Skip to main content

Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment



This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population?


MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015–January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome.


A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified.


This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

Not applicable.


  1. 1.

    Wildes TM, Dua P, Fowler SA, Miller JP, Carpenter CR, Avidan MS, Stark S (2015) Systematic review of falls in older adults with cancer. J Geriatr Oncol 6(1):70–83

    PubMed  Google Scholar 

  2. 2.

    Sattar S, Alibhai SM, Spoelstra SL, Fazelzad R, Puts MT (2016) Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer:1–11

  3. 3.

    Toomey A, Friedman L (2014) Mortality in cancer patients after a fall-related injury: the impact of cancer spread and type. Injury. 45(11):1710–1716

    PubMed  Google Scholar 

  4. 4.

    Sattar S, Alibhai SM, Spoelstra SL, Puts MT (2019) The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: results from a mixed-methods study. J Geriatr Oncol. 10(1):98–104

    PubMed  Google Scholar 

  5. 5.

    Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions. Vol. 4. John Wiley & Sons

  6. 6.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    PubMed  Google Scholar 

  7. 7.

    Ageing WHO, Unit LC (2008) WHO global report on falls prevention in older age. World Health Organ

  8. 8.

    Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. (2018) Mixed methods appraisal tool (MMAT), version 2018. IC Can Intellect Prop Off Ind Can

  9. 9.

    Loh KP, Pandya C, Zittel J, Kadambi S, Flannery M, Reizine N, Magnuson A, Braganza G, Mustian K, Dale W, Duberstein P, Mohile SG (2017) Associations of sleep disturbance with physical function and cognition in older adults with cancer. Support Care Cancer 25(10):3161–3169

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Turner JP, Tervonen HE, Shakib S, Singhal N, Prowse R, Bell JS (2017) Factors associated with use of falls risk-increasing drugs among patients of a geriatric oncology outpatient clinic in Australia: a cross-sectional study. J Eval Clin Pract 23(2):361–368

    PubMed  Google Scholar 

  11. 11.

    Whittle AK, Kalsi T, Babic-Illman G, Wang Y, Fields P, Ross PJ, Maisey NR, Hughes S, Kwan W, Harari D (2017) A comprehensive geriatric assessment screening questionnaire (CGA-GOLD) for older people undergoing treatment for cancer. Eur J Cancer Care (Engl) 26(5):e12509

    Google Scholar 

  12. 12.

    Wildes TM, Depp B, Colditz G, Stark S (2016) Fall-risk prediction in older adults with cancer: an unmet need. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 24(9):3681–3684

    Google Scholar 

  13. 13.

    Winters-Stone KM, Moe E, Graff JN, Dieckmann NF, Stoyles S, Borsch C, Alumkal JJ, Amling CL, Beer TM (2017) Falls and frailty in prostate cancer survivors: current, past, and never users of androgen deprivation therapy. J Am Geriatr Soc 65(7):1414–1419

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Zak M, Biskup M, Macek P, Krol H, Krupnik S, Opuchlik A (2017) Identifying predictive motor factors for falls in post-menopausal breast cancer survivors. PloS One 12(3)

  15. 15.

    Schwenk M, Grewal GS, Holloway D, Muchna A, Garland L, Najafi B (2016) Interactive sensor-based balance training in older cancer patients with chemotherapy-induced peripheral neuropathy: a randomized controlled trial. Gerontology. 62(5):553–563

    PubMed  Google Scholar 

  16. 16.

    Blackwood J (2019) The influence of cognitive function on balance, mobility, and falls in older cancer survivors. Rehabil Oncol 37(2):77–82

    Google Scholar 

  17. 17.

    Farcet A, De Decker L, Pauly V, Rousseau F, Bergman H, Molines C, et al. (2016) Frailty markers and treatment decisions in patients seen in oncogeriatric clinics: results from the ASRO pilot study. PLoS One 11(2)

  18. 18.

    Huang MH, Blackwood J, Godoshian M, Pfalzer L (2018) Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage. PLoS One 13(12):e0208573

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Huang MH, Blackwood J, Godoshian M, Pfalzer L (2017) Prevalence of self-reported falls, balance or walking problems in older cancer survivors from Surveillance, Epidemiology and End Results—Medicare Health Outcomes Survey. J Geriatr Oncol. 8(4):255–261

    PubMed  Google Scholar 

  20. 20.

    Komatsu H, Yagasaki K, Hamamoto Y, Takebayashi T (2018) Falls and physical inactivity in patients with gastrointestinal cancer and hand–foot syndrome. Asia-Pac J Oncol Nurs 5(3):307–313

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Li I-F, Hsiung Y, Hsing H-F, Lee M-Y, Chang T-H, Huang M-Y (2016) Elderly Taiwanese’s intrinsic risk factors for fall-related injuries. Int J Gerontol. 10(3):137–141

    Google Scholar 

  22. 22.

    Pandya C, Magnuson A, Dale W, Lowenstein L, Fung C, Mohile SG (2016) Association of falls with health-related quality of life (HRQOL) in older cancer survivors: a population based study. J Geriatr Oncol. 7(3):201–210

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Wildes TM, Fiala MA (2018) Falls in older adults with multiple myeloma. Eur J Haematol 100(3):273–278

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Wildes TM, Maggiore RJ, Tew WP, Smith D, Sun C-L, Cohen H et al (2018) Factors associated with falls in older adults with cancer: a validated model from the Cancer and Aging Research Group. Support Care Cancer 26(10):3563–3570

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Winters-Stone KM, Horak F, Jacobs PG, Trubowitz P, Dieckmann NF, Stoyles S, Faithfull S (2017) Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy. J Clin Oncol 35(23):2604–2612

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Wu F-J, Sheu S-Y, Lin H-C, Chung S-D (2016) Increased fall risk in patients receiving androgen deprivation therapy for prostate cancer. Urology. 95:145–150

    PubMed  Google Scholar 

  27. 27.

    Decoster L, Kenis C, Schallier D, Vansteenkiste J, Nackaerts K, Vanacker L, Vandewalle N, Flamaing J, Lobelle JP, Milisen K, de Grève J, Wildiers H (2017) Geriatric assessment and functional decline in older patients with lung cancer. Lung. 195(5):619–626

    CAS  PubMed  Google Scholar 

  28. 28.

    Edwards BJ, Sun M, Zhang X, Holmes HM, Song J, Khalil P, Karuturi M, Shah JB, Dinney CP, Gagel RF, Valero V, Champlin RE, Tripathy D, Murphy WA Jr (2018) Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience. Support Care Cancer 26(5):1561–1568

    PubMed  Google Scholar 

  29. 29.

    Fagard K, Casaer J, Wolthuis A, Flamaing J, Milisen K, Lobelle J-P, Wildiers H, Kenis C (2017) Value of geriatric screening and assessment in predicting postoperative complications in patients older than 70 years undergoing surgery for colorectal cancer. J Geriatr Oncol. 8(5):320–327

    PubMed  Google Scholar 

  30. 30.

    Fahimnia S, Mirhedayati Roudsari H, Doucette J, Shahrokni A (2018) Falls in older patients with cancer undergoing surgery: prevalence and association with geriatric syndromes and levels of disability assessed in preoperative evaluation. Curr Gerontol Geriatr Res 2018:1–7

    Google Scholar 

  31. 31.

    Graff JN, Baciarello G, Armstrong AJ, Higano CS, Iversen P, Flaig TW, Forer D, Parli T, Phung D, Tombal B, Beer TM, Sternberg CN (2016) Efficacy and safety of enzalutamide in patients 75 years or older with chemotherapy-naive metastatic castration-resistant prostate cancer: results from PREVAIL. Ann Oncol 27(2):286–294

    CAS  PubMed  Google Scholar 

  32. 32.

    Manokumar T, Aziz S, Breunis H, Rizvi SF, Joshua AM, Tannock IF, Alibhai SMH (2016) A prospective study examining elder-relevant outcomes in older adults with prostate cancer undergoing treatment with chemotherapy or abiraterone. J Geriatr Oncol. 7(2):81–89

    PubMed  Google Scholar 

  33. 33.

    Ozkaraman A, Orlu N (2018) Peripheral neuropathy and falling risk in 65 years old and older patients receiving chemotherapy: a prospective study. Int J Caring Sci 11(1):550–556

    Google Scholar 

  34. 34.

    Tsai J-M, Chien H-H, Shih S-C, Lee S-C, Tsai L-Y, Tsay S-L (2017) Using balanced scorecard on reducing fall incidents and injuries among elderly cancer patients in a medical center in Taiwan. Int J Gerontol 11(4):253–257

    Google Scholar 

  35. 35.

    Huang MH, Blackwood J, Godoshian M, Pfalzer L (2019) Predictors of falls in older survivors of breast and prostate cancer: a retrospective cohort study of surveillance, epidemiology and end results—Medicare health outcomes survey linkage. J Geriatr Oncol. 10(1):89–97

    PubMed  Google Scholar 

  36. 36.

    Vonnes C, Wolf D (2017) Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety. BMJ Open Qual 6(2):e000038

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Vela CM, Grate LM, McBride A, Devine S, Andritsos LA (2018) A retrospective review of fall risk factors in the bone marrow transplant inpatient service. J Oncol Pharm Pract 24(4):272–280

    PubMed  Google Scholar 

  38. 38.

    Sattar S, Spoelstra SL, Alibhai SM, Puts MT (2019) Circumstances of falls and fear of falling in community-dwelling older adults with cancer: results from a mixed-methods study. J Geriatr Oncol. 10(1):105–111

    PubMed  Google Scholar 

  39. 39.

    Weed-Pfaff SH, Nutter B, Bena JF, Forney J, Field R, Szoka L, et al. (2016) Validation of predictors of fall events in hospitalized patients with cancer. Clin J Oncol Nurs 20(5)

  40. 40.

    Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C et al (2006) Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 35(1):5–10

    PubMed  Google Scholar 

  41. 41.

    Tinetti ME, Williams CS (1997 Oct 30) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284

    CAS  PubMed  Google Scholar 

  42. 42.

    National Cancer Institute, SEER Cancer Statistics Factsheets, Bethesda,

  43. 43.

    Lee CE, Warden SJ, Szuck B, Lau YJ (2016) A preliminary study on the efficacy of a community-based physical activity intervention on physical function-related risk factors for falls among breast cancer survivors. Am J Phys Med Rehabil Acad Physiatr 95(8):561–570

    Google Scholar 

  44. 44.

    Guerard EJ, Deal AM, Williams GR, Jolly TA, Nyrop KA, Muss HB (2015) Falls in older adults with cancer: evaluation by oncology providers. J Oncol Pract. JOP–2014

  45. 45.

    Li W, Keegan TH, Sternfeld B, Sidney S, Quesenberry CP Jr, Kelsey JL (2006) Outdoor falls among middle-aged and older adults: a neglected public health problem. Am J Public Health 96(7):1192–1200

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Tofthagen C, Overcash J, Kip K (2012) Falls in persons with chemotherapy-induced peripheral neuropathy. Support Care Cancer 20(3):583–589

    PubMed  Google Scholar 

  47. 47.

    Kolb NA, Smith AG, Singleton JR, Beck SL, Stoddard GJ, Brown S, Mooney K (2016) The association of chemotherapy-induced peripheral neuropathy symptoms and the risk of falling. JAMA Neurol 73(7):860–866

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Silbermann R, Roodman GD (2011) Bone effects of cancer therapies: pros and cons. Curr Opin Support Palliat Care 5(3):251–257

    PubMed  Google Scholar 

  49. 49.

    Klepin HD, Rodin M, Hurria A (2015) Treating older adults with cancer: geriatric perspectives. Am Soc Clin Oncol Educ Book ASCO Am Soc Clin Oncol Meet 35:e544–e552

    Google Scholar 

  50. 50.

    Falls in older patients with cancer: recognizing and reducing the risk - the ASCO post [Internet]. [cited 2019 Sep 24]. Available from:

  51. 51.

    Li Y, Zhang Q, Yang X, Zheng L, Yang J, Zhao H, Yang D (2018) Research of falls risk of taking central nervous system drugs in oncology inpatients. Curr Probl Cancer 42(2):261–267

    PubMed  Google Scholar 

  52. 52.

    Stubblefield MD, McNeely ML, Alfano CM, Mayer DK (2012) A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy. Cancer. 118(S8):2250–2260

    PubMed  Google Scholar 

  53. 53.

    Campbell KL, Pusic AL, Zucker DS, McNeely ML, Binkley JM, Cheville AL et al (2012) A prospective model of care for breast cancer rehabilitation: function. Cancer. 118(S8):2300–2311

    PubMed  Google Scholar 

  54. 54.

    Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 21(8):1295–1306

    CAS  PubMed  Google Scholar 

  55. 55.

    Shelby M, Malloch K, Shellenberger T, Byrum S, Mackie L, Dilli S, Dean Martin A (2019) Addressing falls among older oncology patients through complexity science. Nurs Adm Q 43(3):280–288

    PubMed  Google Scholar 

  56. 56.

    Sattar S, Kenis C, Haase K, Burhenn P, Stolz-Baskett P, Milisen K, et al. (2019) Falls in older patients with cancer: Nursing and Allied Health Group of International Society of Geriatric Oncology review paper. J Geriatr Oncol

  57. 57.

    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J (2011) Gait speed and survival in older adults. Jama. 305(1):50–58

    CAS  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Bennett JA, Winters-Stone KM, Dobek J, Nail LM (2013) Frailty in older breast cancer survivors: age, prevalence, and associated factors. In: Oncology nursing forum. NIH Public Access. p. E126

  59. 59.

    Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148

    CAS  Google Scholar 

  60. 60.

    National Institute for Health & Care Excellence. Falls in older people: quality standard [QS 86] - Google Search [Internet]. Available from:

  61. 61.

    Preventing falls and reducing injury from falls, RNAO 2017 - Google Search [Internet]. [cited 2017 Dec 2]. Available from:

  62. 62.

    American Geriatrics Society BGS (2010) AGS/BGS clinical practice guideline: prevention of falls in older persons. American Geriatrics Society New York, NY

    Google Scholar 

  63. 63.

    Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, Davidson KW et al (2018) Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Jama. 319(16):1696–1704

    PubMed  Google Scholar 

  64. 64.

    Samson K (2016) Word to oncologists: do more to report and prevent falls in older patients. LWW

  65. 65.

    Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146

    Google Scholar 

  66. 66.

    Sherrington C, Tiedemann A, Fairhall N, Close JCT (2011) Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. New South Wales Public Health Bull 22(4):78

    Google Scholar 

  67. 67.

    Clemson L, Singh MAF, Bundy A, Cumming RG, Manollaras K, O’Loughlin P et al (2012) Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. Bmj. 345:e4547

    PubMed  PubMed Central  Google Scholar 

  68. 68.

    Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L et al (2018) Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 7

  69. 69.

    Sajid S, Dale W, Mustian K, Pandya C, Heckler C, Mohile S (2012) A novel physical activity intervention using Wii-fit in older prostate cancer patients on androgen deprivation therapy: a RCT. J Geriatr Oncol. 3:S31

    Google Scholar 

  70. 70.

    Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT (2011) Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Prev Biomark 20(1):123–133

    Google Scholar 

  71. 71.

    Salmon P (2001) Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 21(1):33–61

    CAS  PubMed  Google Scholar 

  72. 72.

    Gardner MM, Robertson MC, Campbell AJ (2000) Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med 34(1):7–17

    CAS  PubMed  PubMed Central  Google Scholar 

  73. 73.

    Tuck SP, Francis RM (2002) Best practice: osteoporosis. Postgrad Med J 78:526–532

    CAS  PubMed  PubMed Central  Google Scholar 

  74. 74.

    Organization WH (2007) WHO global report on falls prevention in older age. World Health Organ 2015:1–7

    Google Scholar 

  75. 75.

    Williams AD, Bird M-L, Hardcastle SG, Kirschbaum M, Ogden KJ, Walters JA (2018) Exercise for reducing falls in people living with and beyond cancer. Cochrane Database Syst Rev 10

Download references

Code availability

Not applicable.


The research of Schroder Sattar has been funded by a recruitment and retention fund from the University of Saskatchewan and by an establishment grant from the Saskatchewan Health Research Foundation.

Author information



Corresponding author

Correspondence to S. Sattar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 22 kb)


(DOCX 27 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sattar, S., Haase, K., Kuster, S. et al. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 29, 21–33 (2021).

Download citation


  • Cancer treatment
  • Falls
  • Geriatric oncology
  • Systematic review