Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors at 6 months post treatment. Poor balance and mobility have been well documented in cancer survivors with CIPN and might be further compounded by fear of falling. Yet, determinants of fear of falling among cancer survivors with CIPN are still unclear.
The aim of this study was to investigate fear of falling and its relationship with disease severity, balance, mobility and physical activity in cancer survivors with CIPN compared with age and sex-matched healthy controls.
Methods
Fifty-eight cancer survivors with CIPN (mean (SD) age: 59.8 (10.0) years) who were ≥3months post chemotherapy and 16 healthy age and sex-matched controls completed a fear of falling questionnaire (Falls Efficacy Scale –International (FES-I)) and a physical activity questionnaire. They also performed assessments of postural sway, choice-stepping reaction time, functional mobility (Timed Up and Go) and walking capacity (6minute walk test). CIPN was assessed using neurological grading and patient-reported outcome measures.
Results
Compared with CIPN participants with low fear of falling (n=40, FES-I score < 28), those with high fear of falling (n=18, FES-I score ≥ 28) had significantly higher objective and patient-reported CIPN severity. They also showed significantly slower choice-stepping reaction time, worse functional mobility and walking capacity, as well as lower energy expenditure compared with both the low fear of falling group and the controls. The CIPN groups did not differ in age, proportion of female or postural sway. Higher CIPN severity and worse stepping or mobility performances were independently associated with fear of falling in multivariate models.
Conclusion
The findings highlight the importance of assessing fear of falling among cancer survivors with CIPN. Future studies should determine whether exercise rehabilitation lead to reductions in fear of falling among cancer survivors with CIPN.