Relationship Between Falls and Chemotherapy in Female Breast Cancer Survivors: A Systematic Review
Haley Hayes, SPT; Hannah Kacerovskis, SPT; Reagan Kaiser, SPT; Patricia Pampolina, SPT; Linda D'Silva, PT, Ph.D.
Faculty Mentor: Ann Marie Decker, PT, MSA, GCS, CEEAA
Haley Hayes, SPT; Hannah Kacerovskis, SPT; Reagan Kaiser, SPT; Patricia Pampolina, SPT; Linda D'Silva, PT, Ph.D.
Faculty Mentor: Ann Marie Decker, PT, MSA, GCS, CEEAA
Institution(s): Rockhurst University Department of Physical Therapy, Kansas City, MO
Purpose/Hypothesis: The main purpose of this research was to examine the literature related to the relationship between chemotherapy and falls in breast cancer survivors
Subjects:
Methods/ Materials: Two databases; CINAHL and PubMed, were systematically searched to access papers for this study. The search words used were: [breast cancer] AND chemotherapy AND falls. Inclusion criteria: women with breast cancer who were treated with chemotherapy, human subjects over the age of 18 years, and written in English. Studies could be randomized control trials, longitudinal studies, quasi-experimental designs, or case reports from 2008-2018. Exclusion criteria: Presence of balance issues unrelated to breast cancer and chemotherapy, patient only received surgery and radiation as treatment, there was a diagnosis of other neurological conditions such as stroke, MS, Parkinson’s, or metastasis to the brain. The Joanna Briggs Institute (JBI) Critical Appraisal tools were used for appraisal.
Results: Five papers were included based on our search criteria: two cross-sectional studies, one case control, and two case reports. The highest appraised article was the case control study by Winters-Stone et al. which focused on determining fall risk in Breast Cancer Survivors (BCS). BCS had difficulty completing the balance task that challenged the vestibular system. Cytotoxic chemotherapy unaccompanied by other drugs resulted in hair loss affecting the vestibular system. Bao et al. presented a cross-sectional analysis which identified risk factors of Chemotherapy Induced Peripheral Neuropathy (CIPN) following taxane therapy. This study showed that CIPN doubled the fall rate in BCS. Winters-Stone 2009 focused on the differences between pre and postmenopausal women who received chemotherapy for breast cancer, showing that postmenopausal women had increased falls. Hile et al. used the Short Physical Performance Battery to assess gait in one survivor and showed deficits in gait even at a 2.5 year follow up assessment. A case report by Chan et al. also addressed CIPN and how it contributes to high levels of neurotoxicity following paclitaxel use. These studies show that BCS may have vestibular and visual deficits along with CIPN, which may contribute to fall risk.
Conclusions: Higher fall risk among breast cancer patients is a potential consequence of chemotherapy due to its multifactorial impact on body systems, including the neuromuscular, vision, and vestibular systems. Physical therapy has a vital role in this population to educate and provide treatment during and after the last dose of chemotherapy due to its persisting side effects that impact fall risk
Funding Source: No additional sources of funding
Purpose/Hypothesis: The main purpose of this research was to examine the literature related to the relationship between chemotherapy and falls in breast cancer survivors
Subjects:
Methods/ Materials: Two databases; CINAHL and PubMed, were systematically searched to access papers for this study. The search words used were: [breast cancer] AND chemotherapy AND falls. Inclusion criteria: women with breast cancer who were treated with chemotherapy, human subjects over the age of 18 years, and written in English. Studies could be randomized control trials, longitudinal studies, quasi-experimental designs, or case reports from 2008-2018. Exclusion criteria: Presence of balance issues unrelated to breast cancer and chemotherapy, patient only received surgery and radiation as treatment, there was a diagnosis of other neurological conditions such as stroke, MS, Parkinson’s, or metastasis to the brain. The Joanna Briggs Institute (JBI) Critical Appraisal tools were used for appraisal.
Results: Five papers were included based on our search criteria: two cross-sectional studies, one case control, and two case reports. The highest appraised article was the case control study by Winters-Stone et al. which focused on determining fall risk in Breast Cancer Survivors (BCS). BCS had difficulty completing the balance task that challenged the vestibular system. Cytotoxic chemotherapy unaccompanied by other drugs resulted in hair loss affecting the vestibular system. Bao et al. presented a cross-sectional analysis which identified risk factors of Chemotherapy Induced Peripheral Neuropathy (CIPN) following taxane therapy. This study showed that CIPN doubled the fall rate in BCS. Winters-Stone 2009 focused on the differences between pre and postmenopausal women who received chemotherapy for breast cancer, showing that postmenopausal women had increased falls. Hile et al. used the Short Physical Performance Battery to assess gait in one survivor and showed deficits in gait even at a 2.5 year follow up assessment. A case report by Chan et al. also addressed CIPN and how it contributes to high levels of neurotoxicity following paclitaxel use. These studies show that BCS may have vestibular and visual deficits along with CIPN, which may contribute to fall risk.
Conclusions: Higher fall risk among breast cancer patients is a potential consequence of chemotherapy due to its multifactorial impact on body systems, including the neuromuscular, vision, and vestibular systems. Physical therapy has a vital role in this population to educate and provide treatment during and after the last dose of chemotherapy due to its persisting side effects that impact fall risk
Funding Source: No additional sources of funding