Falls and hospitalization during chemotherapy in older women with early breast cancer.

Abstract

12035 Background: Hospitalizations are frequent, burdensome, and potentially avoidable complications of cancer treatment in older adults. While geriatric assessments can identify older patients at risk for hospitalization, the use of these assessments in clinic is limited by time and resources. Screening for falls in the past 6 months is a quick and simple question that clinicians can ask in clinic and fall history has been linked to chemo-related toxicity. Here, we hypothesized that in older adults with cancer fall history prior to chemo is associated with an increased risk of hospitalization during chemo. Methods: In a prospective multicenter study of 497 women age ≥65 with stage I-III breast cancer treated with neo/adjuvant chemo, we assessed baseline self-reported fall history in the past 6 months as a dichotomous (yes/no) and continuous variable (no. of falls). Our primary endpoint was hospitalization during chemo (yes/no, yes defined as incident hospitalization assessed from start to end of chemo and attributed to toxicity from chemo). We used multivariable logistic regression to examine the association between fall history and hospitalization during chemo, adjusting for sociodemographic and clinical covariates. Results: The median age was 70 (65-86), 65% had stage II/III disease, 37% had anthracycline, and 72% received primary prophylaxis with G-CSF. Of the 497 participants, 60 (12%) reported falls (median 1.0 [1-6]) at baseline, and 114 (23%) were hospitalized during chemo (median 1.0 [1-4]). The most common toxicities that resulted in hospitalization were febrile neutropenia (25%), anemia (13%), dehydration (13%), and fatigue (13%). Women who fell in the 6 months prior to chemo had greater odds (adjusted OR = 2.69, 95% CI 1.42-5.11, p= 0.003) of being hospitalized during chemo compared to women who did not fall. Conclusions: In this cohort of older women with early breast cancer, fall history prior to chemo was associated with an increased risk of hospitalization during chemo, independent of sociodemographic and clinical factors. Oncologists do not routinely assess fall history when considering chemo in older adults. Screening for falls is a quick, simple, and important indicator of vulnerability that oncologists may use to identify patients at risk for hospitalization during chemo and inform personalized, patient-partnered treatment decisions. Clinical trial information: NCT01472094 . [Table: see text]