Patients with brain metastasis and the risk of falls: a plausibly preventable entity

Falls can be detrimental to the health of any individual with consequences that can be even deadly. In clinical practice, a fall often precipitates the need for medical care, and the physical and psychological impacts to the patient are significant. This problem can cause substantial morbidity and mortality particularly in elderly individuals. Using population studies from Medicare data, 30% of older adults aged 65 and over fall each year resulting in serious injuries with subsequent decreased mobility, and loss of independence.1,2 Falls also have significant economic impact. A 2015 study found that the estimated medical cost attributable to both fatal and nonfatal falls was approximately $50 billion.3

Several studies have attempted to assess the impact of falls in patients with cancer. One study found that patients with primary brain neoplasms or metastases were more than twice as likely to fall as patients without cerebral involvement.4

Although studies identified the incidence and risk factors of falls amongst patients with cancer and metastasis to the CNS, no study has been dedicated specifically to brain metastasis. Until recently, there have been no reports that address the frequency, etiology, or risk factors of falling, nor its impact on the patient’s wellbeing.

The paper published by Dr. Nayan Lamba and colleagues is the first report to address this important health issue of falls amongst patients with brain metastasis.5 The authors extracted a large data cohort from Surveillance, Epidemiology, and End Results (SEER)-Medicare records over a period of 8 years, rendering a large population to study. These data convey important statistics as to the rate at which patients with brain metastasis fall, but do not answer questions such as etiology as they are based on Medicare payment claims. To offset these limitations, the authors studied a contemporaneous institutional cohort which allowed them to obtain more granular data to complement the nation-wide data obtained from the SEER-Medicare archived information. The institutional study renders important information that can be utilized clinically, as it shows the most common causes of falls.

The combined information from both cohorts provides a powerful tool, using risk factors and etiologies that could suggest ways to prevent falls amongst this patient population. This could lead to prospective studies where preventative measures could be implemented to discern whether these measures indeed curtail falls. If proven, then well-defined measures could be implemented which would positively impact the overall health, wellbeing, and quality of life of these patients. Preventative measures for falls could be implemented by identifying risk factors, such as cognitive decline that can be seen in patients with brain metastasis,6,7 to reduce the risk of falls.

Lamba and colleagues’ study demonstrates that there is opportunity for prospective research to identify not only the incidence, but very importantly, risk factors that can be modified to prevent falls. For instance, the US Preventive Services Task Force (USPSTF) has published recommendations on the prevention of falls in community-dwelling older adults.8 The opportunity would be to identify how these recommendations could be implemented for this population.

In summary, falls among patients with brain metastasis can cause significant morbidity and mortality, and there is a real opportunity to conduct collaborative multi-institutional prospective studies to identify tools to prevent falls, and to make the enquiry of risk factors for falling part of daily clinical practice.