Falls prechemotherapy and toxicity-related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial

Jingran Ji, Marie Bae, Can Lan Sun, Tanya M. Wildes, Rachel A. Freedman, Allison Magnuson, Tracey O'Connor, Beverly Moy, Heidi D. Klepin, Andrew E. Chapman, William P. Tew, Efrat Dotan, Mary Anne Fenton, Heeyoung Kim, Vani Katheria, Cary P. Gross, Harvey Jay Cohen, Hyman B. Muss, Mina S. Sedrak

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker of vulnerability in older persons is fall history. Here, the authors examined whether falls prechemotherapy can identify older women at risk for toxicity-related hospitalization during adjuvant chemotherapy for breast cancer. Methods: In a prospective study of women >65 years old with stage I–III breast cancer treated with adjuvant chemotherapy, the authors assessed baseline falls in the past 6 months as a categorical variable: no fall, one fall, and more than one fall. The primary end point was incident hospitalization during chemotherapy attributable to toxicity. Multivariable logistic regression was used to examine the association between falls and toxicity-related hospitalization, adjusting for sociodemographic, disease, and geriatric covariates. Results: Of the 497 participants, 60 (12.1%) reported falling before chemotherapy, and 114 (22.9%) had one or more toxicity-related hospitalizations. After adjusting for sociodemographic, disease, and geriatric characteristics, women who fell more than once within 6 months before chemotherapy had greater odds of being hospitalized from toxicity during chemotherapy compared to women who did not fall (50.0% vs. 20.8% experienced toxicity-related hospitalization, odds ratio, 4.38; 95% confidence interval, 1.66–11.54, p =.003). Conclusions: In this cohort of older women with early breast cancer, women who experienced more than one fall before chemotherapy had an over 4-fold increased risk of toxicity-related hospitalization during chemotherapy, independent of sociodemographic, disease, and geriatric factors.

Original languageEnglish
Pages (from-to)936-946
Number of pages11
JournalCancer
Volume130
Issue number6
Early online dateNov 14 2023
DOIs
StatePublished - Mar 15 2024

Keywords

  • adjuvant chemotherapy
  • breast cancer
  • falls
  • geriatric assessment
  • hospitalization
  • older adults
  • toxicity
  • Prospective Studies
  • Humans
  • Hospitalization
  • Geriatric Assessment/methods
  • Aged, 80 and over
  • Female
  • Aged
  • Chemotherapy, Adjuvant/adverse effects
  • Breast Neoplasms/drug therapy

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