Healthy Living Taking Steps to Prevent Falls

Accidental falls aren’t just a concern for seniors. Cancer survivors of any age are at risk of falls.

Marble steps“Help, I’ve fallen and I can’t get up!” This well-known slogan from an old television ad highlights the high risk of falling among senior citizens. But accidental falls aren’t just a concern for seniors. Cancer survivors of any age are at risk of falls. 

Many survivors are reluctant to think of themselves as being prone to falling; however, falls pose a serious threat for cancer survivors. Falls and fall-related injuries can interfere with your recovery and with important life activities like working, shopping, volunteering, and socializing with family and friends. Falls can lead to serious injuries, such as fractures and brain injuries, and are a leading cause of hospitalizations and even death. Because falls have such serious consequences, it’s critically important to understand the factors that may lead to falls and take steps to prevent them.

Studies estimate that at least half of all cancer survivors will experience a fall. And it isn’t just people in active treatment for whom falls are a concern – even years after treatment ends, survivors continue to be more prone to fall than people of the same age without a history of cancer. In addition, a recent study suggests that near falls are as common as actual falls among cancer survivors. Near falls are slips, trips, stumbles, or losses of balance that don’t result in an actual fall, but that could have. While not as serious as an actual fall, near falls indicate that you may be especially likely to fall and should use caution; you might not be as lucky with avoiding a fall the next time. 

Studies estimate that at least half of all cancer survivors will experience a fall. And it isn’t just people in active treatment for whom falls are a concern – even years after treatment ends, survivors continue to be more prone to fall than people of the same age without a history of cancer.

Why are cancer survivors so likely to experience falls and near falls? Unfortunately, there’s no easy answer. Falls usually occur due to a combination of factors. For example, cancer itself can make people feel weak and tired. And, depending on the location and type of your cancer, symptoms such as pain, shortness of breath, or headaches can interfere with the way you move around. For example, if you have pain in your hips or belly, you may take short, shuffling steps instead of walking normally, thereby increasing your risk of tripping.

Side effects of cancer treatments also make you more prone to falling. Many treatments cause low blood counts (or anemia), resulting in weakness, fatigue, dizziness, and difficulty catching your breath. In addition, many common chemotherapies cause peripheral neuropathy (or numbness,tingling, and pain in the hands and feet) that leads to poor balance and walking problems. Medications, such as those for pain, anxiety, depression, sleep loss, and nausea, can cause dizziness and weakness. And several cancer treatments are linked to fuzzy thinking and poor attention (popularly called brain fog or chemo brain). Not paying close attention when walking down steps, stepping off a curb, or encountering an environmental hazard (such as a wet floor) can contribute to falls. 

Just one of the above-mentioned risk factors increases your chances of experiencing a fall, but many cancer survivors have more than one risk factor. And each additional risk factor adds to the likelihood of you having a fall. On top of that, besides increasing your chances of falling, many cancers and cancer treatments can cause blood-clotting problems and osteoporosis (or brittle bones), so that if you do fall, you are much more likely to experience a serious or even life-threatening injury.

What can I do to prevent falls? Since cancer survivors are at such high risk of falls and fall-related injuries, it’s important to understand the reasons why you are more likely to experience falls, and to do everything possible to prevent them. Unfortunately, there’s no foolproof way to guarantee that it won’t happen to you. But there are several things you can do to lessen your chances of having a fall. Just knowing that, as a cancer survivor, you are at a greater risk of falling is a good first step. 

Here are some other steps you can take to help prevent falls:  
• Talk with your healthcare provider about your cancer and treatment. Ask them about the symptoms and side effects that might cause anemia or that might affect attention, coordination, balance, or walking ability, and increase your risk of falls.
• If you’re taking opioid medications for pain, be sure to change positions slowly and carefully, report side effects such as dizziness or grogginess to your doctor, and try to have a loved one nearby when you are changing positions or walking (at least until you know how the pain medications will affect you). Talk with your doctor about pain management options you can use in addition to opioid medications; for example, massage therapy, music, or meditation. 
• Talk with your pharmacist; they can review all your medications and warn you about those that might increase your chances of falling. Your pharmacist can also identify potentially harmful interactions between your medications, and suggest alternatives.
• Get plenty of rest, but also be sure to get regular exercise (with your doctor’s approval). Even if you are receiving chemotherapy, moderate exercise is generally safe for people with cancer. In fact, studies suggest that survivors who get regular exercise (such as walking 30 minutes a day, 5 days a week) are stronger, have fewer symptoms, are better able to complete their daily life activities, and are less likely to fall.
• Consider asking your healthcare provider for a referral to a rehabilitation clinic to be evaluated by a physiatrist (also called a rehabilitation physician), physical therapist, occupational therapist, or rehabilitation nurse. Rehabilitation professionals specialize in treating impairments that can lead to discomfort, inability to complete daily life activities, and falls. They can also suggest mobility aids and equipment (such as a walking cane or shower grab bars) to help keep you safe.
• Critically examine your home for environmental hazards that could cause a fall, such as throw rugs or loose or missing handrails. You may feel reluctant to install a handrail or get rid of a favorite side table or throw rug, but ask yourself if a serious injury is worth the risk. You could try putting cherished items in a spare bedroom or give them to a family member or friend who may enjoy them and take pleasure in receiving a meaningful gift from you.
• Talk with your family and friends about your increased fall risk. Many survivors are hesitant to admit to loved ones that they may need help because they are eager to prove they have recovered their pre-cancer level of independence. Certainly, nobody wants to have family and friends hovering. But if your loved ones are aware of your fall risk, they can be alert to offer an extra hand if needed. 

Many survivors don’t want to think about their fall risk, and would rather focus on recovery. But understanding your individual risk factors and following some simple preventive steps can decrease your risk of falling and help you have a safe and injury-free life after cancer.

Dr. Grace CampbellDr. Grace Campbell is an assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, PA. As a Certified Rehabilitation Registered Nurse, she has devoted her career to helping people improve their physical functioning in order to get back to living life to the fullest after illness and injury. Her research focuses on understanding the experience of chemotherapy-induced peripheral neuropathy and how it affects physical functioning, fall risk, and disability throughout cancer survivorship. You can follow Dr. Campbell on Twitter @GraceCampbellRN.

This article was published in Coping® with Cancer magazine, September/October 2017.