Cancer-Specific Fall Risk Scales Are Needed

When clinicians know which patients are at elevated risk for falling, they can implement interventions to help prevent the fall from happening. However, no cancer-specific fall risk scales exist, leaving oncology providers to rely on broader assessments that do not account for the complexities of cancer treatment.

“Patient falls are a serious adverse hospital event. Consequences of falls can have devastating effects, including unintended injury, prolonged hospitalization, additional unnecessary treatment, and increased costs,” said Danielle Pollock, BSN, RN, OCN, a nurse at Penn Medicine, who said that fall risk “is a mainstay in nursing.”

Pollock presented her team’s research on falls at the 46th Annual ONS Congress virtual meeting.

“In oncology patients, the consequences of a fall may expand further than just prolonged hospitalization and injuries, such as delays in treatment for disease secondary to the fall, which unfortunately could lead to disease progression and worsening prognosis.”

Pollock and her team conducted a systematic literature review on fall risk assessment tools for oncology patients. They found that there was little heterogeneity in the fall risk approaches, which the researchers said prevents full quantitative data synthesis.

“Older oncology patients experience falls at higher-than-desirable rates. Standard for risk assessments do not account for oncology-specific characteristics,” Pollock said. “Therefore, they may not accurately reflect oncology patients’ true risk for falling.”

Sensitivity and specificity were only analyzed in 1 of the studies that Pollock and colleagues looked at. The study involved adult patients with hematologic malignancies who underwent stem cell transplants: 1882 had an autologous transplant, and 450 had an allogenic transplant. The study used the Hendrich II Fall Risk Model. There was a statistical significance on Hendrich, pulse rate, and transplant type in patients who fell compared to those who did not.

However, it was difficult to compare these results to some of the other study results, such as one that found that diarrhea was significantly correlated with an increase fall risk in patients with cancer.

“In conclusion, there is limited evidence regarding oncology-specific fall risk scoring systems,” Pollock said. “The evidence that does exist lacks agreement regarding the risk factors they evaluate. An oncology-specific fall risk assessment may improve identification in this population.”

Reference

Pollock D, Hermann RM, Mitchell MD, Trotta RL. How Do Oncology Fall Risk Scoring Systems Perform? A Systematic Review. Presented at: 46th Annual ONS Congress. April 20, 22, 27, 29, 2021.