• Cancer-Related Balance and Falls: What You Should Know

    The Centers for Disease Control and Prevention (CDC) ranks falls among the leading cause of fatal and nonfatal injuries among older adults in the United States. Annually, more than 1 in 4 adults over age 65 reports falling.

    Although your risk of falling increases with age, your falls risk is not limited to aging. A history of cancer increases your falls risk at any age. This is true whether you are newly diagnosed or receiving end-of-life care. In some studies, 50% to 75% of cancer survivors, including many under the age of 65, reported falling at least once during a period of 6-18 months.

    Your cancer-related falls risk is linked to the cancer diagnosis itself and/or the side effects from cancer treatment.

    Effects of Cancer and Treatment on Balance

     Contributing factors to poor balance and increase falls risk are:

    • Fatigue and pain. These are the two most common symptoms reported by people with cancer, even after treatment. Body discomfort and general fatigue can occur from the tumor itself, or from treatments like surgery, radiation, and chemotherapy.
    • Weakness. Surgery, radiation, and chemotherapies can cause generalized body weakness, or weakness of specific muscles like those in the shoulders or hips. Hospitalization, bed rest, or a decrease in activity are other causes. Radiation therapy can also weaken muscles.
    • Vision impairment. Chemotherapies can affect vision, compromising your ability to safely navigate your environment.
    • Vestibular system impairment. Certain chemotherapies, especially those that cause hearing loss, may affect your inner ear, which helps you maintain your balance.
    • Neuropathy. Some chemotherapies damage nerves, causing numbness, tingling, or pain in the feet and hands. This is called chemotherapy-induced peripheral neuropathy.

    Factors for Higher Risk of Falls

    As simple as it may sound, having a fear of falling is a sign that you are at higher risk. Here are some other signs to watch for:

    • A fall in the last year. Multiple falls, or a fall with injury, are even more concerning.
    • Difficulty walking, such as “slapping” your feet, scuffing your shoes, or tripping. Lower body weakness (eg, difficulty getting up from a chair without using your arms).
    • Difficulty walking without support from another person, furniture, or a device like a cane or walker.
    • Feeling like you are going to fall when you close your eyes or lift one leg (eg, to shower or get dressed).
    • Feeling lightheaded or dizzy, when you first sit up or stand up, or when you turn your head while walking.
    • Requiring help with activities of daily living (ie, bathing or preparing meals).
    • Abnormal sensations in your hands or feet (ie, pins and needles, numbness, tingling).
    • Urinary incontinence (ie, rushing to the restroom).

    How Can a Physical Therapist help?

    A physical therapist will evaluate your overall health and discuss your treatment goals. Your physical therapist will perform a thorough examination to assess your strength, flexibility, sensation, vision, vestibular function, balance, and gait using tasks that simulate your daily activities.

    An individualized treatment plan could include, but is not limited to:

    • Education in postural awareness and correction
    • Balance training, implementing safe but challenging standing and walking tasks to improve your balance
    • Gait training to improve the safety and quality of walking
    • Muscular strength training and conditioning for improved physical function
    • Vestibular rehabilitation activities to challenge your inner ear and brain
    • Education to improve your home and community safety and reduce falls risk; consultation on safe footwear

    Bibliography

    Centers for Disease Control and Prevention. Important facts about falls. Accessed September 18, 2018.

    Winters-Stone KM, Horak F, Jacobs PG, et al. Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy. J Clin Oncol. 2017;35(23):2604–2612. Free Article.

    Huang MH, Shilling T, Miller KA, et al. History of falls, gait, balance, and fall risks in older cancer survivors living in the community. Clin Interv Aging. 2015;10:1497–1503. Free Article.

    Winters-Stone KM, Torgrimson B, Horak F, et al. Identifying factors associated with falls in postmenopausal breast cancer survivors: a multidisciplinary approach. Arch Phys Med Rehabil. 2011;92(4):646–652. Free Article.

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