Lamba Nayan, Cao Fang, Cagney Daniel N, Catalano Paul J, Haas-Kogan Daphne A, Wen Patrick Y, Aizer Ayal A
Harvard Radiation Oncology Program, Harvard University, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Neurooncol Pract. 2021 Nov 1;9(2):114-122. doi: 10.1093/nop/npab061. eCollection 2022 Apr.
Falls in patients with cancer harbor potential for serious sequelae. Patients with brain metastases (BrM) may be especially susceptible to falls but supporting investigations are lacking. We assessed the frequency, etiologies, risk factors, and sequelae of falls in patients with BrM using 2 data sources.
We identified 42 648 and 111 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham and Women's Hospital/Dana-Farber Cancer Institute (BWH/DFCI) institutional data (2015), respectively, and characterized falls in these populations.
Among SEER-Medicare patients, 10 267 (24.1%) experienced a fall that prompted medical evaluation, with cumulative incidences at 3, 6, and 12 months of 18.0%, 24.3%, and 34.1%, respectively. On multivariable Fine/Gray's regression, older age (≥81 or 76-80 vs 66-70 years, hazard ratio [HR] 1.18 [95% CI, 1.11-1.25], < .001 and HR 1.10 [95% CI, 1.04-1.17], < .001, respectively), Charlson comorbidity score of >2 vs 0-2 (HR 1.08 [95% CI, 1.03-1.13], = .002) and urban residence (HR 1.08 [95% CI, 1.01-1.16], = .03) were associated with falls. Married status (HR 0.94 [95% CI, 0.90-0.98], = .004) and Asian vs white race (HR 0.90 [95% CI, 0.81-0.99], = .03) were associated with reduced fall risk. Identified falls were more common among BWH/DFCI patients (N = 56, 50.4% of cohort), resulting in emergency department visits, hospitalizations, fractures, and intracranial hemorrhage in 33%, 23%, 11%, and 4% of patients, respectively.
Falls are common among patients with BrM, especially older/sicker patients, and can have deleterious consequences. Risk-reduction measures, such as home safety checks, physical therapy, and medication optimization, should be considered in this population.
癌症患者跌倒有可能导致严重的后遗症。脑转移（BrM）患者可能尤其容易跌倒，但缺乏相关的支持性研究。我们使用两个数据源评估了BrM患者跌倒的频率、病因、危险因素和后遗症。
我们分别利用监测、流行病学和最终结果（SEER）-医疗保险数据（2008 - 2016年）和布莱根妇女医院/达纳-法伯癌症研究所（BWH/DFCI）机构数据（2015年）确定了42648例和111例BrM患者，并对这些人群中的跌倒情况进行了特征描述。
在SEER-医疗保险患者中，10267例（24.1%）经历了促使进行医学评估的跌倒，3个月、6个月和12个月时的累积发生率分别为18.0%、24.3%和34.1%。在多变量Fine/Gray回归分析中，年龄较大（≥81岁或76 - 80岁与66 - 70岁相比，风险比[HR]分别为1.18[95%置信区间，1.11 - 1.25]，P <.001和HR 1.10[95%置信区间，1.04 - 1.17]，P <.001）、Charlson合并症评分>2分与0 - 2分相比（HR 1.08[95%置信区间，1.03 - 1.13]，P =.002）以及居住在城市（HR 1.08[95%置信区间，1.01 - 1.16]，P =.03）与跌倒相关。婚姻状况（HR 0.94[95%置信区间，0.90 - 0.98]，P =.004）以及亚裔与白人种族相比（HR 0.90[95%置信区间，0.81 - 0.99]，P =.03）与跌倒风险降低相关。在BWH/DFCI患者中发现的跌倒更为常见（N = 56，占队列的50.4%），分别导致33%、23%、11%和4%的患者前往急诊科就诊、住院、骨折和颅内出血。
跌倒在BrM患者中很常见，尤其是年龄较大/病情较重的患者，并且可能产生有害后果。对于这一人群，应考虑采取降低风险的措施，如家庭安全检查、物理治疗和药物优化。
