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Jensen-Battaglia M, Mohammed M, Loh KP, Wells M, Tylock R, Ramsdale E, Canin B, Geer J, O'Rourke MA, Liu JJ, Seplaki CL, Mohile SG, Wildes TM. Modifiable fall risk factors among older adults with advanced cancer: Secondary analysis of a cluster-randomized clinical trial. J Geriatr Oncol 2023; 14:101650. [PMID: 37897888 PMCID: PMC10872468 DOI: 10.1016/j.jgo.2023.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Older adults with cancer have unique fall risk factors related to their disease and treatment such as polypharmacy and neurotoxic treatments. In this secondary analysis, we identified modifiable risk factors associated with future falls among older adults with advanced cancers. MATERIALS AND METHODS Data were from the COACH study (ClinicalTrials.gov: NCT02107443; PI: Mohile). Patients were age ≥ 70, had stage III/IV solid tumor or lymphoma, ≥1 geriatric assessment impairment, and were receiving palliative intent treatment. Falls were self-reported at baseline (in the past six months), four to six weeks, three months, and six months. We generated inverse probability weights to account for mortality-related loss to follow-up and applied these in generalized linear mixed models to estimate incidence rate ratios. RESULTS Of 541 patients (mean age: 77, standard deviation [SD]: 5.27), 140 (26%) reported prior falls at baseline, and 467 (86%) had falls data for ≥1 follow-up timepoint. Of those, 103 (22%) reported at least one fall during the follow-up period, and 112 (24%) had incomplete follow-up due to death. In fully adjusted models, prior falls and impaired Timed Up and Go score were associated with higher incidence of falls over 6 months. DISCUSSION We identified several potentially modifiable fall risk factors in older adults with advanced cancers. Future studies should consider ways to integrate fall risk assessment into ongoing cancer care and intervene to reduce falls in this population.
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Affiliation(s)
- Marielle Jensen-Battaglia
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Mostafa Mohammed
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Megan Wells
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Rachael Tylock
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Beverly Canin
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St. Louis Park, MN, USA.
| | - Mark A O'Rourke
- NCORP of the Carolinas (Prisma Health NCORP), Greenville, SC, USA.
| | | | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Tanya M Wildes
- University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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Drury A, O'Brien A, O'Connell L, Cosgrave S, Hannan M, Smyth C, Fessele K, Harkin M, Rogers L. Setting a Patient-Driven Agenda for Cancer Research Priorities in Geriatric Oncology: A Qualitative Study. Semin Oncol Nurs 2023; 39:151463. [PMID: 37419848 DOI: 10.1016/j.soncn.2023.151463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES This study aims to explore older adults' perceptions of priorities for research in cancer and hematological malignancies and proposes an agenda of patient-driven priorities for cancer care research in the field of geriatric oncology. DATA SOURCES Sixteen older adults (≥65 years) living with or after a diagnosis of cancer participated in a descriptive qualitative study. Participants were purposively recruited via a regional cancer center and cancer advocacy organizations. Semistructured telephone interviews explored participants' experiences of cancer and perceptions of priorities for future cancer-related research. CONCLUSION Participants reported positive experiences of cancer care. However, positive and negative experiences of information, symptoms, and support both within and beyond the hospital setting were highlighted. Forty-two research priorities in six thematic areas were identified: 1) recognition of the signs and symptoms of cancer; 2) research about cancer treatment; 3) assessment and management of comorbidities; 4) unmet needs of older adults living with and after cancer; 5) impact of COVID-19; and 6) impact on caregivers and family members of people living with and after cancer. IMPLICATIONS FOR NURSING PRACTICE The results of this study provide a basis for future priority-setting activities that are culturally and contextually sensitive to health care systems, resources, and needs of older adults living with and after cancer. Based on the findings of this study, we make recommendations for the development of interventions that can build awareness, capacity, and competence in geriatric oncology among cancer care professionals and consideration of the diverse needs of older adults in the development of interventions to address unmet information and supportive care needs.
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Affiliation(s)
- Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
| | - Aoife O'Brien
- Research Assistant, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Liz O'Connell
- Haematology Advanced Nurse Practitioner, Haematology Department, Tallaght University Hospital, Dublin, Ireland
| | - Sarah Cosgrave
- Registered Advanced Nurse Practitioner, Caritas Day Hospital, St Vincent's Hospital, Dublin, Ireland
| | - Michelle Hannan
- Advanced Nurse Practitioner in Geriatric Oncology, Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Caroline Smyth
- Advanced Nurse Practitioner, Community Intervention Team, Anam Cara, Dublin, Ireland
| | - Kristen Fessele
- Nurse Scientist, Memorial Sloan Kettering Office of Nursing Research, New York, New York
| | - Mary Harkin
- Research & Evaluation Manager, Age & Opportunity Lisa Rogers, Assistant Professor, School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Lisa Rogers
- Research Assistant, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Jensen-Battaglia M, Lei L, Xu H, Loh KP, Wells M, Tylock R, Ramsdale E, Kleckner AS, Mustian KM, Dunne RF, Kehoe L, Bearden J, Burnette BL, Whitehead M, Mohile SG, Wildes TM. Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment. JCO Oncol Pract 2022; 18:e1630-e1640. [PMID: 35984998 PMCID: PMC9835996 DOI: 10.1200/op.22.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations. METHODS Eligible patients (ClinicalTrials.gov identifier: NCT02107443) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample. RESULTS Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% v 10.3%, P < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; P = .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; P = .002) were significantly associated with patient-oncologist conversations about falls. CONCLUSION GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.
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Affiliation(s)
- Marielle Jensen-Battaglia
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Huiwen Xu
- Department of Preventive Medicine and Population Health and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Megan Wells
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Rachael Tylock
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Erika Ramsdale
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Amber S. Kleckner
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland Baltimore, Baltimore, MD
| | - Karen M. Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Richard F. Dunne
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Lee Kehoe
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | | | - Brian L. Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI
| | - Mary Whitehead
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Supriya G. Mohile
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
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