Causes of Instability and Falls in Breast Cancer Survivors Treated with Chemotherapy Implications for Physical Therapy Practice
Grabowski, S., SPT; Renner, T., SPT; Wyatt, B., SPT
Faculty Mentor: Janice K. Loudon, PT, Ph.D., SCS, ATC, CSCS
Grabowski, S., SPT; Renner, T., SPT; Wyatt, B., SPT
Faculty Mentor: Janice K. Loudon, PT, Ph.D., SCS, ATC, CSCS
Institution(s): Rockhurst University Department of Physical Therapy, Kansas City, MO
Purpose/Hypothesis: Breast cancer is the second leading cause of death in women in the United States, with a woman having a one in eight chance of being diagnosed with breast cancer. Although chemotherapy is the treatment of choice, it has debilitating side effects which increases risk for falls. Falls and resulting fractures are important to consider in this patient population because chemotherapy results in decreased bone density. The aim of this literature review was to critically analyze the evidence examining breast cancer chemotherapy treatment and the effect on balance and fall risk. As the survival rate of breast cancer patients increases, there is an increased need for interventions to appropriately manage balance deficits. Physical therapy interventions in the form of exercise programs have been reviewed in this study.
Subjects:
Methods/ Materials: Papers were identified from Jstor, PubMed, Cinahl, Scopus, and Ebscohost search engines using the following keywords: breast cancer, chemotherapy, balance, falls, and therapeutic exercise. Based on the Oxford Centre for Evidence-based Medicine levels of evidence, twenty papers were critically analyzed to identify the effect of chemotherapy on balance and falls and the role of physical therapy interventions in breast cancer survivors.
Results: One animal study showed that taxanes and platins altered schwann cell metabolism resulting in symptoms of polyneuropathy, while another demonstrated loss of auditory stereocilia with prolonged and higher doses of taxanes. In humans, because the threshold dose for developing peripheral neuropathy lies very close to the standard dose of chemotherapy being administered, as many as 90% of patients experience chemotherapy-induced peripheral neuropathy following taxane chemotherapy, with associated numbness, tingling, mechanical allodynia and neuropathic pain. Chemotherapy related complications are responsible for almost 58% of breast cancer patients reporting a fall either during or after chemotherapy treatment. Exercise interventions have been shown to improve cardiorespiratory fitness, muscular strength, body composition, quality of life, and decrease fatigue. Survivors initiating exercise immediately after chemotherapy treatments reported a significant increase in quality of life. Aerobic and strengthening effectively improved self-esteem (p=.015), aerobic fitness (p=.006) and maintained body fat levels, while resistance training improved self-esteem (p=.018), muscular strength (p<.001), lean body mass (p=.015), and improved chemotherapy completion rate. Community based programs were effective in reducing fall risk.
Conclusions: A strong correlation is seen between chemotherapy treatment and instability in breast cancer patients. This instability can be secondary to chemotherapy-induced peripheral neuropathy, increased fatigue, decreased muscle strength post-treatment or damage to the vestibular system. Exercise programs initiated as soon as possible can increase strength, endurance, self-esteem, and quality of life while decreasing fatigue. Further research directed specifically at the impact of early exercise intervention on fall risk for breast cancer survivors post chemotherapy treatment are required.
Funding Source: No additional sources of funding
Purpose/Hypothesis: Breast cancer is the second leading cause of death in women in the United States, with a woman having a one in eight chance of being diagnosed with breast cancer. Although chemotherapy is the treatment of choice, it has debilitating side effects which increases risk for falls. Falls and resulting fractures are important to consider in this patient population because chemotherapy results in decreased bone density. The aim of this literature review was to critically analyze the evidence examining breast cancer chemotherapy treatment and the effect on balance and fall risk. As the survival rate of breast cancer patients increases, there is an increased need for interventions to appropriately manage balance deficits. Physical therapy interventions in the form of exercise programs have been reviewed in this study.
Subjects:
Methods/ Materials: Papers were identified from Jstor, PubMed, Cinahl, Scopus, and Ebscohost search engines using the following keywords: breast cancer, chemotherapy, balance, falls, and therapeutic exercise. Based on the Oxford Centre for Evidence-based Medicine levels of evidence, twenty papers were critically analyzed to identify the effect of chemotherapy on balance and falls and the role of physical therapy interventions in breast cancer survivors.
Results: One animal study showed that taxanes and platins altered schwann cell metabolism resulting in symptoms of polyneuropathy, while another demonstrated loss of auditory stereocilia with prolonged and higher doses of taxanes. In humans, because the threshold dose for developing peripheral neuropathy lies very close to the standard dose of chemotherapy being administered, as many as 90% of patients experience chemotherapy-induced peripheral neuropathy following taxane chemotherapy, with associated numbness, tingling, mechanical allodynia and neuropathic pain. Chemotherapy related complications are responsible for almost 58% of breast cancer patients reporting a fall either during or after chemotherapy treatment. Exercise interventions have been shown to improve cardiorespiratory fitness, muscular strength, body composition, quality of life, and decrease fatigue. Survivors initiating exercise immediately after chemotherapy treatments reported a significant increase in quality of life. Aerobic and strengthening effectively improved self-esteem (p=.015), aerobic fitness (p=.006) and maintained body fat levels, while resistance training improved self-esteem (p=.018), muscular strength (p<.001), lean body mass (p=.015), and improved chemotherapy completion rate. Community based programs were effective in reducing fall risk.
Conclusions: A strong correlation is seen between chemotherapy treatment and instability in breast cancer patients. This instability can be secondary to chemotherapy-induced peripheral neuropathy, increased fatigue, decreased muscle strength post-treatment or damage to the vestibular system. Exercise programs initiated as soon as possible can increase strength, endurance, self-esteem, and quality of life while decreasing fatigue. Further research directed specifically at the impact of early exercise intervention on fall risk for breast cancer survivors post chemotherapy treatment are required.
Funding Source: No additional sources of funding