Falls among cancer patients are a significant safety concern that can greatly impact their quality of life. Understanding the various underlying reasons for these falls is important for patients and their caregivers. Multiple factors, from the disease itself to its treatments and other co-existing health conditions, can increase the risk of losing balance and falling. Addressing these elements is a key step toward preventing falls and promoting overall well-being.
How the Cancer Itself Contributes
The presence of cancer can directly contribute to an increased risk of falls through several physiological changes. Cancer-related fatigue (CRF) is a common and debilitating symptom that impairs physical and cognitive function, making stable movement challenging. This profound exhaustion can affect a person’s awareness and ability to react quickly to balance disturbances.
Muscle weakness, often presenting as cancer cachexia, involves significant muscle loss and reduced strength, making it harder to maintain balance. When cancer spreads to the bones (bone metastases), it can weaken the skeletal structure, increasing the risk of fractures or causing pain that alters gait. Neurological involvement, such as tumors affecting the brain or spinal cord, can directly impair balance, coordination, and motor control. Additionally, paraneoplastic syndromes, where the immune system attacks healthy nervous system cells, can cause symptoms like trouble walking, loss of coordination, and muscle weakness, further elevating fall risk.
Treatment-Related Causes
Cancer treatments, while often life-saving, can significantly increase a patient’s risk of falling due to side effects. Chemotherapy frequently causes peripheral neuropathy, a type of nerve damage leading to numbness, tingling, pain, or weakness in the hands and feet. This neuropathy can severely affect sensation and balance, making foot placement difficult. Chemotherapy can also induce fatigue and nausea, which may lead to dehydration and dizziness, further compromising stability.
Radiation therapy contributes to fall risk, primarily through inducing fatigue. If directed at areas like the brain or spine, it can directly affect balance and coordination. Surgical interventions can result in post-operative weakness, pain, and temporary mobility restrictions. Immunotherapy and targeted therapies can still cause fatigue, inflammatory side effects affecting muscles and joints, or neurological toxicities, all of which may impair balance and increase the likelihood of falls.
Medication Side Effects
Many supportive medications commonly prescribed to cancer patients can independently raise the risk of falls. Pain medications, particularly opioids, can cause sedation, dizziness, and orthostatic hypotension (a sudden drop in blood pressure upon standing), which impair balance and alertness.
Anti-nausea drugs can sometimes induce drowsiness or dizziness, contributing to unsteadiness. Corticosteroids can lead to muscle weakness, particularly with long-term use, and may also affect fluid retention. Sedatives and other medications for anxiety or sleep can significantly impair a patient’s alertness and coordination. The cumulative effect of taking multiple medications, known as polypharmacy, is concerning, as drug interactions can exacerbate side effects and significantly increase fall risk.
Other Health Factors and Their Role
Several other health factors, often pre-existing or exacerbated by cancer and its treatments, play a role in increasing fall risk. Anemia can lead to generalized weakness, fatigue, and dizziness due to reduced oxygen delivery. Nutritional deficiencies can result in muscle wasting and overall weakness, compromising physical stability.
Vision impairment affects a person’s ability to navigate their environment safely and perceive obstacles. Cognitive changes, sometimes referred to as “chemo brain,” can impair judgment, attention, and reaction time. Pre-existing medical conditions, such as diabetes, cardiovascular disease, or arthritis, can independently contribute to balance issues, muscle weakness, or neuropathies, further compounding the risk of falls.