Abstract
Purpose
Cross-sectional studies suggest that falls are prevalent among older breast cancer survivors. However, fall risk in this population has not been comprehensively examined. Therefore, we compared fall risk in older women post-breast cancer diagnosis to fall risk before cancer diagnosis and to risk in cancer-free matched controls.
Methods
Among 2019 women in the Women’s Health Initiative with localized breast cancer diagnosed at age ≥ 60 years with fall assessment data for 3 years pre-diagnosis and 3 years post-diagnosis, recurrent fall risk post-diagnosis was compared to risk in 2019 cancer-free controls matched by age, year of WHI entry, and baseline fall frequency. Generalized estimating equations under a logistic regression model were used to compare fall recurrence in breast cancer survivors and controls. Multi-variable models were adjusted for the matching factors, race/ethnicity, body mass index, and multiple chronic conditions.
Results
In breast cancer survivors aged 70.8 years (mean) at diagnosis, over the 3-year pre-diagnosis interval, recurrent falls were reported by 18.5%. Over the 3-year post-diagnosis interval, recurrent falls were reported by 21.8% of breast cancer survivors and 20.0% of controls over the same time period (P = 0.27). Recurrent fall risk did not differ between breast cancer survivors and control women (OR 1.07, 95% CI 0.92–1.25), even after multi-variable adjustment.
Conclusions
In contrast to prior reports, older breast cancer survivors were not more likely to experience recurrent falls than age-matched counterparts. These findings underscore the need for incorporation of cancer-free control populations in survivorship studies to distinguish cancer sequelae from processes related to aging.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Robertson MC, Gillespie LD (2013) Fall prevention in community-dwelling older adults. JAMA 309(13):1406–1407. https://doi.org/10.1001/jama.2013.3130
Hartholt KA, Lee R, Burns ER, van Beeck EF (2019) Mortality from falls among US adults aged 75 years or older, 2000–2016. JAMA 321(21):2131–2133. https://doi.org/10.1001/jama.2019.4185
Mohile SG, Fan L, Reeve E, Jean-Pierre P, Mustian K, Peppone L, Janelsins M, Morrow G, Hall W, Dale W (2011) Association of cancer with geriatric syndromes in older Medicare beneficiaries. J Clin Oncol 29(11):1458–1464. https://doi.org/10.1200/jco.2010.31.6695
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics CA 66(4):271–289. https://doi.org/10.3322/caac.21349
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. https://doi.org/10.1016/j.jgo.2014.10.003
Williams GR, Deal AM, Nyrop KA, Pergolotti M, Guerard EJ, Jolly TA, Muss HB (2015) Geriatric assessment as an aide to understanding falls in older adults with cancer. Support Care Cancer 23(8):2273–2280. https://doi.org/10.1007/s00520-014-2598-0
Gewandter JS, Fan L, Magnuson A, Mustian K, Peppone L, Heckler C, Hopkins J, Tejani M, Morrow GR, Mohile SG (2013) Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study. Support Care Cancer 21(7):2059–2066. https://doi.org/10.1007/s00520-013-1766-y
Bylow K, Dale W, Mustian K, Stadler WM, Rodin M, Hall W, Lachs M, Mohile SG (2008) Falls and physical performance deficits in older patients with prostate cancer undergoing androgen deprivation therapy. Urology 72(2):422–427. https://doi.org/10.1016/j.urology.2008.03.032
Overcash JA, Beckstead J (2008) Predicting falls in older patients using components of a comprehensive geriatric assessment. Clin J Oncol Nurs 12(6):941–949. https://doi.org/10.1188/08.Cjon.941-949
Spoelstra SL, Given BA, Schutte DL, Sikorskii A, You M, Given CW (2013) Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer. Oncol Nurs Forum 40(2):E69–E78. https://doi.org/10.1188/13.Onf.E69-e78
Chen Z, Maricic M, Aragaki AK, Mouton C, Arendell L, Lopez AM, Bassford T, Chlebowski RT (2009) Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women's Health Initiative. Osteoporosis Int 20(4):527–536. https://doi.org/10.1007/s00198-008-0721-0
Anderson GL, Manson J, Wallace R, Lund B, Hall D, Davis S, Shumaker S, Wang CY, Stein E, Prentice RL (2003) Implementation of the Women's Health Initiative study design. Ann Epidemiol 13(9 Suppl):S5–17
Carbone LD, Johnson KC, Bush AJ, Robbins J, Larson JC, Thomas A, LaCroix AZ (2009) Loop diuretic use and fracture in postmenopausal women: findings from the Women's Health Initiative. Arch Intern Med 169(2):132–140. https://doi.org/10.1001/archinternmed.2008.526
Masud T, Morris RO (2001) Epidemiology of falls. Age Ageing 30(4):3–7
Ganz DA, Higashi T, Rubenstein LZ (2005) Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval. J Am Geriatr Soc 53(12):2190–2194. https://doi.org/10.1111/j.1532-5415.2005.00509.x
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 34(6):611–635. https://doi.org/10.1200/jco.2015.64.3809
Kojima G, Kendrick D, Skelton DA, Morris RW, Gawler S, Iliffe S (2015) Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomised controlled trial. BMC Geriatr 15:155. https://doi.org/10.1186/s12877-015-0152-7
Bao T, Basal C, Seluzicki C, Li SQ, Seidman AD, Mao JJ (2016) Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk. Breast Cancer Res Treat 159(2):327–333. https://doi.org/10.1007/s10549-016-3939-0
Morishita S, Mitobe Y, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T (2018) Differences in balance function between cancer survivors and healthy subjects: a pilot study. Integr Cancer Therapies 17(4):1144–1149. https://doi.org/10.1177/1534735418790387
Komatsu H, Yagasaki K, Komatsu Y, Yamauchi H, Yamauchi T, Shimokawa T, Doorenbos AZ (2019) Falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy. Asia-Pacific J Oncol Nurs 6(3):253–260. https://doi.org/10.4103/apjon.apjon_7_19
Basal C, Vertosick E, Gillis TA, Li Q, Bao T, Vickers A, Mao JJ (2019) Joint pain and falls among women with breast cancer on aromatase inhibitors. Support Care Cancer 27(6):2195–2202. https://doi.org/10.1007/s00520-018-4495-4
Ejlertsen B, Offersen BV, Overgaard J, Christiansen P, Jensen MB, Kroman N, Knoop AS, Mouridsen H (2018) Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration. Acta Oncol 57(1):3–12. https://doi.org/10.1080/0284186x.2017.1408962
Pan K, Hurria A, Chlebowski RT (2018) Breast cancer survivorship: state of the science. Breast Cancer Res Treat 168(3):593–600. https://doi.org/10.1007/s10549-017-4650-5
Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer–effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132
Arnold BJ, Cumming CE, Lees AW, Handman MD, Cumming DC, Urion C (2001) Tamoxifen in breast cancer: symptom reporting. Breast J 7(2):97–100
Day R, Ganz PA, Costantino JP (2001) Tamoxifen and depression: more evidence from the National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention (P-1) Randomized Study. J Natl Cancer Inst 93(21):1615–1623. https://doi.org/10.1093/jnci/93.21.1615
Cuzick J, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A, Forbes JF (2015) Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol 16(1):67–75. https://doi.org/10.1016/s1470-2045(14)71171-4
Pan K, Chlebowski RT, Simon MS, Ray RM, Livaudais-Toman J, Sullivan SD, Stefanick ML, Wallace RB, LeBoff M, Bluhm EC, Paskett ED (2016) Medication use trajectories of postmenopausal breast cancer survivors and matched cancer-free controls. Breast Cancer Res Treat 156(3):567–576. https://doi.org/10.1007/s10549-016-3773-4
Pahor M (2019) Falls in older adults: prevention, mortality, and costs. JAMA 321(21):2080–2081. https://doi.org/10.1001/jama.2019.6569
Liu-Ambrose T, Davis JC, Best JR, Dian L, Madden K, Cook W, Hsu CL, Khan KM (2019) Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial. JAMA 321(21):2092–2100. https://doi.org/10.1001/jama.2019.5795
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE (2019) Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 1:CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL (2018) Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services task force. JAMA 319(16):1705–1716. https://doi.org/10.1001/jama.2017.21962
Lee R (2017) The CDC's STEADI initiative: promoting older adult health and independence through fall prevention. Am Fam Phys 96(4):220–221
Acknowledgements
We thank the Women’s Health Initiative investigators, staff, and the trial participants for their outstanding dedication and commitment.
Women’s Health Initiative Investigators Program Office: (National Heart, Lung, and Blood Institute, Bethesda, MD) Jacques Rossouw, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kopperberg. Investigators and Academic Centers: (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E, Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thompson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller;(The Lundquist Institute, Torrance, CA) Rowan T. Chlebowski; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker. Additional information: A full list of all the investigators who have contributed to Women’s Health Initiative science appears at: https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pd.
Funding
The WHI program is supported by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129–32, and 44221. Additional support provided by the National Cancer Institute. This report was additionally funded by American Institute for Cancer Research Grant 30210-01 (RTC).
Author information
Authors and Affiliations
Contributions
KP wrote the analysis proposal and initial draft of the report. RR and KP had full access to the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. RR undertook the statistical analysis. All authors provided critical review of the manuscript for important intellectual content. RTC and JAC collected the data and obtained study funding.
Corresponding author
Ethics declarations
Conflict of interest
Dr. Chlebowski reported being a consultant for Novartis, Amgen, AstraZeneca, Genentech, Puma, and Immunomedics and serving on the speaker’s bureau for Novartis, Astra Zeneca and Genentech. No other authors report conflicts.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study as detailed in Women’s Health Initiative study protocol.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pan, K., Ray, R.M., Cauley, J.A. et al. Trajectory of recurrent falls in post-menopausal breast cancer survivors and in matched cancer-free controls. Breast Cancer Res Treat 180, 767–775 (2020). https://doi.org/10.1007/s10549-020-05576-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-020-05576-8