Association of falls with health-related quality of life (HRQOL) in older cancer survivors: A population based study

Falls experienced by adult cancer survivors: a scoping review

PURPOSE

Accidental falls among adult cancer survivors are a health concern. Falls impose economic burdens and detrimental consequences to cancer survivors. This review aimed to synthesize findings from published research to explore the relationship between falls and cancer diagnosis and treatment among cancer survivors.

MATERIALS AND METHODS

A scoping review was conducted using four databases (Medline, EMBASE, CINAHL, and Scopus) for the years 2001-2021. A total of 425 abstracts were identified after removing duplicates. A second search for the years 2022-2023 was completed where 80 abstracts were identified. Abstract screening, full-text review, and data extraction were conducted. Study characteristics and key findings were extracted from full texts. Descriptive numerical summaries were presented, and narrative analyses were performed.

RESULTS AND CONCLUSIONS

A total of 42 articles were included in the scoping review which demonstrated (1) an increased prevalence of falls among cancer survivors, (2) the presence of cancer-specific fall risk factors, (3) a lack of cancer-specific fall prediction tools, and (4) few fall prevention interventions as part of usual care among cancer survivors. Younger cancer survivors were underrepresented. Cancer survivors should be aware of their risk of falls, and health professionals should ensure that fall prevention is part of usual care.

Cancer survivorship challenges of rural older adults: a qualitative study

BACKGROUND

Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults.

METHODS

This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study.

RESULTS

Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them.

CONCLUSIONS

Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.

Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults

BACKGROUND

Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL.

METHODS

In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable.

RESULTS

Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL.

CONCLUSIONS

Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.

Association Between Cancer-Related Fatigue and Falls in Patients With Myeloproliferative Neoplasms: Results of a Multicenter Cross-Sectional Survey From the East German Study Group for Hematology and Oncology (OSHO #97)

OBJECTIVE

This study retrospectively examined the association between cancer-related fatigue (CrF) and the number of falls during the last 12 months in patients with myeloproliferative neoplasms (MPNs).

METHODS

A multicenter, 1-time anonymous survey was conducted using analog and digital questionnaires. Sex-stratified multinomial logistic regression analysis was applied to investigate the association between CrF and number of falls. All analyses were adjusted for age, school education, body mass index, MPN subtype, and quality of life.

RESULTS

The final sample comprised 688 patients (mean age 57.4 ± 13.8, 62.4% women). The fall rate was 16.2% in women and 12.2% in men (P = .153). There were no differences between women and men in terms of CrF between individuals with more than 1 fall, whereas women with 1 fall had a higher CrF compared to those without a fall (RRR = 1.019; 95% CI [1.002-1.039]), respectively.

CONCLUSION

CrF increases the risk of falls in women with MPN. Physicians should evaluate and manage CrF symptoms and implement fall prevention strategies for those who are at increased risk. Further research is needed to better understand the effects of CrF on gait performance and associated fall risk.

The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12)

There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.

Falls, walking or balance problems, and limitations in activities of daily living (ADLs) among older endometrial cancer survivors

PURPOSE

Functional status deficits are important quality of life concerns for older cancer survivors. We examined the prevalence of falls, walking/balance problems, and limitations in activities of daily living (ADLs) among older women with a history of endometrial cancer.

METHODS

Cancer registry records from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare Health Outcomes Survey (MHOS) data were used to identify endometrial cancer survivors aged ≥ 65 years who completed a survey ≥ 1 year after their cancer diagnosis (N = 3766), as well as an age- and race-matched group of women without a cancer history (N = 3766). We estimated prevalence ratios (PRs) to compare the prevalence of falls, walking or balance problems, and limitations in ADLs (bathing, dressing, eating, getting in/out of chairs, walking, using the toilet) between groups.

RESULTS

Difficulty with walking or balance was more common among survivors than the noncancer group (43% vs 36%; PR = 1.19; 95% CI: 1.10-1.27). Fall prevalence was similar between groups (endometrial cancer: 25%; noncancer: 26%; PR = 0.98; 95% CI: 0.89-1.08). Nearly half of endometrial cancer survivors (47%) reported at least one ADL limitation, with several activities (getting in/out of a chair, walking, bathing, using the toilet) more often limited among survivors than among women without cancer.

CONCLUSION

Functional impairments, especially problems with walking and/or balance, are common among older endometrial cancer survivors. Our results highlight the importance of addressing functional problems during the ongoing survivorship care of women with a history of endometrial cancer, with referral to rehabilitation or other relevant services when indicated.

Validation and Application of the Chinese Version of the M. D. Anderson Symptom Inventory in Breast Cancer Patients

OBJECTIVE

To validate and use the Chinese Version of the M. D. Anderson Symptom Inventory (MDASI-C) to assess the symptom burden of breast cancer patients in China.

METHODS

A total of 342 breast cancer patients in China participated in this study. Their symptoms were investigated with the MDASI-C from November 2020 to February 2021, and the reliability and validity of this tool were evaluated, respectively. Cluster analysis and correlation analysis were also performed.

RESULTS

The Cronbach's alpha coefficient values of the symptom and interference items were 0.827 and 0.880, respectively. Construct validity revealed a four-factor structure. The Kaiser-Meyer-Olkin value was 0.760. The Karnofsky Performance Status, treatment phase, and cancer stage of the patients were grouped, and the differences of scores within the groups were significant. In addition, the employment status, education level, and age of the patients were significantly correlated with the symptoms. The correlation analysis of the education level of the patients showed that most of the symptoms and interference items were reduced as the education level was increased. The top three symptoms were disturbed sleep (3.10±2.52), difficulty remembering (2.54±2.30), and fatigue (2.24±2.13). The clinical and biochemical indicators such as body mass index and neutral granulocyte lymphocyte ratio had effects on many symptoms. As the patients' BMI increased, the patients' pain, disturbed sleep, and difficulty remembering were aggravated, and numbness was alleviated.

CONCLUSION

The MDASI-C is a reliable and effective assessment tool to evaluate patients with breast cancer in China. The symptoms are related to many clinical and biochemical indicators.

Can assessment of disease burden and quality of life based on mobility level in patients with end-stage cancer provide an insight into unmet needs? An exploratory cross-sectional study

PURPOSE

The purpose of this study was to: 1) investigate the differences in the needs of end-stage cancer who can move independently, using mobility aids (MA), or are bedridden; and 2) determine the effects of these different mobility levels on the patients' current quality of life (QoL), fatigue, and mental conditions.

METHODS

The study employed an exploratory prospective cross-sectional study design, which was carried out in two hospitals. The study included 99 end-stage cancer. The mobility levels of the patients were evaluated in three groups: Group 1: bedridden; Group 2: mobile with MA; and Group 3: ambulatory (under supervision or fully independent). A core cancer-specific questionnaire-integrating system for assessing health-related QOL (EORTC-QLQ-C15-PAL), the Piper Fatigue Scale (PFS), and the Hospital Anxiety-Depression scale were utilized.

The median age was 60years (31-83). Cancer types were as follows: gastrointestinal (45.5%), lung (38.4%), breast (4%), genitourinary system (4%), and others (8%). Forty-two percent of the patients were completely bedridden, 42.2% used MA, and 15.2% were independently ambulatory. The EORTC QLQ-C15-PAL physical (=.000) and emotional function values (=.029) differed among mobilization statuses. There was a significant difference among mobilization groups, in terms of behavioral values, in the PFS (=.006). The depression rate in the independent ambulatory group was lower than in the bedridden and MA groups (=0.011; =0.004).  p p p p1  p2 .

CONCLUSION

Health-related QoL, fatigue level, and emotional state vary in end-stage cancer who undergo evaluations according to their mobility levels. These patients should be assessed comprehensively, and treatment plans should be organized carefully, with a multidisciplinary approach.

Bortezomib in first-line therapy is associated with falls in older adults with multiple myeloma

BACKGROUND

Bortezomib is a common multiple myeloma therapy that can cause treatment-related peripheral neuropathy, a risk factor for falls. The relationship between bortezomib and falls in older patients with multiple myeloma is unknown.

METHODS

We analyzed the SEER-Medicare database for patients aged 65 or older diagnosed with multiple myeloma between 2007 and 2013. Claims were analyzed for myeloma treatments, falls, and covariates of interest. We evaluated accidental falls occurring within 12 months after starting first-line multiple myeloma treatment with bortezomib.

RESULTS

Bortezomib was used in first-line therapy for 2052 older adults with new diagnoses of multiple myeloma. Claims for falls were reported in 157 (8%) patients within 12 months after starting bortezomib, compared to 102 (5%) patients not receiving bortezomib (p < 0.001). Bortezomib was associated with a 36% increased risk of falls after controlling for covariates (aHR 1.36; 95% CI 1.05-1.75; p = 0.018). In a landmark analysis of those who survived 12 months after starting treatment, the median overall survival of those with a fall was 35.7 months compared to 49.1 months for those without (p < 0.0001). A fall in the first year after diagnosis was associated with a 26% increased risk in hazard for death (aHR 1.26; 95% CI 1.02-1.56; p = 0.033).

CONCLUSION

In older adults with multiple myeloma, bortezomib was associated with an increased risk of having a diagnostic code for falls. Decreased overall survival was seen in those who fell within the year of starting therapy. Prospective trials involving fall assessments and fall-prevention interventions are needed in this population.

Physical function measurement in older long-term cancer survivors

OBJECTIVE

To establish reliability, validity, and minimal detectable change in measures of function in older long-term cancer survivors.

METHODS

Older cancer survivors were recruited to perform functional measures; 5 Times Sit-to-Stand (5xSTS), 30-second Timed Chair Rise (30sTCR), Short Physical Performance Battery (SPPB), Physical Performance Test-7 (PPT-7). Two testing sessions were completed two weeks apart. Test-retest reliability was examined using the intraclass correlation coefficient (ICC2,1), convergent and discriminant validity using Spearman's rho and Minimal Detectable Change (MDC95) was calculated.

RESULTS

Forty-seven older long-term cancer survivors participated. Test-retest reliability was good for 5xSTS (ICC2,1=0.86), 30sTCR (ICC2,1=0.89), and SPPB (ICC2,1=0.85) and poor for PPT-7 (ICC2,1=0.48). Both convergent and discriminant validity was established.

CONCLUSIONS

SPPB, 5xSTS, and 30sTCR are reliable and valid tools to measure function in older long-term cancer survivors. MDC95 values were larger than those reported in geriatrics and should be interpreted with caution. Residual effects of cancer treatment, comorbidity, and physical inactivity may contribute to decreased physical function in older long-term cancer survivors, therefore valid and reliable measures like SPPB and the timed chair rise tests should be used objectively measure function throughout the survivorship spectrum.

Association of Frailty Status with Risk of Fall among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

To investigate the association between frailty status and risk of fall among middle-aged and older Chinese people.

DESIGN

A nationally representative prospective cohort study.

SETTING AND PARTICIPANTS

The study included 13,877 community-dwelling participants aged 45 years and above from the China Health and Retirement Longitudinal Study.

METHODS

Frailty status was identified by the frailty index of health deficit accumulation. 34 variables at baseline were selected to calculate the frailty index. We excluded participants with incomplete information in construction of the frailty index at baseline. Falls were measured based on the respondents' self-report. We used a logistic regression model to estimate the associations between the frailty status and risk of fall, and subgroup analyses and sensitivity analyses were further conducted.

RESULTS

Of 13,877 participants, 2310 (16.6%) had falls during the observation period. 9027 (65.0%) participants were classified as robust, 4019 (29.0%) participants were classified as pre-frail, and 831 (6.0%) participants were classified as frail. Our results indicated per 0.01 increment in the frailty index was significantly associated with an increased risk of fall among middle-aged and older participants (OR: 1.52, 95%CI: 1.45-1.60). Such association was stronger when frailty was presented as a categorical variable, with an OR of 1.75 (95%CI: 1.59-1.93) for pre-frail and 3.04 (95%CI: 2.60-3.56) for frail. The area under the curve of the logistic model was 0.612 (95%CI: 0.600-0.625). Each 0.01 increment of the frailty index was association with a higher risk of fall among middle-aged (45-59years) participants (OR: 1.44, 95%CI: 1.29-1.60) than among older (≥60 years) participants (OR: 1.28, 95%CI: 1.16-1.41) at baseline (p=0.015 for interaction).

CONCLUSION

Frailty was significantly associated with an increased risk of fall among community-dwelling middle-aged and older people in China. It is necessary to screen and recognize frailty status to prevent falls among middle-aged and older adults.

Association between cardiorespiratory fitness, obesity, and incidence of atrial fibrillation

BACKGROUND

The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans.

METHODS

Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2), obese (BMI 30-35 kg/m2), or severely obese (BMI > 35 kg/m2). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF.

RESULTS

Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF.

CONCLUSION

Improving CRF should be advocated when assessing those at risk for developing AF.

Relationship between fall risks and activities of daily living in older individuals

Objective

To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.

Methods

This study is cross-sectional. It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.

Results

The mean older individuals’ DENN Fall Risks Assessment Scale score was 11.73 ± 7.13, and 62.2% of the participants were in the high-risk group. Barthel Index of Activities of Daily Living (ADL) mean score was 68.03 ± 25.36, and 45.1% of the participants were in the moderately dependent group. There was a statistically significant, negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score. In addition, there was a statistically significant, positive relationship between the DENN Fall Risks Assessment Scale score and age (p < 0.01).

Conclusions

This study found that level of dependency and fall risks increased with the increase in age. Effective global and multidisciplinary interventions are needed to decrease older individuals’ dependency levels and fall risks today when the number of older individuals is increasing.

Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment

PURPOSE

This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population?

METHODS

MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome.

RESULTS

A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified.

CONCLUSION

This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.

Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year-A Cross-Sectional Study in a Geriatric Ward

Falls are a serious health problem in older adults. A limited number of studies assessed their multifactorial nature in geriatric ward patients. The aim of this study is to explore health, functional and nutritional correlates of experiencing fall(s) in the previous year by older inpatients. A cross-sectional study of patients admitted to the department of geriatrics was conducted. A "faller status" was defined based on positive history of falls in the previous 12 months. Health, functional and nutritional factors associated with falls were evaluated, and multivariable logistic regression analysis models were built. A total of 358 patients (median age 82 (IQR 76-86) years, 77.9% women) were recruited, 43.9% of whom reported falls. The "fallers" presented with a significantly higher number of chronic diseases, higher prevalence of Parkinson's disease, peripheral arterial disease, chronic osteoarthritis, more frequently reported urinary incontinence and were dependent on others for daily living activities. They had significantly worse results for the assessment of gait, balance and frailty status. The Mini Nutritional Assessment-Short Form scores and the mean value of serum albumin were significantly lower in the fallers' group. Parkinson's disease (OR = 2.82, CI-1.07-7.45; p = 0.04) and osteoarthritis (OR = 2.08, CI-1.02-4.23; p = 0.04) were the main variables for the outcome prediction, according to the direct multivariable logistic regression analysis. Our findings suggest that Parkinson's disease and osteoarthritis are the main predictors independently associated with a history of falls in patients admitted to the geriatric ward, although the influence of some factors may be underestimated due to the tendency of not taking the history of falls in very frail, functionally dependent and bedridden individuals.

Falls and Cancer

Falls among older people are common and are associated with substantial morbidity, mortality and healthcare costs. Increasingly cancer is becoming a disease of older people and fall rates are higher in elders living with cancer. Cancer and its treatments potentiate important risk factors for falls, including muscle weakness, poor balance, proprioception, cognitive impairment and functional disability. Sarcopenia refers to the progressive deterioration in muscle strength, mass and quality with ageing. Chronic conditions and cancer amplify this decline and are associated with a greater negative effect on function. Age-related impairments of lower limb neurological function are commonly exacerbated by neurotoxic chemotherapy, resulting in gait and balance deficits. Postural instability and falls erode confidence and result in a negative cycle of diminishing activity levels, further deconditioning and a higher risk of further falls. Cancer-related fatigue, sleep and mood disturbances compound this progressive frailty, further worsening treatment tolerance and outcomes. Cognitive impairment is a potent risk factor for falling and is frequently associated with gait abnormalities. The well-recognised effects of cancer treatment on working memory, attention, processing speed and executive function are often apparent (when their presence is sought) before treatment and may be as much the result of the cancer itself as they are 'chemo brain'. Structured exercise programmes focusing on progressively challenging strength and balance training are of proven benefit in falls prevention. Regular aerobic exercise accrues additional benefits in improved cardiorespiratory resilience and concomitant positive effects on treatment tolerance. Increased activity levels positively influence cognition, mood and foster an improved sense of well-being. Simple, practicable clinic-based tests of physical functioning, cognition and neurological function can help to identify those at high risk of falls and functional decline. The use of such instruments can aid judicious treatment planning and identify those most likely to benefit from more detailed specialist comprehensive geriatric assessment.

Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer

PURPOSE

Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival.

METHODS

HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS.

RESULTS

Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p < 0.0001), male sex (HR 1.4, p = 0.011), advanced disease (regional-HR 2.0, p < 0.0001; distant-HR 7.0, p < 0.0001), and decreased mental HRQOL (HR 1.4, p = 0.005). Decreased DSS was independently associated with advanced disease (regional-HR 4.1, p < 0.0001; distant-HR 16.5, p < 0.0001) and rectal primary (HR 1.6, p = 0.047). Decreased non-DSS was independently associated with age ≥ 75 (HR 2.2, p < 0.0001), male sex (HR 1.4, p = 0.03), decreased mental HRQOL (HR 1.4, p = 0.02), and increased comorbidities (HR 1.4, p = 0.04).

CONCLUSIONS

The potential overall survival benefit of oncologic surgery is diminished by declines in physical and mental health. Early identification of older surgical patients at risk for functional and HRQOL declines may improve survival following colorectal cancer surgery.

Validation and Application of the Chinese Version of the M. D. Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI-C)

OBJECTIVES

To validate and use the Chinese Version of the M. D. Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI-C) to assess the symptom burden of Chinese-speaking patients with gastrointestinal cancer.

METHODS

In total, 527 patients with postoperative or advanced digestive tract tumors were enrolled in the trial, who had definitive diagnoses and different treatments in our cancer center. MDASI-GI-C was administered to these patients between February and December 2017. The item-scale correlations and internal consistency were evaluated. Construct validity was established by factor analysis. Hierarchical cluster analysis was performed.

RESULTS

Cronbach's alpha of the symptom severity and interference subscales was 0.842 and 0.859, respectively. Construct validity revealed a four-factor structure. Known-group validity was established by comparing the MDASI-GI-C scores between patients having different Karnofsky Performance Status scores (≤70 or >70), which were observed to have significant differences. The overall mean subscale scores for the core and interference subscales were 1.63 ± 2.02 and 2.17 ± 2.34, respectively. Fatigue, disturbed sleep, and lack of appetite had the highest scores for most serious symptoms. No significant differences in age, working status, and educational level were found.

CONCLUSIONS

MDASI-GI-C is a reliable and valid tool for assessing cancer-related symptoms in Chinese-speaking patients with digestive tract tumors, facilitates the understanding of the common symptoms of patients with digestive tract tumors, and enables timely management of these symptoms. Cognitive debriefing demonstrated that the patients found MDASI-GI-C to be an easy-to-use and understandable instrument.

Risk Factors for Falls in Adult Cancer Survivors: An Integrative Review

PURPOSE

The aim of the study was to identify risk factors for falls among cancer survivors.

DESIGN

Integrative literature review.

METHODS

We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and PEDro for studies investigating fall risk in cancer. Reports of randomized controlled trials, descriptive studies (quantitative and qualitative), and theoretical papers meeting predetermined criteria were included. Quality ratings of included studies were done, and data were extracted and compiled by two independent reviewers.

FINDINGS

Twenty-nine articles met inclusion criteria. Literature quality was moderate (median quality score: 1.67 out of 3 possible points). Heterogeneity of statistics and reporting methods precluded calculation of summary effect sizes, but physical function, cognitive function, balance/gait, and certain medication types appear to increase fall risk.

CONCLUSIONS AND CLINICAL RELEVANCE

Modifiable risk factors, such as those identified in this review, represent tangible intervention targets for rehabilitation professionals for decreasing the risk of falls among cancer survivors.

Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: Results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage

Background

Cancer and its treatment affect body systems that are important in preventing falls and controlling balance/walking. This study examined factors associated with self-reported falls and balance/walking difficulty in the past 12 months in older survivors of four major cancers.

Methods

This was a cross-sectional study analyzing population-based data from Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey (SEER-MHOS). Data from cohorts 9 to 14 (January 2006 to December 2013) were extracted. Inclusion criteria were: age ≥65 years at cancer diagnosis, first MHOS completed during years 1–5 post-cancer diagnosis, first primary breast (n = 2725), colorectal (n = 1646), lung (n = 752), and prostate (n = 4245) cancer, and availability of cancer staging information. Primary outcomes were self-reported falls and balance/walking difficulty in the past 12 months. Multivariable logistic regression was constructed for each cancer type to examine independent factors associated with falls and balance/walking difficulty.

Results

In all cancer types, advancing age at cancer diagnosis and dependence in activities of daily living were significant independent factors associated with increased odds of reporting falls and balance/walking difficulty in the past 12 months. Additionally, depression was independently associated with falls and sensory impairment in feet was independently linked to balance/walking difficulty in all cancer types. Other independent factors of falls and balance/walking difficulty varied across cancer types. In breast cancer only, localized or regional cancer stage was significantly associated with increased odds of reporting falls and balance/walking difficulty, whereas treatment with radiation decreased the odds of falling. No association between falls and balance/walking difficulty with time since cancer diagnosis, cancer stage, or cancer treatment was found in colorectal, lung, and prostate cancer.

Conclusion

There exists some heterogeneity in factors associated with self-reported falls and balance/walking difficulty between different cancer types. Future research is necessary to ascertain factors predictive of falls and balance/walking difficulty in older cancer survivors, particularly factors related to cancer diagnosis and treatment.

Health status of older cancer survivors-results of the PolSenior study

PURPOSE

The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study.

METHODS

We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors.

RESULTS

There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4 ± 8.2 years and the median time since cancer diagnosis was 8.5 years (Q1-Q3: 4-16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR = 1.38; 95% CI: 1.04-1.83), and to report poor health (OR = 1.49; 95%CI: 1.83-2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p < 0.001).

CONCLUSIONS

Cancer survivors over the age of 65 years have a higher prevalence of falls, are more likely to report poor health status, and have a higher number of chronic conditions than the non-cancer population, but they maintain independence in IADLs. Advanced age and elementary education are associated with increased occurrence of functional impairments in older cancer survivors IMPLICATIONS FOR CANCER SURVIVORS: Older cancer survivors may require preventive services to reduce the risk of functional decline.

Falls in Older Patients with Cancer Undergoing Surgery: Prevalence and Association with Geriatric Syndromes and Levels of Disability Assessed in Preoperative Evaluation

Falls are common among older adults. However, not much is known about the prevalence of falls among older patients with cancer. In 2015, older patients with cancer referred to Geriatrics service for preoperative evaluation were assessed for fall history, basic and instrumental activities of daily living (ADL and IADL), KPS, and use of assistive device. Of 806 patients, 215 (26.7%) patients reported fall. Incidence of last fall inside and outside home was 54.4% and 45.5%, respectively. Among patients with no falls, 33.6% had KPS ≤ 80 compared to 59.6% with one-time fall and 60.7% with multiple falls (p < 0.001). Among IADL, 8.5% of patients with no falls were unable to do shopping compared with 14.7% in one-time fall and 18.8% in multiple fallers (p < 0.001). In ADL items, the percentage of patients who were limited a lot in walking outside was 10.7% in no falls, 20.2% in one-time fall, and 27.1% in multiple fallers groups (p < 0.001). Only 17.8% of patients with no falls were using canes while 27.7% of patients with one-time fall and 38.8% with multiple falls were using canes (p < 0.001). Falls are prevalent among older patients with cancer. Fall history and number of falls are associated with functional status.

Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage

OBJECTIVES

To identify predictors of falls in older breast and prostate cancer survivors.

METHODS

This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC).

RESULTS

At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers.

CONCLUSIONS

Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.

Falls in older adults with multiple myeloma

OBJECTIVE

To examine the prevalence of falls, factors associated with falls and the relationship between falls and survival in older adults with multiple myeloma.

METHODS

In an analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS)-linked database, we examined 405 older adults with multiple myeloma (MM) and 513 matched non-cancer controls. The primary outcome was self-reported within the past 12 months. Age, race, gender, symptoms, and comorbidities were self-reported in the MHOS. Survival was calculated from SEER data.

RESULTS

Of the patients with MM, 171 were within 1 year of diagnosis (cohort 1) and 234 were ≥1 year postdiagnosis (cohort 2). Patients in cohorts 1 and 2 were more likely to have fallen than controls (26% and 33% vs 23%, P = .012). On multivariate analysis, among patients with myeloma (combined cohorts 1 and 2), factors associated with falls included self-report of fatigue (aOR 2.52 [95% CI 1.34-4.93]), depression (aOR 1.90 [95% CI 1.14-3.18]), or poorer general health (aOR 1.86 [95% CI 1.05-3.36]). Falls were not associated with survival.

CONCLUSIONS

Older adults with MM have a greater prevalence of falls than matched controls. Self-reported fatigue, depression, and poorer general health are associated with greater odds of falls.

Falls and subjective well-being. Results of the population-based German Ageing Survey

PURPOSE

The aim of the current study was to determine the relationship between falling in the past 12 months and subjective well-being in a broader sense.

METHODS

Cross-sectional data were gathered from a representative sample of community-dwelling individuals in the second half of life (40 to 95 years; n=7808) in Germany. While life satisfaction was quantified using the Satisfaction with Life Scale (SWLS), positive and negative affect was measured using the Positive and Negative Affect Schedule (PANAS).

RESULTS

The prevalence of falling in the preceding 12 months was 17.6%. After controlling for sociodemographic factors, various lifestyle factors, self-rated health, and morbidity, multiple linear regression analysis revealed that falling in the past 12 months was associated with higher negative affect (β=0.08, p<0.001), lower positive affect (β=-0.04, p<0.05) as well as lower life satisfaction (β=-0.12, p<0.001).

CONCLUSION

The present study stresses the relationship between falls and subjective well-being. Future longitudinal studies are needed to validate the findings of the present cross-sectional study and to better understand the nature of this relationship.