Abstract
BackgroundCancer 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.MethodsThis 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.ResultsIn 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.ConclusionThere 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.
Highlights
Falls and balance/walking difficulty are significant concerns in older adults
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
There exists some heterogeneity in factors associated with self-reported falls and balance/ walking difficulty between different cancer types
Summary
Falls and balance/walking difficulty are significant concerns in older adults. One in four adults aged 65 years fall annually [1]. Among those who fall, 20%-30% sustain serious injuries [2]. Research suggests that fall rates are higher in older cancer survivors than non-cancer individuals (33% vs 30% in a community-dwelling sample [10] and 26% vs 22% among Medicare beneficiaries [11]). In a study of cancer survivors in outpatient setting, balance/walking difficulty (19.4%23.9%) was identified as the leading functional problem [12]. 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
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