotherapy for breast cancer. The aim of this analysis is to determine the baseline fall risk among 62 study participants with persistent taxane-induced CIPN assigned to the control group. METHODS This analysis used the baseline demographic, medical data, nerve conduction, gait, balance, and muscle strength variables of participants prior to randomization to develop an explanatory model of fall risk. The analytic approach utilized generalized linear modeling with Lasso to select baseline risk factors for future falls. RESULTS Characteristics of the study sample by intervention and control group revealed no significant differences between the groups at baseline. The only baseline risk factors that were significantly associated with future falls were near falls within the last month (β = 0.90, P = .056) with an odds ratio = 2.46, 95% confidence interval 0.31 to 17, and right ankle plantar flexion torque. (β = 0. 05, P = .006) with an odds ratio = 1.05, 95% confidence interval 1.01 to 1.10. Demographic and medical data, nerve conduction parameters, gait, balance, or muscle strength variables did not significantly influence fall risk in this population. CONCLUSIONS The potential for injury and disability from falls is a considerable concern among oncology clinicians and women with breast cancer and persistent CIPN. While falls and fall risk have been previously examined in other studies of breast cancer survivors, the majority of studies fail to capture the occurrence of "near falls" a significant predictor of fall risk. In addition, it is possible that ankle strength may prove to be a potential target for fall prevention in this population. Evidence-based interventions focused on improving neuropathic symptoms, physical function, and quality of life in persons with CIPN are still needed. IMPLICATION FOR NURSING PRACTICE Oncology nurses and nurse practitioners should query patients who received taxane-based chemotherapy for not only the incidence and frequency of falls but the occurrence of near falls. A prompt referral to physical therapy may be useful in strengthening the lower extremities to improve balance and prevent falls.
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Affiliation(s)
| | | | | | - Ming Ji
- University of New Mexico, Albuquerque, NM
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2
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Holt J, Salas M, Lee SW. Aromatase Inhibitor-Associated Distal Radioulnar Joint Instability and Tear of the Extensor Digiti Minimi: A Case Report. Am J Phys Med Rehabil 2024; 103:e86-e89. [PMID: 38466152 DOI: 10.1097/phm.0000000000002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors.
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Affiliation(s)
- Jonathan Holt
- From the MountainView Hospital, Sunrise Health Graduate Medical Education Consortium, Las Vegas, Nevada (JH, SWL); and VA Southern Nevada Healthcare System, Las Vegas, Nevada (MS)
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Dai ACK, Mackenzie L. Falls experienced by adult cancer survivors: a scoping review. Disabil Rehabil 2024:1-21. [PMID: 38946208 DOI: 10.1080/09638288.2024.2362399] [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: 08/06/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Accidental falls among adult cancer survivors are a health concern. Falls impose economic burdens and detrimental consequences to cancer survivors. This review aimed to synthesize findings from published research to explore the relationship between falls and cancer diagnosis and treatment among cancer survivors. MATERIALS AND METHODS A scoping review was conducted using four databases (Medline, EMBASE, CINAHL, and Scopus) for the years 2001-2021. A total of 425 abstracts were identified after removing duplicates. A second search for the years 2022-2023 was completed where 80 abstracts were identified. Abstract screening, full-text review, and data extraction were conducted. Study characteristics and key findings were extracted from full texts. Descriptive numerical summaries were presented, and narrative analyses were performed. RESULTS AND CONCLUSIONS A total of 42 articles were included in the scoping review which demonstrated (1) an increased prevalence of falls among cancer survivors, (2) the presence of cancer-specific fall risk factors, (3) a lack of cancer-specific fall prediction tools, and (4) few fall prevention interventions as part of usual care among cancer survivors. Younger cancer survivors were underrepresented. Cancer survivors should be aware of their risk of falls, and health professionals should ensure that fall prevention is part of usual care.
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Affiliation(s)
- Anson Chuk Kwan Dai
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Verdini NP, Gelblum DY, Vertosick EA, Ostroff JS, Vickers AJ, Gomez DR, Gillespie EF. Evaluating a Physician Audit and Feedback Intervention to Increase Clinical Trial Enrollment in Radiation Oncology in a Multisite Tertiary Cancer Center: A Randomized Study. Int J Radiat Oncol Biol Phys 2024; 119:11-16. [PMID: 37769853 DOI: 10.1016/j.ijrobp.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Clinical trial participation continues to be low, slowing new cancer therapy development. Few strategies have been prospectively tested to address barriers to enrollment. We investigated the effectiveness of a physician audit and feedback report to improve clinical trial enrollment. METHODS AND MATERIALS We conducted a randomized quality improvement study among radiation oncologists at a multisite tertiary cancer network. Physicians in the intervention group received quarterly audit and feedback reports comparing the physician's trial enrollments with those of their peers. The primary outcome was trial enrollments. RESULTS Among physicians randomized to receive the feedback report (n = 30), the median proportion of patients enrolled during the study period increased to 6.1% (IQR, 2.6%-9.3%) from 3.2% (IQR, 1.1%-10%) at baseline. Among those not receiving the feedback report (n = 29), the median proportion of patients enrolled increased to 4.1% (IQR, 1.3%-7.6%) from 1.6% (IQR, 0%-4.1%) at baseline. There was a nonsignificant change in the proportion of enrollments associated with receiving the feedback report (-0.6%; 95% CI, -3.0% to 1.8%; P = .6). Notably, there was an interaction between baseline trial accrual and receipt of feedback reports (P = .005), with enrollment declining among high accruers. There was an increase in enrollment throughout the study, regardless of study group (P = .001). CONCLUSIONS In this study, a positive effect of physician audit and feedback on clinical trial enrollment was not observed. Future efforts should avoid disincentivizing high accruers and might consider pairing feedback with other patient- or physician-level strategies. The increase in trial enrollment in both groups over time highlights the importance of including a comparison group in quality improvement studies to reduce confounding from secular trends.
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Affiliation(s)
- Nicholas P Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jamie S Ostroff
- Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Oncology, University of Washington, Seattle, Washington.
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5
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Jing F, Zhu Z, Qiu J, Tang L, Xu L, Xing W. Symptom Profiles and Related Factors Among Breast Cancer Patients Undergoing Endocrine Therapy: A Latent Profile Analysis. Cancer Nurs 2023; 46:E297-E304. [PMID: 37607380 DOI: 10.1097/ncc.0000000000001125] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To provide person-centered symptom management, the interindividual variability in breast cancer patients merits further exploration. However, how sociodemographic and clinical characteristics influence symptom profile membership in endocrine therapy for breast cancer is still unknown. OBJECTIVES This study aimed to explore symptom profiles of breast cancer patients undergoing endocrine therapy and to identify sociodemographic and clinical characteristics among symptom subgroup members. METHODS A cross-sectional study was conducted, and participants were invited to complete a general information questionnaire and Functional Assessment of Cancer Therapy-Endocrine Subscale. Latent profile analysis, univariate analysis, and multinomial logistic regression were performed to explore symptom profiles and identify interindividual variability. RESULTS Three distinct subgroups were identified: "all high" (9.8%), "all moderate but high sexual symptoms" (25.4%), and "all low" (64.8%). Age, body mass index, main payment source for medical expenses, type of endocrine therapy, and history of breast cancer treatment were factors that determined membership in these 3 symptom subgroups. CONCLUSION Patients' demographic and clinical characteristics were associated with their endocrine therapy-related symptom profiles. In general, those younger in age who pay out of pocket for medical expenses, use aromatase inhibitors, present a history of chemotherapy, and have a higher body mass index have a greater risk of symptom burden. IMPLICATION FOR PRACTICE The findings of this study will contribute to implementing individual cancer care based on the characteristics and needs of patient subgroups, which may improve the allocation of medical resources and provide interventions tailored to patients' unique needs.
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Affiliation(s)
- Feng Jing
- Author Affiliations: School of Nursing and Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University (Ms Feng Jing, Mr Zheng Zhu, Ms Lei Xu, and Ms Weijie Xing); Department of Nursing Administration, Shanghai Cancer Center, Fudan University (Ms Jiajia Qiu); Department of Oncology, Shanghai Medical College, Fudan University (Ms Jiajia Qiu and Dr Lichen Tang); and Department of Breast Surgery, Shanghai Cancer Center, Fudan University (Dr Lichen Tang), Shanghai, China
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6
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Felser S, Gube M, Gruen J, Coutre PI, Schulze S, Muegge LO, Junghanss C, Ulbricht S. Association Between Cancer-Related Fatigue and Falls in Patients With Myeloproliferative Neoplasms: Results of a Multicenter Cross-Sectional Survey From the East German Study Group for Hematology and Oncology (OSHO #97). Integr Cancer Ther 2022; 21:15347354221143064. [PMID: 36539979 PMCID: PMC9791269 DOI: 10.1177/15347354221143064] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study retrospectively examined the association between cancer-related fatigue (CrF) and the number of falls during the last 12 months in patients with myeloproliferative neoplasms (MPNs). METHODS A multicenter, 1-time anonymous survey was conducted using analog and digital questionnaires. Sex-stratified multinomial logistic regression analysis was applied to investigate the association between CrF and number of falls. All analyses were adjusted for age, school education, body mass index, MPN subtype, and quality of life. RESULTS The final sample comprised 688 patients (mean age 57.4 ± 13.8, 62.4% women). The fall rate was 16.2% in women and 12.2% in men (P = .153). There were no differences between women and men in terms of CrF between individuals with more than 1 fall, whereas women with 1 fall had a higher CrF compared to those without a fall (RRR = 1.019; 95% CI [1.002-1.039]), respectively. CONCLUSION CrF increases the risk of falls in women with MPN. Physicians should evaluate and manage CrF symptoms and implement fall prevention strategies for those who are at increased risk. Further research is needed to better understand the effects of CrF on gait performance and associated fall risk.
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Affiliation(s)
- Sabine Felser
- Rostock University Medical Center, Rostock, Germany,Sabine Felser, Department of Internal Medicine, Clinic III—Hematology, Oncology and Palliative Care, Rostock University Medical Center, Ernst-Heydemann-Straße 06, Rostock 18057, Germany.
| | - Martin Gube
- Rostock University Medical Center, Rostock, Germany,University of Rostock, Rostock, Germany
| | - Julia Gruen
- Rostock University Medical Center, Rostock, Germany
| | | | - Susann Schulze
- University Hospital Halle, Halle (Saale), Germany,Carl-von-Basedow-Klinikum, Merseburg, Germany
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7
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Liu XL, Huang YY, Wang T, Molassiotis A, Yao LQ, Huang HQ, Zheng SL, Tan JY(B. Psychometric assessment of the Chinese version of the Oxford Knee Score in breast cancer survivors experiencing hormone treatment-related knee dysfunction. Asia Pac J Oncol Nurs 2022; 9:135-142. [PMID: 35494097 PMCID: PMC9052842 DOI: 10.1016/j.apjon.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To test the validity, reliability, and acceptability of the Oxford Knee Score (OKS) Mandarin Chinese version for measuring knee pain and function among Chinese breast cancer survivors. Methods This validation study was a secondary analysis of a cross-sectional survey that was conducted at the Affiliated Hospital of Southwest Medical University, Sichuan, China. Recruited from a larger arthralgia-related survey cohort, those who experienced knee arthralgia and completed the OKS Chinese version were selected for the current analysis. The Cronbach’s alpha coefficient was calculated to identify the internal consistency reliability of the OKS. Spearman’s correlations were adopted to identify the concurrent validity of the OKS. The discriminate performance of the OKS via subgroup analysis of breast cancer survivors with or without arthritis, as well as different exercise levels, cancer stages, chemotherapy protocols, and occupations, was also conducted. Results One hundred and fifty-nine breast cancer survivors were included. There were significant correlations between the OKS and the FACT-B, the SF-36, and the BPI in measuring knee pain symptoms and their impact on daily living activities. The Cronbach’s alpha for the OKS total scores was 0.90. The participants with arthritis reported significantly lower OKS scores than those without arthritis (P = 0.040). The difference in OKS total scores between the participants with different exercise levels (P < 0.001) and the participants with different occupations (P = 0.006) was statistically significant. Considerable ceiling effects (>15%) of the OKS Chinese version were found in 11 of 12 items. Conclusions The OKS Mandarin Chinese version is a short, valid, reliable, and sensitive tool for knee pain and function assessment among breast cancer survivors.
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Affiliation(s)
- Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Yu-Yan Huang
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Li-Qun Yao
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Hou-Qiang Huang
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Si-Lin Zheng
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing-Yu (Benjamin) Tan
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
- Corresponding author.
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8
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Tsai CL, Liu LC, Liao CY, Liao WL, Liu YH, Hsieh CL. Yoga versus massage in the treatment of aromatase inhibitor-associated knee joint pain in breast cancer survivors: a randomized controlled trial. Sci Rep 2021; 11:14843. [PMID: 34290337 PMCID: PMC8295273 DOI: 10.1038/s41598-021-94466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Aromatase inhibitors (AIs) are standard adjuvant therapy for postmenopausal women with oestrogen receptor-positive, early-stage, and metastatic breast cancer. Although effective, the risk of falls due to AI-associated knee joint pain significantly increased. The aim of this study was to evaluate the therapeutic effects of yoga and massage on AI-associated knee joint pain. Breast cancer survivors were randomly assigned to a 6-week yoga intervention-2-week rest-6-week massage exposure (Yoga first, n = 30) or a 6-week massage intervention-2-week rest-6-week yoga exposure (Massage first, n = 30). Evaluations of the treatment efficacy were made at baseline, post-intervention, and post-exposure using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, plasma cytokine levels, and changes in meridian energy. The results showed that yoga, superior to massage intervention, significantly reduced AI-associated knee joint pain, as demonstrated by the WOMAC pain score. The yoga intervention improvements were also associated with changes in plasma cytokine levels and meridian energy changes. In conclusion, this study provides scientific evidence that yoga was more effective than massage for reducing AI-associated knee joint pain. Meridian energy changes may provide another scientific, objective, non-invasive way to monitor the therapeutic effects of yoga and investigate another alternative, complementary medicine.
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Affiliation(s)
- Chia-Lin Tsai
- Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Liang-Chih Liu
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Ying Liao
- Department of Radiation Therapy and Oncology, Department of Health, Taichung Hospital, Executive Yuan, Taichung, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan.,Center for Personalized Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Huei Liu
- Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Drug Development Centre, China Medical University, Taichung, Taiwan. .,Department of Medical Genetics and Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Ching-Liang Hsieh
- Graduate Institute of Acupuncture Science, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Chinese Medicine Research Centre, China Medical University, Taichung, Taiwan. .,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
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Li W, Gamber M, Han J, Sun W, Yu T. The Association Between Pain and Fall Among Middle-Aged and Older Chinese. Pain Manag Nurs 2020; 22:343-348. [PMID: 33272831 DOI: 10.1016/j.pmn.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Falls and fall-induced injuries in elderly people are common worldwide. However, few reports have examined the association between body pain and fall in middle-aged and older Chinese adults. The objective of this study is to access the association between pain and fall among middle-aged and older Chinese. METHODS Data were drawn from the 2011 China Health and Retirement Longitudinal Study (CHARLS) from respondents who were middle-aged and older (over 45 years old). A logistic regression model was used to estimate the odds ratios (AOR) and 95% confidence interval (95% CI) of the association between body pain and fall, after controlling for confounders. RESULTS After adjusting for demographic characteristics, socioeconomic status, lifestyle, health status and comorbidity, those participants who had pain were 73% more likely to report falls than those who did not have pain (AOR = 1.73, 95% CI 1.56-1.92). Elder age was associated with a higher risk of fall (AOR = 1.77, 95% CI 1.47-2.13). Comparing to female, male was associated with a lower risk of fall (AOR = 0.64, 95% CI 0.56-0.74). Lifestyle such as drinking status, self-reported health status, chronic diseases, vision impairment and disability were significantly associated with fall. CONCLUSION Body pain is significantly associated with fall among middle-aged and older Chinese adults. Appropriate pain management programs and policies are needed in fall prevention.
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Affiliation(s)
- Wei Li
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Michelle Gamber
- School of Health Professions, Shenandoah University, Winchester, Virginia
| | - Jingnan Han
- Department of Medicine, The University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Wenjie Sun
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Tong Yu
- Department of Medical Insurance, School of Humanities and Management, Wannan Medical College, Wuhu, China.
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Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic. Breast Cancer Res Treat 2020; 184:445-457. [PMID: 32794062 DOI: 10.1007/s10549-020-05862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Unintentional falls and breast cancer are common among older women, but the associations between them are understudied. We aimed to identify factors associated with falls in older women with breast cancer. METHODS We retrospectively reviewed clinical records of older women with breast cancer at Duke Medical Center who had completed the Senior Adult Oncology Program geriatric assessment. Characteristics were compared between women had had at least one fall in the past year and those who did not. Pearson's Chi-square tests and t tests were used for comparison of groups' characteristics. Logistic regression determined factors associated with falling. RESULTS We identified 425 women, age 76.2 years (range 65-89 years), at the time of the assessment. 118 (27.8%) women reported a fall in the prior year. Age, race, ethnicity, and time since diagnosis (all p > 0.05) were similar between groups. In univariate analyses, metastatic disease (p = 0.023) and history of endocrine therapy (p = 0.042) were more common among women who fell. Women who fell had lower systolic (p = 0.001), diastolic (p < 0.001) blood pressures, and SpO2 (p = 0.018). Women who had fallen had a higher Charlson Comorbidity Index (CCI: p = 0.033), and were more likely to report using a walking aide (p < 0.001), nutritional issues (p = 0.006), and depression symptoms (p = 0.038). In multivariate analysis, falling was associated with low DBP (OR 0.93; p = 0.0017), low SpO2 (OR 0.79; p = 0.0169), a higher CCI (OR 1.23; p = 0.0076), and depression symptoms (OR 1.61; p = 0.039). CONCLUSIONS Among older women with breast cancer, depressive symptoms, higher comorbidity level, and vital sign measurements were associated with having fallen.
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Pan K, Ray RM, Cauley JA, Shadyab AH, Hurria A, Chlebowski RT. Trajectory of recurrent falls in post-menopausal breast cancer survivors and in matched cancer-free controls. Breast Cancer Res Treat 2020; 180:767-775. [PMID: 32076891 DOI: 10.1007/s10549-020-05576-8] [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: 12/08/2019] [Accepted: 02/11/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Cross-sectional studies suggest that falls are prevalent among older breast cancer survivors. However, fall risk in this population has not been comprehensively examined. Therefore, we compared fall risk in older women post-breast cancer diagnosis to fall risk before cancer diagnosis and to risk in cancer-free matched controls. METHODS Among 2019 women in the Women's Health Initiative with localized breast cancer diagnosed at age ≥ 60 years with fall assessment data for 3 years pre-diagnosis and 3 years post-diagnosis, recurrent fall risk post-diagnosis was compared to risk in 2019 cancer-free controls matched by age, year of WHI entry, and baseline fall frequency. Generalized estimating equations under a logistic regression model were used to compare fall recurrence in breast cancer survivors and controls. Multi-variable models were adjusted for the matching factors, race/ethnicity, body mass index, and multiple chronic conditions. RESULTS In breast cancer survivors aged 70.8 years (mean) at diagnosis, over the 3-year pre-diagnosis interval, recurrent falls were reported by 18.5%. Over the 3-year post-diagnosis interval, recurrent falls were reported by 21.8% of breast cancer survivors and 20.0% of controls over the same time period (P = 0.27). Recurrent fall risk did not differ between breast cancer survivors and control women (OR 1.07, 95% CI 0.92-1.25), even after multi-variable adjustment. CONCLUSIONS In contrast to prior reports, older breast cancer survivors were not more likely to experience recurrent falls than age-matched counterparts. These findings underscore the need for incorporation of cancer-free control populations in survivorship studies to distinguish cancer sequelae from processes related to aging.
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Affiliation(s)
- Kathy Pan
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, 1124 W. Carson Street, Building N-18, Torrance, CA, 90502, USA.
| | - Roberta M Ray
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA, USA
| | - Rowan T Chlebowski
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, 1124 W. Carson Street, Building N-18, Torrance, CA, 90502, USA
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