The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: Results from a mixed-methods study

Background: 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. Methods: 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. Results: 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. Conclusion: 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. (C) 2018 Elsevier Ltd. All rights reserved.