The University of Texas MD Anderson Cancer Center, Houston, TX
Maxine De la Cruz, Neha Didwaniya, Kimberson Tanco, SeongHoon Shin, Akhila Sunkepally Reddy, Maria Teresa San Miguel Arregui, Herlinda Moreno, Eduardo Bruera, Gary B. Chisholm, Janet L. Williams
Background: Falls are a concern in patients who are frail, have advance age or severe underlying medical condition as a significant cause of morbidity and reduced quality of life. It has been reported to occur in up to 50% of palliative care patients in different settings. Our aim was to determine the frequency of falls and identify its predictors and correlates in patients with advanced cancer. Methods: We reviewed 1,984 consecutive patients with advanced cancer seen in the outpatient supportive care center and determined the frequency of patient reported falls within the last month prior to the visit. Baseline patient characteristics, symptom severity scores in the Edmonton Symptom Assessment Scale (ESAS), medication use, functional status, and use of assistive devices were used to identify factors that are predictive of falls using backwards stepwise logistic regression. Results: 1,041 (52%) were female, 1,377 (69%) were non-Hispanic-white, 343 (17%) had peripheral neuropathy, 237 (12%) were on psychotropic medications, and 1,140 (58%) were on opioids. There were 211 (11%) patient reported falls. Presence of brain metastasis, use of assistive device, ECOG, ESAS depression, and weight prior to visit were significantly associated with patient reported falls in the multivariate model. Conclusions: One tenth of patients seen in the outpatient supportive care clinic reported falls. Our findings showing that falls to be associated with brain metastasis, assistive device, functional status, ESAS depression and weight are useful in stratifying high risk patients. They also show that certain medications deemed as risk factors in other populations were not associated with falls.
Odds ratio estimates (c=0.72) | ||||
---|---|---|---|---|
Effect | OR | 95% Wald confidence limits |
P value | |
Age (per year) | 1.003 | 0.991 | 1.015 | 0.6274 |
Brain mets (Y vs N) | 2.394 | 1.442 | 3.973 | 0.0007 |
Assistive device | 2.695 | 1.872 | 3.881 | <.0001 |
Wt prior to visit (per kg) | 1.008 | 1.001 | 1.016 | 0.0352 |
ECOG | 1.469 | 1.145 | 1.885 | 0.0025 |
Depression (per ESAS point) | 1.075 | 1.018 | 1.135 | 0.0092 |
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