Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada..
Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Room EN 14-214, 200 Elizabeth Street, M5G 2C4 Toronto, Canada.
J Geriatr Oncol. 2019 Jan;10(1):98-104. doi: 10.1016/j.jgo.2018.08.006. Epub 2018 Aug 31.
Falls are major health issues among older adults and even more so in those with cancer due to cancer and its treatment. Delays in cancer treatment caused by fall injuries may have significant implications on disease trajectory and patient outcomes. However, it is not known how falls impact cancer treatment in this population.
We conducted a convergent-parallel mixed-methods study at the Princess Margaret Cancer Centre in Toronto, Canada, to examine how falls impact cancer treatment in community-dwelling cancer patients aged ≥ 65, patients' fall reporting, and how falls were assessed and managed in oncology clinics. Data were collected by self-reported survey, chart review, and open-ended interviews.
One hundred older adults and fourteen oncologists participated. Falls were not commonly reported by patients to their oncologists (72 of 168 falls [43%] reported to researchers by patients were also reported to oncologists). One of fourteen oncologists routinely assessed falls. In 7% of all 72 reported falls, cancer treatment was impacted (e.g. treatment delay/cessation, dose reduction). Fifty-seven patients perceived their fall as minor incident not worth mentioning (amounted to a total of 72 falls not reported). When a participant reported their fall to the oncologist, actions were taken to assess and manage the fall. Oncologists indicated that the majority of patients were not forthcoming in reporting falls.
One in twenty who fall appear to lead to change in cancer management. However, falls were not commonly reported by patients nor prioritized by oncologists. Incorporating routine fall assessment in oncology clinic appointments may help identify those at risk for falls so that timely interventions can be triggered.
跌倒对于老年人来说是一个主要的健康问题，对于癌症患者来说更是如此，这是由于癌症及其治疗所致。因跌倒受伤而导致的癌症治疗延误可能对疾病进程和患者结局产生重大影响。然而，目前尚不清楚跌倒对这一人群的癌症治疗有何影响。
我们在加拿大多伦多的玛格丽特公主癌症中心进行了一项汇聚平行混合方法研究，以研究跌倒如何影响≥65 岁的社区居住癌症患者的癌症治疗、患者的跌倒报告，以及肿瘤学诊所如何评估和管理跌倒。通过自我报告调查、图表审查和开放式访谈收集数据。
共有 100 名老年人和 14 名肿瘤学家参与了这项研究。患者并未向其肿瘤医生常规报告跌倒（患者向研究人员报告的 168 次跌倒中有 72 次[43%]也向肿瘤医生报告）。14 名肿瘤医生中有 1 名常规评估跌倒。在所有报告的 72 次跌倒中，有 7%（共 72 次跌倒未报告）影响了癌症治疗（例如治疗延迟/停止、剂量减少）。57 名患者认为自己的跌倒只是轻微的、不值得一提的事件（总共 72 次未报告的跌倒）。当患者向肿瘤医生报告其跌倒时，医生会采取行动评估和管理跌倒。肿瘤医生表示，大多数患者不会主动报告跌倒。
每 20 名跌倒的患者中就有 1 名似乎会导致癌症管理的改变。然而，患者并未常规报告跌倒，肿瘤医生也未将其作为优先事项。在肿瘤学门诊预约中纳入常规的跌倒评估可能有助于识别有跌倒风险的患者，以便及时进行干预。
