Fall-related injuries in elderly cancer patients treated with neurotoxic chemotherapy: a retrospective cohort study.
BACKGROUND
Fall-related injuries are a well-described cause of morbidity and mortality in the community-dwelling elderly population, but have not been well described in patients with cancer. Cancer treatment with chemotherapy can result in many unwanted side effects, including peripheral neuropathy if the drugs are potentially neurotoxic. Peripheral neuropathy and other side effects of chemotherapy may lead to an increased risk of fall-related injuries.


METHODS
We conducted a retrospective cohort analysis using the records of 65,311 patients with breast, colon, lung, or prostate cancer treated with chemotherapy in the SEER-Medicare database from 1994 to 2007. The primary outcome was any fall-related injury defined as a traumatic fracture, dislocation, or head injury within 12 months of the first dose of chemotherapy. The sample population was divided into 3 cohorts based on whether they most frequently received a neurotoxic doublet, single agent, or a non-neurotoxic chemotherapy. Cox proportional-hazards analyses were adjusted for baseline characteristics to determine the risk of fall-related injuries among the 3 cohorts.


RESULTS
The rate of fall-related injuries for patients receiving a doublet of neurotoxic chemotherapy (9.15 per 1000 person-months) was significantly higher than for those receiving a single neurotoxic agent (7.76 per 1000 person-months) or a non-neurotoxic agent (5.19 per 1000 person-months). Based on the Cox proportional-hazards model risk of fall-related injuries was highest for the cohort receiving a neurotoxic doublet after the model was adjusted for baseline characteristics.


CONCLUSIONS
Among elderly patients with cancer, use of neurotoxic chemotherapy is associated with an increased risk of fall-related injuries.
UCLA Medical Center, Los Angeles, CA, USA. Electronic address: prward23@me.com.
Peter R
PR
Ward
UCLA Medical Center, Los Angeles, CA, USA.
Mitchell D
MD
Wong
UCLA Medical Center, Los Angeles, CA, USA.
Ravaris
R
Moore
UCLA Medical Center, Los Angeles, CA, USA.
Arash
A
Naeim
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D020258:Neurotoxicity Syndromes / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D012189:Retrospective Studies
D000970:Antineoplastic Agents
Cancer; Chemotherapy; Complications; Elderly; Falls; Neuropathy