Falls Experienced by Older Patients Are Often Not Recorded or Responded to by Oncology Providers

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A study comparing self-reported falls by older patients with cancer with the history and physical and/or clinic notes completed by their oncology providers “found that oncology providers rarely recorded or responded to falls in their older patients.” There was minimal evidence of documentation of falls “or actions that would suggest oncology provider awareness of interventions that could lower the risk of future falls,” Emily J. Guerard, MD, and colleagues from the University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, reported in the Journal of Oncology Practice.

The study involved 125 patients 65 years or older who reported at least one fall, as noted in the Carolina Senior Registry cross-sectional geriatric assessment data. These data were collected independently for the registry and were not shared with the patients’ oncology providers. The history and physical and/or clinic notes completed by the oncology providers within 6 months of completion of the geriatric assessment were retrospectively reviewed for documentation of falls and gait assessment, as well as referrals to geriatrics or physical and/or occupational therapy, and measurement of vitamin D levels. The authors noted: “Low vitamin D levels are commonly found in older adults, and supplementation has been shown to reduce falls risk.”

The median age of the study participants was 71 years, 78% were female, and 62% had a diagnosis of breast cancer. More than half had one fall, but 31 patients (25%) had two falls, and 27 patients (22%) had three or more falls. The self-reports indicated that 44 patients (35%) had a Karnofsky performance status of 70% or less, indicating functional impairment.

An Unmet Need

“Chart reviews showed that 13 (10%) had falls documented, 25 (20%) had a gait assessment, 8 (6%) were referred, and 21 (17%) had vitamin D level measured,” the researchers reported. Four referrals were to geriatrics and four were to physical/occupational therapy (two for lymphedema).

“Oncology providers need to be able to recognize falls, given that 50% of older adults with advanced cancer will experience a fall that is associated with a high risk of morbidity and mortality,” the investigators stated. “In light of the nationwide shortage of geriatricians, it is important for oncology providers not only to screen for falls, but also to evaluate and provide interventions or referrals as needed.”

Further Commentary

This theme was echoed by Heidi D. Klepin, MD, MS, of Wake Forest School of Medicine, Winston Salem, North Carolina, in a recent commentary on the study. “Although oncologists should never be expected to function as geriatricians, the oncology workforce is under increasing pressure to incorporate geriatric principles into cancer care,” Dr. Klepin wrote. “Oncologists often function as the primary care providers for many of their older patients, particularly during the time of active cancer treatment. Geriatric consultations will not be available in a timely manner for many patients.”

Noting that studies have suggested that falls may be more common among older people with cancer than in the general population, Dr. Klepin continued: “Falls are associated with significant complications, including increased chemotherapy toxicity, increased health care use, and functional decline. Assessing falls may add to our understanding of an individual patient’s vulnerability when considering treatment planning.” Furthermore, “Asking about falls may also uncover additional related risk factors,” Dr. Klepin added, and offers an opportunity for actionable interventions that may minimize the risk of future falls, improve treatment tolerance, and enhance the quality of survivorship. ■

Guerard EJ, et al: J Oncol Pract. July 14, 2015 (early release online).

Klepin HD: J Oncol Pract. September 22, 2015 (early release online).