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Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic

Published online by Cambridge University Press:  13 February 2014

Meiko Kuriya ,
Sriram Yennurajalingam ,
Maxine Grace de la Cruz ,
Wei Wei ,
Shana Palla  and
Eduardo Bruera
Meiko Kuriya
Affiliation:
Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
Sriram Yennurajalingam
Affiliation:
Department of Palliative Care and Rehabilitative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Maxine Grace de la Cruz
Affiliation:
Department of Palliative Care and Rehabilitative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Wei Wei
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
Shana Palla
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera*
Affiliation:
Department of Palliative Care and Rehabilitative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprints requests to: Eduardo Bruera, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard. Houston, Texas 77030. E-mail: ebruera@mdanderson.org
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Abstract

Objective:

The aim of this study was to determine the frequency and factors associated with fall episodes in advanced cancer patients.

Method:

We analyzed data that included demographic characteristics, utilization of assistive devices, cancer diagnosis, metastatic site, performance status, medications including hypnotics and opioids, Edmonton Symptom Assessment Scale (ESAS) score, and Memorial Delirium Assessment Scale (MDAS) score in 384 consecutive patients who were newly referred to the Supportive Care Clinic at the MD Anderson Cancer Center from January 1 to December 31, 2009. All patients completed standardized forms to report falls within the last month. Multivariate backward regression analyses were employed to identify factors predictive of falls in advanced cancer.

Results:

The mean age of patients was 58 years, and 192 (50%) were male. Mean (SD)/median score for pain was 5 (2.8), 5; fatigue 5.6 (2.6), 6; sleep disturbance 5(2.7), 5; drowsiness 3.7(3), 3; and anorexia 5(3), 5. Some 31 patients (8%) reported fall episodes within the past month, 17 (55%) of whom reported the use of assistive devices. Using assist devices (OR = 5.5, 95% CI: 2.6–11.9, p < 0.0001) and taking zolpidem (OR = 3.39, 95% CI: 1.39–7.7, p = 0.008) were associated with an enhanced chance of falling. Higher MDAS score (4.00 vs. 1.42, p = 0.001) and MDAS positive screening for delirium (21 vs. 3.6%, p < 0.001) were also associated with falls. However, severity on the ESAS at the initial consult was not associated with falls.

Significance of Results:

We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.

Keywords

Advanced cancerSupportive careFalls
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 223 - 227
Copyright
Copyright © Cambridge University Press 2014 

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