1
|
McNeish BL, Shores CMS, Bell SG, Dittus K, Mossburg J, Krant N, Steinharter JA, Feb K, Hehir MK, Redfern MS, Rosano C, Richardson JK, Kolb N. Association of intraindividual variability in simple reaction time with balance and falls in older cancer survivors: A secondary analysis. J Geriatr Oncol 2025; 16:102288. [PMID: 40516230 DOI: 10.1016/j.jgo.2025.102288] [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: 12/22/2024] [Revised: 04/29/2025] [Accepted: 06/05/2025] [Indexed: 06/16/2025]
Abstract
INTRODUCTION Intraindividual reaction time variability (IIRV) is associated with physical function and falls in older cancer-free adults but has been minimally studied in aging cancer survivors. The aims of this study were (a) to assess the association of IIRV with physical function and falls in chemotherapy-treated cancer survivors, (b) to determine if this relationship varied between middle-aged and older cancer survivors, and (c) to determine if any associations are independent of reaction response central tendency (i.e., total reaction accuracy) and locomotor impairment. MATERIALS AND METHODS Fifty cancer survivors (n = 28 with age ≥ 65 years, 88 % female) post chemotherapy treatment were included in this cross-sectional study. Simple IIRV was defined as the standard deviation of simple reaction time from stick drop paradigm. Physical function was measured by time to complete five sit-to-stand (5STS), number of sit-to-stand repetitions in thirty seconds (STS30), and unipedal stance time (UST). Self-reported recurrent and injurious falls in the past year were recorded as secondary outcomes. Bivariate analyses were conducted between IIRV measures and physical function variables in middle-aged and older aged cancer survivors. Multivariable models were used to examine the associations of simple IIRV with UST and falls outcomes. Included covariates were age, total reaction accuracy, a measure of central reaction tendency, and presence of a locomotor risk factor (obesity or neuropathy). RESULTS In older cancer survivors, Spearman correlations demonstrated significant relationships of simple IIRV with UST and STS30, but not STS. In multivariable models, the interaction of age ≥ 65 years with increasing levels of simple IIRV was independently associated with worse UST (B -0.919, 95 % CI -1.68, -0.159, p = 0.02), increased recurrent falls (OR 1.29, 95 % CI,1.04 1.61, p = 0.02), and injurious falls (OR 1.30, 95 % CI,1.04 1.63, p = 0.02). DISCUSSION Simple IIRV was independently associated with balance and falls outcomes in older chemotherapy-treated cancer survivors. The relationship of IIRV to balance and falls did not extend to middle-aged cancer survivors, suggesting that IIRV may be of greater importance for cognitive motor control in older cancer survivors.
Collapse
Affiliation(s)
- Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - C M S Shores
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA..
| | - Sarah G Bell
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kim Dittus
- Department of Medicine, University of Wisconsin, Madison, WI, USA; Department of Physical Therapy, University of Vermont, Burlington, VT, USA..
| | - Jurdan Mossburg
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Krant
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Jack A Steinharter
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Kendall Feb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Michael K Hehir
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA..
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - Noah Kolb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| |
Collapse
|
2
|
Colombage UN, Ackerman IN, Parry SM, Granger CL, Nguyen T, Hill KD, Soh SE. Prevalence and incidence of falls in older adults with cancer: a systematic review with meta-analysis. J Cancer Surviv 2025:10.1007/s11764-025-01796-3. [PMID: 40329127 DOI: 10.1007/s11764-025-01796-3] [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: 11/30/2024] [Accepted: 03/27/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE To determine the prevalence and incidence of falls and fall-related injuries in community-dwelling older adults with a diagnosis of cancer and examine whether falls prevalence varies with specific cancer characteristics. METHODS A systematic search of five databases was conducted. Studies that included community-dwelling adults with a mean age ≥ 60 years with a current or past diagnosis of cancer and that reported data on the prevalence and/or incidence of falls and/or fall-related injuries were included. Prevalence and incidence rates of falls were pooled for meta-analysis, and meta-regression was used to investigate associations between cancer characteristics (e.g. cancer type and cancer treatment received) and prevalence of falls. RESULTS Fifty-seven studies with sample sizes ranging from 51-146,959 participants were included. The pooled prevalence of older adults with cancer who fell in the last 6 months (25%; 95% CI 19%, 32%) and 12 months (29%; 95% CI 24%, 34%) was similar. Subgroup analysis showed that the pooled prevalence of falls for older adults with breast cancer was higher (26%; 95% CI 22%, 30%) compared to those with prostate (14%; 95% CI 9%, 20%) or colorectal cancer (13%; 95% CI 11%, 16%). CONCLUSIONS The overall prevalence of falls amongst community-dwelling older adults with cancer is relatively similar compared to the general older adult population, noting that fall events may have been under-reported. IMPLICATIONS FOR CANCER SURVIVORS Falls are common amongst older adults with cancer, but the link between cancer characteristics and exposure to falls risk requires further investigation to better understand the risk factors specific to cancer survivors.
Collapse
Affiliation(s)
- Udari N Colombage
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Catherine L Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Thanh Nguyen
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
| |
Collapse
|
3
|
Blajovan MD, Abu-Awwad SA, Tomescu MC, Tudoran C, Gurgus D, Dinu A, Abu-Awwad A. The Role of Inflammatory Sarcopenia in Increasing Fall Risk in Older Adults: Exploring the Impact on Mobility-Impaired and Immunocompromised Patients. Geriatrics (Basel) 2025; 10:52. [PMID: 40277851 PMCID: PMC12026734 DOI: 10.3390/geriatrics10020052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/14/2025] [Accepted: 03/21/2025] [Indexed: 04/26/2025] Open
Abstract
Background/Objectives: Inflammatory sarcopenia, characterized by muscle weakness exacerbated by chronic systemic inflammation, has emerged as a critical factor in fall risk among older adults. While previous studies have examined sarcopenia and inflammation independently, few have investigated their combined impact on mobility impairments and fall susceptibility, particularly in immunocompromised individuals. This study aimed to assess the role of inflammatory sarcopenia in increasing fall risk by comparing functional performance, muscle strength, and inflammatory biomarkers across three groups: healthy older adults, individuals with non-inflammatory sarcopenia, and those with inflammatory sarcopenia. A secondary objective was to evaluate fall incidence in immunocompromised versus non-immunocompromised individuals. Methods: A prospective observational study was conducted on 250 adults aged ≥65 years, categorized based on inflammatory status and muscle health. Functional assessments included handgrip strength, the Timed Up and Go (TUG) test, and fall frequency analysis. Inflammatory status was determined by measuring C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Multivariate regression models were used to identify predictors of fall risk. Results: Participants with inflammatory sarcopenia exhibited significantly higher CRP and IL-6 levels, greater muscle weakness, poorer mobility performance, and a fourfold increase in fall incidence compared to controls (p < 0.001). Immunocompromised individuals had nearly double the fall risk of their non-immunocompromised counterparts (p < 0.001). TUG test performance was the strongest fall predictor. Conclusions: Our findings highlight the importance of integrating fall prevention strategies that not only focus on muscle-strengthening programs but also include regular screening for inflammatory markers. Given the strong association between systemic inflammation, muscle weakness, and fall risk, identifying and managing chronic inflammation may play a crucial role in reducing mobility impairments and improving outcomes in older adults.
Collapse
Affiliation(s)
- Marc-Dan Blajovan
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.); (A.A.-A.)
- Department XII, Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Mirela-Cleopatra Tomescu
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 340001 Timisoara, Romania;
- Department of Internal Medicine I, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 340001 Timisoara, Romania
- Timisoara Municipal Clinical Emergency Hospital, Hector Str., Nr. 1, 300040 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.); (A.A.-A.)
- Department VII, Internal Medicine II, Discipline of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of the “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Daniela Gurgus
- Department of Balneology, Medical Recovery and Rheumatology, Family Discipline, Center for Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Anca Dinu
- Department XVI—Medical Recovery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center for Assessment of Human Motion and Functionality and Disability, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Ahmed Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.); (A.A.-A.)
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center University Professor Doctor Teodor Șora, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| |
Collapse
|
4
|
Kourtis E, Zygogiannis K, Fanourgiakis I, Koulalis D, Stathopoulos KD. Understanding and Managing Fracture Risk in Patients With Cancer: A Literature Review. Cureus 2025; 17:e83082. [PMID: 40438830 PMCID: PMC12116790 DOI: 10.7759/cureus.83082] [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] [Accepted: 04/18/2025] [Indexed: 06/01/2025] Open
Abstract
One of the most important complications of cancer and its treatments is the increased fracture risk. Fractures can have a significant impact on the patient's quality of life and may be associated with morbidity, mortality, and reduced functional status. The present study aims to investigate the mechanisms underlying the increased risk of fractures in cancer patients, the effect of cancer treatments on fracture risk, and strategies to prevent fractures in this population. This is a literature review using the PubMed - National Center for Biotechnology Information (NCBI), Web of Science, Cochrane Library, Scopus, and electronic internet databases. The search was based on the keywords "fracture risk" AND "cancer", NOT ("osteoporosis" OR "osteoporotic"). Inclusion criteria were clinical studies assessing fracture pathogenesis and prevention, along with fracture risk estimation in cancer patients. Non-human studies, pediatric studies, non-English studies, editorials, and study protocols were excluded. After the application of inclusion and exclusion criteria, 146 studies were finally included. Fracture risk is particularly increased in patients with malignancies. This is due to the direct effect of cancer cells on bone metabolism, the existence of cancer-related factors (bone metastases, hypercalcemia, malnutrition, and increased risk of falls), coexisting diseases (osteoporosis, diabetes mellitus, and rheumatoid arthritis), and the side effects of anticancer treatments (chemotherapy, radiotherapy, and hormone therapy). Fracture risk assessment is based on the measurement of bone mineral density (DXA), the use of the Fracture Risk Assessment Tool (FRAX), laboratory tests (measurement of calcium, phosphorus, vitamin D, alkaline phosphatase, parathyroid hormone, and biomarkers of bone metabolism), and imaging methods (X-rays, computed tomography, magnetic resonance imaging, and PET/CT of bones). To reduce fracture risk in cancer patients, lifestyle changes (exercise, smoking cessation) and anti-osteoclastic drugs such as bisphosphonates and denosumab are administered. Fracture risk in cancer patients is influenced by various factors, including the type of cancer, stage of disease, cancer treatments, bone health status, and presence of bone metastases. Overall, fracture risk in cancer patients is multifactorial and requires comprehensive evaluation and management to optimize bone health and quality of life.
Collapse
Affiliation(s)
| | | | | | - Dimitrios Koulalis
- Orthopedics and Traumatology Department, Attikon University Hospital, Athens, GRC
| | | |
Collapse
|
5
|
Jebanesan N, Alibhai SMH, Santa Mina D, Jones J, Legacy N, Freeman L, Smith A, Cobbing S, Vadali N, Lo S, Godhwani K, Nasiri F, Antonio M, Stephens D, Pitters E, Bennie F, Stephens A, Papadakos J, Cerullo L, Zjadewicz M, Jang R, Eng L, Krzyzanowska M, Matthew A, Durbano S, Mehta R, Menjak I, Emmenegger U, Sattar S, Sun V, Ladham K, Puts M. Supporting older adults with cancer and their support person through geriatric assessment and remote exercise and education: The SOAR study protocol. J Geriatr Oncol 2025; 16:102194. [PMID: 39909737 DOI: 10.1016/j.jgo.2025.102194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 12/04/2024] [Accepted: 01/28/2025] [Indexed: 02/07/2025]
Abstract
INTRODUCTION Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored. This study aims to determine the feasibility and acceptability of implementing geriatric assessment and management (GAM) in combination with virtual chair-based exercise (CBE) and health education for frail older adults with cancer and their support persons. MATERIALS AND METHODS This phase 2 randomized controlled trial will include patients aged 70 years and above with a lung, gastrointestinal, or genitourinary cancer referred for first- or second-line chemotherapy, immunotherapy, or targeted therapy. Patients must be frail (≥3 on the Vulnerable Elders Survey), sedentary on the Godin Leisure Time Activity Questionnaire (<90 min of moderate/intense activity per week), have English proficiency with ability to consent, a physician-estimated life expectancy of at least six months, and deemed safe to exercise. Each older adult will be invited to bring a support person to participate in the study. Patients will be randomized 1:1 to GAM combined with online CBE and health education for 12 weeks or waitlist control. Participating support persons will follow the same intervention group. Primary endpoints for feasibility and acceptability will be recruitment rate, retention, adherence, and data collection. Outcome measures include physical activity, function, fatigability, quality of life, treatment toxicity, and unplanned hospital visits. Outcome measures will be used to obtain estimates of the effect size and feasibility analysis needed for designing a phase 3 study. The study will take place at two hospitals in Toronto, Canada. DISCUSSION This study will investigate the feasibility, acceptability, and obtain preliminary estimates of the outcomes of GAM plus CBE and health education in preventing functional decline and improving quality of life in frail older adults receiving cancer treatment and their support persons. The results will help to design a definitive phase 3 randomized controlled trial. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (Registration Number: NCT05509751).
Collapse
Affiliation(s)
- Nirusha Jebanesan
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Jones
- Cancer Survivorship program, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Legacy
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laura Freeman
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ainslee Smith
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Saul Cobbing
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Neera Vadali
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; NSW Health, Australia
| | - Shiuhang Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kian Godhwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ferozah Nasiri
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Maryjo Antonio
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Stephens
- Older Adult Team and Family Caregiver Team Members, Ontario, Canada
| | - Eric Pitters
- Older Adult Team and Family Caregiver Team Members, Ontario, Canada
| | - Fay Bennie
- Older Adult Team and Family Caregiver Team Members, Ontario, Canada
| | - Anne Stephens
- Older Adult Team and Family Caregiver Team Members, Ontario, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, University Health Network and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Linda Cerullo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Margaret Zjadewicz
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Hematology and Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lawson Eng
- Department of Hematology and Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Department of Hematology and Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Matthew
- Departments of Surgery and Supportive Care, Cancer Survivorship Centre and Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sara Durbano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajin Mehta
- Department of Geriatric Medicine Sunnybrook Health Sciences Centre and faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ines Menjak
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California, United States of America
| | - Katherina Ladham
- Department of Geriatric Medicine Sunnybrook Health Sciences Centre and faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
6
|
Capezuti E, Tan A, Talatala RA, Scaramuzzino M, Lall S, Tennill PA, Marcel S, Yu K, Scacalossi A, Zaman S, Attaway M, Chong M, Pathak A, Abedalrhman O, George A. Interventions to Prevent Falls and Injuries in Inpatient Oncology Units: A Scoping Review. J Nurs Care Qual 2025:00001786-990000000-00202. [PMID: 40146975 DOI: 10.1097/ncq.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025]
Abstract
BACKGROUND Individuals with cancer are at a heightened risk of experiencing falls and related injuries during hospitalization. PURPOSE Our aim was to systematically summarize and evaluate the literature examining the effectiveness of fall prevention interventions employed in the oncology inpatient setting. METHODS Guided by the PRISMA statement, a health librarian conducted searches of 5 databases, which uncovered 1039 unduplicated studies that were screened by 2 independent reviewers. The Quality Improvement Minimum Quality Criteria Set was used to evaluate methodological quality. RESULTS The 10 quality improvement studies all included a multifactorial intervention and most based these on an assessment with few targeting cancer-specific factors. Most interventions were staff-focused with a few incorporating the patient's input. CONCLUSIONS Individualized assessments and interventions enhance care effectiveness when patient care teams and patients are aligned. Nurse rounding and engaging patients improve communication, self-assessment, satisfaction, and adherence, warranting further research and technological advancements.
Collapse
Affiliation(s)
- Elizabeth Capezuti
- Author Affiliations: Hunter-Bellevue School of Nursing (Drs Capezuti, Tan, and Marcel, and Ms Yu, Mr Scacalossi, Mss Zaman, Attaway, and Chong), Hunter College of the City University of New York New York, New York; Nursing Professional Development Department (Dr Talatala), Nursing Quality (Dr Lall), NYC Health and Hospitals/Bellevue Hospital (Mss Scaramuzzino and Tennill, and Dr Abedalrhman), New York, New York; Hunter College of the City University of New York (Ms Pathak) New York, New York; and Corporate Office of Nursing Administration (Dr George), NYC Health + Hospitals, New York, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Cobbing S, Timilshina N, Tomlinson G, Yang H, Kim VS, Emmenegger U, Alibhai SMH. Falls in older adults during treatment for metastatic castration-resistant prostate cancer. J Geriatr Oncol 2025; 16:102047. [PMID: 39181835 DOI: 10.1016/j.jgo.2024.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/23/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Saul Cobbing
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Helen Yang
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Valerie S Kim
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | | |
Collapse
|
8
|
McNeish BL, Rosso AL, Campbell G, Fedor J, Durica KC, Bartel C, Marchetti G, Low CA. An association of cognitive function with mobile metrics of community walking in older cancer survivors: A pilot study. J Geriatr Oncol 2025; 16:102146. [PMID: 39482216 PMCID: PMC11655247 DOI: 10.1016/j.jgo.2024.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 09/25/2024] [Accepted: 10/25/2024] [Indexed: 11/03/2024]
Abstract
INTRODUCTION Older cancer survivors have an elevated risk for mobility dysfunction compared to their cancer-free peers. Despite the established link between cognitive function and community walking in older cancer-free adults, little is known about this relationship in older cancer survivors. This pilot study aimed to evaluate the association of performance-based and self-reported cognitive function with mobile metrics of community walking collected by a wearable Fitbit device. MATERIALS AND METHODS This study enrolled older cancer survivors (mean age 73 years old, range 65-83; 98 % White; 50 % female) within five years of completing primary treatment. Cognitive function, specifically executive function and processing speed was collected with the digit symbol substitution test (DSST) and self-reported cognition was evaluated by the Patient Reported Outcomes Measurement Information System- Cognitive (PROMIS-Cog). Continuous walking data from Fitbit wearable devices were collected passively over four weeks. To examine associations between DSST and PROMIS-Cog with mobile measures of walking, we conducted bivariate correlation and multivariable linear regression analyses adjusting for age, education, and number of comorbidities. RESULTS In bivariate analyses, higher DSST scores were correlated with higher step count and peak cadence and lower fragmentation of walking in daily life (r = 0.48-0.51, p < 0.01). Higher PROMIS-Cog scores were correlated with higher peak cadence (r = 0.32, p < 0.05), trended towards correlation with step count (r = 0.30, p = 0.06), and were not correlated with fragmentation of walking (r = -0.24, p = 0.13). In multivariable models adjusting for age, presence of graduate level education, and number of comorbidities, higher DSST scores were independently associated with higher peak cadence, step count, and demonstrated a trend towards lower fragmentation of walking in daily life, but PROMIS-Cog was not independently associated with any mobility metrics. Similar results for association of DSST with walking when models included adjustment for PROMIS-depression scale, receipt of chemotherapy treatment, or when education was defined by presence of a bachelor's degree. DISCUSSION This study suggests an association between cognitive functions of executive function and processing speed with mobile metrics of community walking in older cancer survivors. Understanding how cognitive function affects walking may help identify new rehabilitation targets for older cancer survivors.
Collapse
Affiliation(s)
- Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Grace Campbell
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, USA; Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, USA.
| | - Jennifer Fedor
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, USA.
| | - Krina C Durica
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, USA.
| | - Christianna Bartel
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, USA.
| | | | - Carissa A Low
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA, USA.
| |
Collapse
|
9
|
Ye C, Leslie WD, Al-Azazi S, Yan L, Lix LM, Czaykowski P, McCloskey EV, Johansson H, Harvey NC, Kanis JA, Singh H. Fracture Risk Prediction Using the Fracture Risk Assessment Tool in Individuals With Cancer. JAMA Oncol 2024; 10:1554-1560. [PMID: 39361310 PMCID: PMC11450576 DOI: 10.1001/jamaoncol.2024.4318] [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: 01/19/2024] [Accepted: 06/27/2024] [Indexed: 10/06/2024]
Abstract
Importance The Fracture Risk Assessment Tool (FRAX) is a fracture risk prediction tool for 10-year probability of major osteoporotic fracture (MOF) and hip fracture in the general population. Whether FRAX is useful in individuals with cancer is uncertain. Objective To determine the performance of FRAX for predicting incident fractures in individuals with cancer. Design, Setting, and Participants This retrospective population-based cohort study included residents of Manitoba, Canada, with and without cancer diagnoses from 1987 to 2014. Diagnoses were identified through the Manitoba Cancer Registry. Incident fractures to March 31, 2021, were identified in population-based health care data. Data analysis occurred between January and March 2023. Main Outcomes and Measures FRAX scores were computed for those with bone mineral density (BMD) results that were recorded in the Manitoba BMD Registry. Results This study included 9877 individuals with cancer (mean [SD] age, 67.1 [11.2] years; 8693 [88.0%] female) and 45 877 individuals in the noncancer cohort (mean [SD] age, 66.2 [10.2] years; 41 656 [90.8%] female). Compared to individuals without cancer, those with cancer had higher rates of incident MOF (14.5 vs 12.9 per 1000 person-years; P < .001) and hip fracture (4.2 vs 3.5 per 1000 person-years; P = .002). In the cancer cohort, FRAX with BMD results were associated with incident MOF (HR per SD increase, 1.84 [95% CI, 1.74-1.95]) and hip fracture (HR per SD increase, 3.61 [95% CI, 3.13-4.15]). In the cancer cohort, calibration slopes for FRAX with BMD were 1.03 for MOFs and 0.97 for hip fractures. Conclusions and Relevance In this retrospective cohort study, FRAX with BMD showed good stratification and calibration for predicting incident fractures in patients with cancer. These results suggest that FRAX with BMD can be a reliable tool for predicting incident fractures in individuals with cancer.
Collapse
Affiliation(s)
- Carrie Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - William D. Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Saeed Al-Azazi
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lin Yan
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M. Lix
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piotr Czaykowski
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Eugene V. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John A. Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Harminder Singh
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
10
|
Lund CM, Nielsen DL, Schultz M, Dolin TG. Physical decline, falls, and hospitalization among vulnerable older patients in the trajectory of colorectal cancer treatment. J Geriatr Oncol 2024; 15:101820. [PMID: 38955634 DOI: 10.1016/j.jgo.2024.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/02/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults. MATERIALS AND METHODS This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves. RESULTS In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization. DISCUSSION Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.
Collapse
Affiliation(s)
- Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Dorte L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
| |
Collapse
|
11
|
Cope DG. Enhancing Mobility and Well-Being in Older Adults with Cancer. Semin Oncol Nurs 2024; 40:151674. [PMID: 38965023 DOI: 10.1016/j.soncn.2024.151674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/12/2024] [Accepted: 05/19/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To analyze mobility challenges in older adult with cancer. METHODS Data from previous literature was extracted and analyzed pertaining to the topic of interest. RESULTS Mobility issues for the older adult with cancer are multi-factorial and are impacted by age-related changes, comorbidities, cancer itself, and cancer treatment. CONCLUSIONS Proven benefits have been suggested with mobility assessments, exercise and dietary interventions, and cancer rehabilitation programs however further research is needed to define integration and utilization of programs, facilitation of cancer survivors returning to work, inclusion of socially disadvantaged patients, program compliance, economic aspects, and caregiver involvement to improve quality of life across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are in a key role to impact the care of the older adult with cancer with mobility through patient assessment of mobility function, facilitation of patient referrals for supportive services and cancer rehabilitation and execution of nurse-led intervention programs.
Collapse
Affiliation(s)
- Diane G Cope
- Florida Cancer Specialists and Research Institute, Fort Myers, Florida.
| |
Collapse
|
12
|
Skiba MB, El-Gohary M, Horak F, Dieckmann NF, Guidarelli C, Meyers G, Hayes-Lattin B, Winters-Stone K. Assessment of Mobility Trajectories Using Wearable Inertial Sensors During Autologous Hematopoietic Cell Transplant. Arch Phys Med Rehabil 2024; 105:1106-1115. [PMID: 38354878 PMCID: PMC11144568 DOI: 10.1016/j.apmr.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study aimed to characterize mobility patterns using wearable inertial sensors and serial assessment across autologous hematopoietic cell transplant (autoHCT) and investigate the relation between mobility and perceived function in patients with hematologic cancer. DESIGN Prospective longitudinal study. SETTING Hospital adult transplant clinic followed by discharge. PARTICIPANTS 78 patients with hematological cancer receiving autoHCT. MAIN OUTCOME MEASURES Mobility was measured across 3 clinical phases (pretransplant, pre-engraftment, and post-engraftment) in using inertial sensors worn during prescribed performance tests in the hospital. Perceived function was assessed using validated provider-reported (Eastern Cooperative Oncology Group [ECOG] Performance Status Scale) and patient-reported [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) measures. Trajectories of 5 selected mobility characteristics (turn duration, gait speed, stride time variability, double support time, and heel strike angle) across the clinical phases were also evaluated using piecewise linear mixed-effects models. RESULTS Using Principal Components Analysis, 4 mobility patterns were identified pretransplant: Gait Limitation, Sagittal Sway, Coronal Sway, and Balance Control. Gait Limitation measured pretransplant was significantly inversely associated with perceived function reported by the provider- (β = -0.11; 95% CI: -0.19, -0.02) and patient- (β = -4.85; 95% CI: -7.72, -1.99) post-engraftment in age-adjusted linear regression models. Mobility characteristics demonstrated immediate declines early pre-engraftment with stabilization by late pre-engraftment. CONCLUSION Patients with hematological cancer experiencing gait limitations pretransplant are likely to have worse perceived function post-engraftment. Mobility declines in early phases post-transplant and may not fully recover, indicating an opportunity for timely rehabilitation referrals. Wearable inertial sensors can be used to identify early mobility problems and patients who may be at risk for future functional decline who may be candidates for early physical rehabilitation.
Collapse
Affiliation(s)
- Meghan B Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ; Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Fay Horak
- APDM, a Clario Inc Company, Portland, OR; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | - Gabrielle Meyers
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR.
| |
Collapse
|
13
|
McNeish BL, Dittus K, Mossburg J, Krant N, Steinharter JA, Feb K, Cote H, Hehir MK, Reynolds R, Bell SG, Redfern MS, Rosano C, Richardson JK, Kolb N. Unipedal stance time is associated with fall outcomes in older chemotherapy-treated cancer survivors: A retrospective study. J Geriatr Oncol 2024; 15:101667. [PMID: 37973427 PMCID: PMC10994744 DOI: 10.1016/j.jgo.2023.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT, USA; Department of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jurdan Mossburg
- Department of Physical Therapy, University of Vermont, Burlington, VT, USA
| | - Nicholas Krant
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Jack A Steinharter
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Kendall Feb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Hunter Cote
- Department of Physical Therapy, University of Vermont, Burlington, VT, USA.
| | - Michael K Hehir
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | | | - Sarah G Bell
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - Noah Kolb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| |
Collapse
|
14
|
Low CA, Bartel C, Fedor J, Durica KC, Marchetti G, Rosso AL, Campbell G. Associations between performance-based and patient-reported physical functioning and real-world mobile sensor metrics in older cancer survivors: A pilot study. J Geriatr Oncol 2024; 15:101708. [PMID: 38277879 PMCID: PMC10923123 DOI: 10.1016/j.jgo.2024.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Older cancer survivors are at increased risk for impaired physical functioning, but current assessments of function are difficult to implement in busy oncology clinics. Mobile devices measuring continuous activity and mobility in daily life may be useful for estimating physical functioning. The goal of this pilot study was to examine the associations between consumer wearable device (a wrist-worn activity tracker) and smartphone sensor data and commonly used clinical measures of physical function in cancer survivors aged 65 and older. MATERIALS AND METHODS Older adults within five years of completing primary treatment for any cancer completed standardized questionnaires and performance-based tests to measure physical functioning. Continuous passive data from smartphones and consumer wearable devices were collected for four weeks and linked to patient-reported and performance-based physical functioning as well as patient-reported falls or near falls at the end of the four-week monitoring period. To examine associations between sensor variables and physical functioning, we conducted bivariate Pearson correlations as well as multivariable linear regression analyses. To examine associations between sensor variables and falls, we conducted exploratory receiver operating characteristic curve and multivariable logistic regression analyses. RESULTS We enrolled 40 participants (mean age 73 years old, range 65-83; 98% White; 50% female). In bivariate analyses, consumer wearable device features reflecting greater amount and speed and lower fragmentation of walking in daily life were significantly related to better patient-reported function (r= 0.43-0.65) and performance-based physical function (r = 0.56-0.72), while smartphone features reflecting more geographic mobility were related to better performance-based physical function (r = 0.40-0.42) but not patient-reported function. After adjusting for age and comorbidities, only consumer wearable device features remained associated with performance-based physical functioning. In exploratory analyses, peak gait cadence was associated with fall risk even after covariate adjustment. DISCUSSION This study provides preliminary evidence that real-world data from consumer devices may be useful for estimating functional performance among older cancer survivors and potentially for remotely and longitudinally monitoring functioning in older patients during and after cancer treatment.
Collapse
Affiliation(s)
- Carissa A Low
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA.
| | - Christianna Bartel
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA
| | - Jennifer Fedor
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA
| | - Krina C Durica
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA
| | | | - Andrea L Rosso
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA
| | - Grace Campbell
- University of Pittsburgh, 3347 Forbes Avenue, Suite 200, Pittsburgh, PA 15213, USA; Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| |
Collapse
|
15
|
Hunter H, Qin E, Wallingford A, Hyon A, Patel A. Neurorehabilitation for Adults with Brain and Spine Tumors. Semin Neurol 2024; 44:64-73. [PMID: 38049116 DOI: 10.1055/s-0043-1777407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.
Collapse
Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - April Hyon
- Department of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amar Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
16
|
McNeish BL, Dittus K, Mossburg J, Krant N, Steinharter JA, Feb K, Cote H, Hehir MK, Reynolds R, Redfern MS, Rosano C, Richardson JK, Kolb N. Executive function is associated with balance and falls in older cancer survivors treated with chemotherapy: A cross-sectional study. J Geriatr Oncol 2023; 14:101637. [PMID: 37776612 PMCID: PMC10841675 DOI: 10.1016/j.jgo.2023.101637] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Balance decrements and increased fall risk in older cancer survivors have been attributed to chemotherapy-induced peripheral neuropathy (CIPN). Cognition is also affected by chemotherapy and may be an additional contributing factor to poor balance through changes in executive functioning. We examined the association of executive function with balance and falls in older cancer survivors who had been treated with chemotherapy. MATERIALS AND METHODS Fifty cancer survivors (aged 65.6 ± 11.5 years; 88% female) who were all treated with chemotherapy were included in this cross-sectional study at a tertiary medical center. Executive function was measured by Trails-B, Stroop, and rapid reaction accuracy, a measure emphasizing rapid inhibitory function. Balance was measured by five sit-to-stand time (5STS), repetitions of sit-to-stand in thirty seconds (STS30), and unipedal stance time (UST), which was the primary balance outcome measure. Self-reported falls in the past year were also recorded and was a secondary outcome. Bivariate analyses were conducted between executive function measures and balance variables. Multivariable models were constructed for UST and falls outcomes and included covariates of age and chemotherapy induced peripheral neuropathy status. RESULTS Pearson correlations demonstrated significant relationships between two executive function measures (rapid reaction accuracy, Trails-B) and all the balance measures assessed (UST, STS30, and 5STS). Rapid reaction accuracy correlations were stronger than Trails-B. The Stroop measure correlated solely with UST. In multivariable models, rapid reaction accuracy was associated with better UST (standardized regression coefficient: 64.1, p < 0.01), decreased any fall (odds ratio = 0.000901, p = 0.04), and decreased recurrent falls (odds ratio = 0.0000044, p = 0.01). The interaction of CIPN with the inhibitory measures in the prediction of balance was not significant. DISCUSSION Measures of executive function were associated with balance, but among the executive function tests, rapid reaction accuracy had the strongest correlations to balance and was independently associated with falls. The findings suggest that executive function should be considered when assessing fall risk and developing interventions intended to reduce fall risk in older chemotherapy-treated cancer survivors.
Collapse
Affiliation(s)
- Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT, USA; Department of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jurdan Mossburg
- Department of Physical Therapy, University of Vermont, Burlington, VT, USA.
| | - Nicholas Krant
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - John A Steinharter
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Kendall Feb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Hunter Cote
- Department of Physical Therapy, University of Vermont, Burlington, VT, USA.
| | - Michael K Hehir
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | | | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - Noah Kolb
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Jacobs LA. Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit: Should Examination Be Disease Specific? JCO Oncol Pract 2023; 19:683-684. [PMID: 37418681 DOI: 10.1200/op.23.00327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Abstract
Will population-specific studies better demonstrate the benefit of inpatient cancer rehabilitation?
Collapse
Affiliation(s)
- Linda A Jacobs
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA
| |
Collapse
|
19
|
Ramsdale E, Kunduru M, Smith L, Culakova E, Shen J, Meng S, Zand M, Anand A. Supervised learning applied to classifying fallers versus non-fallers among older adults with cancer. J Geriatr Oncol 2023; 14:101498. [PMID: 37084629 PMCID: PMC10174263 DOI: 10.1016/j.jgo.2023.101498] [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: 08/18/2022] [Revised: 02/17/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Supervised machine learning approaches are increasingly used to analyze clinical data, including in geriatric oncology. This study presents a machine learning approach to understand falls in a cohort of older adults with advanced cancer starting chemotherapy, including fall prediction and identification of contributing factors. MATERIALS AND METHODS This secondary analysis of prospectively collected data from the GAP 70+ Trial (NCT02054741; PI: Mohile) enrolled patients aged ≥70 with advanced cancer and ≥ 1 geriatric assessment domain impairment who planned to start a new cancer treatment regimen. Of ≥2000 baseline variables ("features") collected, 73 were selected based on clinical judgment. Machine learning models to predict falls at three months were developed, optimized, and tested using data from 522 patients. A custom data preprocessing pipeline was implemented to prepare data for analysis. Both undersampling and oversampling techniques were applied to balance the outcome measure. Ensemble feature selection was applied to identify and select the most relevant features. Four models (logistic regression [LR], k-nearest neighbor [kNN], random forest [RF], and MultiLayer Perceptron [MLP]) were trained and subsequently tested on a holdout set. Receiver operating characteristic (ROC) curves were generated and area under the curve (AUC) was calculated for each model. SHapley Additive exPlanations (SHAP) values were utilized to further understand individual feature contributions to observed predictions. RESULTS Based on the ensemble feature selection algorithm, the top eight features were selected for inclusion in the final models. Selected features aligned with clinical intuition and prior literature. The LR, kNN, and RF models performed equivalently well in predicting falls in the test set, with AUC values 0.66-0.67, and the MLP model showed AUC 0.75. Ensemble feature selection resulted in improved AUC values compared to using LASSO alone. SHAP values, a model-agnostic technique, revealed logical associations between selected features and model predictions. DISCUSSION Machine learning techniques can augment hypothesis-driven research, including in older adults for whom randomized trial data are limited. Interpretable machine learning is particularly important, as understanding which features impact predictions is a critical aspect of decision-making and intervention. Clinicians should understand the philosophy, strengths, and limitations of a machine learning approach applied to patient data.
Collapse
Affiliation(s)
- Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA.
| | - Madhav Kunduru
- Goergen Institute for Data Science, University of Rochester, NY, USA
| | - Lisa Smith
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Eva Culakova
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Junchao Shen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sixu Meng
- College of Engineering, University of California, Berkeley, CA, USA
| | - Martin Zand
- Clinical and Translational Science Institute, University of Rochester Medical Center, NY, USA
| | - Ajay Anand
- Goergen Institute for Data Science, University of Rochester, NY, USA
| |
Collapse
|
20
|
Fujita T, Babazono A, Li Y, Jamal A, Kim SA. Hypnotics and injuries among older adults with Parkinson's disease: a nested case-control design. BMC Geriatr 2023; 23:259. [PMID: 37127561 PMCID: PMC10152606 DOI: 10.1186/s12877-023-03944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Patients with Parkinson's disease often experience sleep disorders. Hypnotics increase the risk of adverse events, such as injuries due to falls. In this study, we evaluated the association between hypnotics and injuries among older adults with Parkinson's disease. METHODS The study used a nested case-control design. The participants were 5009 patients with Parkinson's disease aged ≥ 75 years based on claims data between April 2016 and March 2019 without prescription hypnotics 1 year before the study started. Hypnotics prescribed as oral medications included benzodiazepines, non-benzodiazepines, orexin receptor antagonists, and melatonin receptor agonists. The incidences of outcomes, including injuries, fractures, and femoral fractures, were determined. Each case had four matched controls. Conditional logistic regression analyses were performed to calculate the odds ratios and 95% confidence intervals for the number of hypnotics taken per day for each type of hypnotic. RESULTS The proportion of participants taking at least one type of hypnotic was 18.6%, with benzodiazepines being the most common. The incidence of injuries, fractures, and femoral fractures was 66.7%, 37.8%, and 10.2%, respectively. Benzodiazepines significantly increased the risk of injuries (odds ratio: 1.12; 95% confidence interval: 1.03-1.22), and melatonin receptor agonists significantly increased the risk of femoral fractures (odds ratio: 2.84; 95% confidence interval: 1.19-6.77). CONCLUSIONS Benzodiazepines and non-benzodiazepines, which are not recommended according to current guidelines, were the most prevalent among older adults with Parkinson's disease. Benzodiazepines significantly increased the risk of injuries, and melatonin receptor agonists significantly increased the risk of femoral fractures.
Collapse
Affiliation(s)
- Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aziz Jamal
- Health Administration Program, Department of International Business and Management, Faculty of Business and Management, Universiti Teknologi MARA, Selangor Campus, Shah Alam, Malaysia
| | - Sung-A Kim
- St. Mary's Research Center, Kurume, Japan
| |
Collapse
|
21
|
Morishita S, Suzuki K, Okayama T, Inoue J, Tanaka T, Nakano J, Fukushima T. Recent Findings in Physical Exercise for Cancer Survivors. Phys Ther Res 2023; 26:10-16. [PMID: 37181484 PMCID: PMC10169310 DOI: 10.1298/ptr.r0023] [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: 10/12/2022] [Accepted: 02/10/2023] [Indexed: 05/16/2023]
Abstract
In recent years, the number of cancer survivors has been increasing each year due to advances in the early diagnosis and treatment of cancer. Cancer survivors present a variety of physical and psychological complications due to cancer and its treatment. Physical exercise is an effective nonpharmacological treatment for complications in cancer survivors. Furthermore, recent evidence has shown that physical exercise improves the prognosis of cancer survivors. The benefits of physical exercise have been widely reported, and guidelines for physical exercise for cancer survivors have been published. These guidelines recommend that cancer survivors engage in moderate- or vigorous-intensity aerobic exercises and/or resistance training. However, many cancer survivors have a poor commitment to physical exercise. In the future, it is necessary to promote physical exercise among cancer survivors through outpatient rehabilitation and community support.
Collapse
Affiliation(s)
- Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, Japan
| | | | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Japan
| | | |
Collapse
|
22
|
Skiba MB, Harker G, Guidarelli C, El-Gohary M, Horak F, Roeland EJ, Silbermann R, Hayes-Lattin B, Winters-Stone K. Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study. JMIR Cancer 2022; 8:e39271. [PMID: 36480243 PMCID: PMC9782382 DOI: 10.2196/39271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. OBJECTIVE We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. METHODS Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. RESULTS Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. CONCLUSIONS Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.
Collapse
Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, AZ, United States
- The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Graham Harker
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Eric J Roeland
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca Silbermann
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brandon Hayes-Lattin
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
23
|
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: 12] [Impact Index Per Article: 4.0] [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.
Collapse
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
| |
Collapse
|
24
|
Zhao J, Wang G, Chen L, Yu S, Li W. Risk factors for falls in hospitalized patients with cancer: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2022; 9:100107. [PMID: 36033969 PMCID: PMC9398916 DOI: 10.1016/j.apjon.2022.100107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
A primary cancer diagnosis has been confirmed as an important risk factor for falls, and the incidence of falls has been shown to be higher in patients who have undergone cancer treatment than in those who have not undergone cancer treatment. Falls during hospitalization increase the medical costs of additional treatment and falls-related mortality. Many falls are preventable and a good understanding of the predictors of falls in this population is needed. However, the risk factors for falls have not yet been identified. The purpose of this review was to identify the risk factors for falls in hospitalized patients with cancer. Eleven English and Chinese electronic databases were searched from their inception to April 2022 and the methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Five studies involving 1237 patients with cancer were included. The meta-analysis identifies eleven risk factors for falls in hospitalized patients with cancer, including age, history of falls, opiates, benzodiazepines, steroids, antipsychotics, sedatives, radiation therapy, chemotherapy, the use of an assistive device and length of hospitalization. Based on the evidence presented in this article, healthcare workers have the capacity to help reduce fall risk through the development of preventive support strategies in this population. Multicenter, prospective studies of patients with cancer should be conducted to further identify and validate their risk factors for falls.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Corresponding author.
| | - Guozhou Wang
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Lei Chen
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Simiao Yu
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Wenli Li
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
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: 0.7] [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.
Collapse
|
27
|
Rattanakrong N, Siriphorn A, Boonyong S. Incidence and risk factors associated with falls among women with breast cancer during taxane-based chemotherapy. Support Care Cancer 2022; 30:7499-7508. [PMID: 35665857 DOI: 10.1007/s00520-022-07181-5] [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: 01/24/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to evaluate the falling incidence density and examine the potential risk factors associated with falling among women with breast cancer during taxane-based chemotherapy. METHODS One hundred and twenty-three women with breast cancer participated in this study. The fall incidence density, taxane-induced peripheral neuropathy (TIPN) symptoms, and physical performance tests were evaluated at five time points throughout chemotherapy treatment. A fall diary was used to record fall incidence during treatment. The fall incidence density was calculated by dividing the number of first fall occurrences by person-time at risk. The risk factors associated with time to first fall were analyzed using the Cox proportional hazards model. The Kaplan-Meier curve illustrated the probability of survival from a fall during chemotherapy treatment. RESULTS Over the course of treatment, 29 (23.58%) participants reported falls. The fall incidence density was 3 per 1000 person-day. This study discovered a significant link between age (adjusted HR (HRadj) = 1.07; 95% CI: 1.02-1.13) and BMI (HRadj = 1.11; 95% CI: 1.02-1.21) and falling. CONCLUSIONS Women with breast cancer could fall for the first time at any time after starting chemotherapy until the end of the follow-up period. Furthermore, time to first fall was associated with age and BMI. Early detection of falling in women with breast cancer, particularly among older persons and those with a high BMI, may be essential to preventing falls.
Collapse
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.
| |
Collapse
|
28
|
Negrete-Najar JP, Sehovic M, Rodriquenz MG, Garcia-Martinez J, Extermann M. Development of a health data derived frailty index as a predictor of adverse outcomes in older patients with pancreatic cancer. J Geriatr Oncol 2022; 13:308-314. [PMID: 34740560 DOI: 10.1016/j.jgo.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/01/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Pancreatic cancer is a prevalent disease among older adults. Well-selected patients, based on a geriatric assessment for risk stratification, could be good candidates for chemotherapy and/or curative resection. Deficits accumulation frailty indices (FI) utilize readily available clinical data and easily obtained patient-reported information to predict hospitalization and mortality of older individuals. Retrospective data from 440 older adults (median age 76 years) with pancreatic cancer, obtained from electronic health records, was used to develop a FI and its ability to predict mortality and other geriatric and cancer related outcomes was tested. Fatigue (n = 45), infection (n = 40) and neutropenia (n = 36) were the most common registered adverse events of treatment; 153 subjects had no adverse events. The mean FI score was 0.26, 112 subjects were fit (0.0 < 0.2), 255 pre-frail (0.2 < 0.35), and 73 frail (≥ 0.35). Median survival was twelve months for the whole sample; at one year 62.5% of fit patients, 46.3% of pre-frail, and 26% of frail patients were alive. The FI categories correlated with institutionalization (p < 0.001) and non-planned hospitalization (p < 0.001). The FI categories did not correlate with the presence of Common Terminology Criteria for Adverse Events (CTCAE) grade 3-4 adverse events (p = 0.377). We conclude that patients with pancreatic cancer classified as frail with our FI had worse survival than those fit and pre-frail. Non-fit patients were also more prone to be institutionalized and have non-planned hospitalizations. The items used for this FI can be usually acquired from electronic health records and could be automated in the future, which could simplify its use as a helping tool for decisions in older patients with pancreatic cancer.
Collapse
Affiliation(s)
| | | | - Maria Grazia Rodriquenz
- Oncology Unit, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | | |
Collapse
|
29
|
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: 0.3] [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.
Collapse
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
| |
Collapse
|
30
|
Machado TRL, Menezes de Pádua CA, Drummond PLDM, Silveira LP, Malta JS, Santos RMMD, Costa NL, Reis AMM. Use of fall risk-increasing drugs in older adults with multiple myeloma: A cross-sectional study. J Geriatr Oncol 2022; 13:493-498. [DOI: 10.1016/j.jgo.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/03/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
|
31
|
Akagunduz B, Altın Z, Atcı MM, Ozer M, Güven DC, Çil İ, Özçiçek F, Demirtaş L, Duzgun E, Gunderci A, Arslan Y. Assessment of abuse and related factors in older patients with cancer. Support Care Cancer 2021; 29:7957-7964. [PMID: 34213643 DOI: 10.1007/s00520-021-06391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Older cancer patients are more likely to present with functional dependency, multiple comorbidities, polypharmacy, malnutrition, and cognitive dysfunction than their younger counterparts which increases the risk of elder abuse. Herein, in this single-institution observational study, we aimed to determine the frequency and risk factors of abuse in cancer patients aged 70 and above. METHODS A total of 217 cancer patients aged ≥ 70 years who applied to the medical oncology outpatient clinic between June 2020 and January 2021 were included in this study. Informed consent was obtained before data collection. The Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) was used to evaluate elder abuse. Sociodemographic characteristics and clinical measurements were collected. RESULTS The mean age was 75.5, and 59.4% were male. The prevalence of abuse risk in older patients with cancer was 39.2%. In the multivariate logistic regression model, applying to the outpatient clinic for treatment (OR: 3.369, 95% CI: 1.455-7.802, p = 0.005), living in urban (OR: 5.787, 95% CI: 2.377-14.090, p < 0.001), history of falls (OR: 4.587, 95% CI: 1.789-11.762, p = 0.002), and being depressed according to the Geriatric Depression Scale-15 (GDS-15) score (OR: 10.788, 95% CI: 4.491-25.914, p < 0.001) were associated with an increased risk of elder abuse. Primary/junior education level and high school/university education level were protective against elder abuse risk compared to being illiterate (OR: 0.073, 95% CI: 0.025-0.210 and OR: 0.213, 95% CI: 0.056-0.806, respectively). CONCLUSION Cancer patients aged ≥ 70 years had a high risk of elder abuse. Elder abuse should be screened in patients with cancer, and the effects of this phenomenon on cancer care should be investigated in larger studies.
Collapse
Affiliation(s)
- Baran Akagunduz
- Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey.
| | - Zeynep Altın
- Department of Internal Medicine, Izmir Tepecik Research Hospital, 35000, Izmir, Turkey
| | - Muhammed Mustafa Atcı
- Department of Medical Oncology, Prof. Dr Cemil Taşçıoğlu State Hospital, 34000, İstanbul, Turkey
| | - Muhammet Ozer
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, 08638, USA
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Medical School, 06010, Ankara, Turkey
| | - İbrahim Çil
- Department of Medical Oncology, Umraniye Research Hospital, 34000, İstanbul, Turkey
| | - Fatih Özçiçek
- Department of Internal Medicine, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey
| | - Levent Demirtaş
- Department of Internal Medicine, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey
| | - Eren Duzgun
- Department of Internal Medicine, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey
| | - Azad Gunderci
- Department of Psychiatry, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Arslan
- Department of Biostatistics, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey
| |
Collapse
|
32
|
Mohile SG, Mohamed MR, Xu H, Culakova E, Loh KP, Magnuson A, Flannery MA, Obrecht S, Gilmore N, Ramsdale E, Dunne RF, Wildes T, Plumb S, Patil A, Wells M, Lowenstein L, Janelsins M, Mustian K, Hopkins JO, Berenberg J, Anthony N, Dale W. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet 2021; 398:1894-1904. [PMID: 34741815 PMCID: PMC8647163 DOI: 10.1016/s0140-6736(21)01789-x] [Citation(s) in RCA: 341] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Older adults with advanced cancer are at a high risk for treatment toxic effects. Geriatric assessment evaluates ageing-related domains and guides management. We examined whether a geriatric assessment intervention can reduce serious toxic effects in older patients with advanced cancer who are receiving high risk treatment (eg, chemotherapy). METHODS In this cluster-randomised trial, we enrolled patients aged 70 years and older with incurable solid tumours or lymphoma and at least one impaired geriatric assessment domain who were starting a new treatment regimen. 40 community oncology practice clusters across the USA were randomly assigned (1:1) to the intervention (oncologists received a tailored geriatric assessment summary and management recommendations) or usual care (no geriatric assessment summary or management recommendations were provided to oncologists) by means of a computer-generated randomisation table. The primary outcome was the proportion of patients who had any grade 3-5 toxic effect (based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4) over 3 months. Practice staff prospectively captured toxic effects. Masked oncology clinicians reviewed medical records to verify. The study was registered with ClinicalTrials.gov, NCT02054741. FINDINGS Between July 29, 2014, and March 13, 2019, we enrolled 718 patients. Patients had a mean age of 77·2 years (SD 5·4) and 311 (43%) of 718 participants were female. The mean number of geriatric assessment domain impairments was 4·5 (SD 1·6) and was not significantly different between the study groups. More patients in intervention group compared with the usual care group were Black versus other races (40 [11%] of 349 patients vs 12 [3%] of 369 patients; p<0·0001) and had previous chemotherapy (104 [30%] of 349 patients vs 81 [22%] of 369 patients; p=0·016). A lower proportion of patients in the intervention group had grade 3-5 toxic effects (177 [51%] of 349 patients) compared with the usual care group (263 [71%] of 369 patients; relative risk [RR] 0·74 (95% CI 0·64-0·86; p=0·0001). Patients in the intervention group had fewer falls over 3 months (35 [12%] of 298 patients vs 68 [21%] of 329 patients; adjusted RR 0·58, 95% CI 0·40-0·84; p=0·0035) and had more medications discontinued (mean adjusted difference 0·14, 95% CI 0·03-0·25; p=0·015). INTERPRETATION A geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment. Geriatric assessment with management should be integrated into the clinical care of older patients with advanced cancer and ageing-related conditions. FUNDING National Cancer Institute.
Collapse
Affiliation(s)
- Supriya G Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA.
| | - Mostafa R Mohamed
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Huiwen Xu
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Eva Culakova
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Kah Poh Loh
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie A Flannery
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Spencer Obrecht
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Nikesha Gilmore
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Erika Ramsdale
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard F Dunne
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tanya Wildes
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandy Plumb
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amita Patil
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Megan Wells
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Janelsins
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Karen Mustian
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Judith O Hopkins
- Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, NC, USA
| | | | - Navin Anthony
- Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, NC, USA
| | - William Dale
- Department of Supportive Care, City of Hope National Medical Center, Duarte, CA, USA
| |
Collapse
|
33
|
Feasibility of a Remotely Delivered Strength and Balance Training Program for Older Adults with Cancer. Curr Oncol 2021; 28:4408-4419. [PMID: 34898562 PMCID: PMC8628693 DOI: 10.3390/curroncol28060374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Falls are a major issue among older adults with cancer and lead to interruptions in cancer treatment. Resistance and balance training can prevent falls in older adults, but minimal evidence is available regarding the older cancer population, who often have unique risk factors. We used a pre-post design to assess the feasibility of a remotely delivered exercise program that progressed in difficulty and its efficacy on lower body strength, balance, and falls in older adults with cancer who had prior in-person exercise experience. Twenty-six older adults with cancer completed the intervention. Attendance rate for the virtual component was 97.6% and for the independent component was 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). The median balance score at baseline and end-of-study was 4 (IQR = 0). The median chair-stand time decreased from 9.2 s (IQR = 3.13) to 7.7 s (IQR = 4.6). A statistically significant difference in lower body strength (r = 0.68, p = 0.001) was detected post-intervention. The findings from this study can inform the design of a larger randomized trial.
Collapse
|
34
|
Chiang PK, Tsai WK, Chiu AWH, Lin JB, Yang FY, Lee J. Muscle Loss During Androgen Deprivation Therapy Is Associated With Higher Risk of Non-Cancer Mortality in High-Risk Prostate Cancer. Front Oncol 2021; 11:722652. [PMID: 34604058 PMCID: PMC8485032 DOI: 10.3389/fonc.2021.722652] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 12/14/2022] Open
Abstract
The changes in body composition are early adverse effects of androgen deprivation therapy (ADT); however, their prognostic impact remains unclear in prostate cancer. This study aimed to evaluate the association between body composition changes and survival in patients with high-risk prostate cancer. We measured the skeletal muscle index (SMI) and total adipose tissue index (TATI) at the L3 vertebral level using computed tomography at baseline and within one year after initiating ADT in 125 patients with high-risk prostate cancer treated with radiotherapy and ADT between 2008 and 2018. Non-cancer mortality predictors were identified using Cox regression models. The median follow-up was 49 months. Patients experienced an average SMI loss of 5.5% over 180 days (95% confidence interval: -7.0 to -4.0; p<0.001) and TATI gain of 12.6% over 180 days (95% confidence interval: 9.0 to 16.2; p<0.001). Body mass index changes were highly and weakly correlated with changes in TATI and SMI, respectively (Spearman ρ for TATI, 0.78, p<0.001; ρ for SMI, 0.27, p=0.003). As a continuous variable, each 1% decrease in SMI was independently associated with a 9% increase in the risk of non-cancer mortality (hazard ratio: 1.09; p=0.007). Moreover, the risk of non-cancer mortality increased 5.6-fold in patients with SMI loss ≥5% compared to those with unchanged SMI (hazard ratio: 5.60; p=0.03). Body mass index and TATI were not associated with non-cancer mortality. Muscle loss during ADT is occult, independent of weight change, and independently associated with increased non-cancer mortality in patients with high-risk prostate cancer.
Collapse
Affiliation(s)
- Pai-Kai Chiang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- PhD Program in Nutrition and Food Science, Graduate Institute of Biomedical and Pharmaceutical Science, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Allen Wen-Hsiang Chiu
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Feng-Yi Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Biophotonics and Molecular Imaging Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jie Lee
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
35
|
Blackwood J, Rybicki K. Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors. Integr Cancer Ther 2021; 20:15347354211006462. [PMID: 33784836 PMCID: PMC8020039 DOI: 10.1177/15347354211006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors. METHODS Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls. RESULTS The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65. CONCLUSION When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.
Collapse
|