Mortality in Cancer Patients after a Fall-Related Injury: The Impact of Cancer Spread and Type
thesisposted on 2012-12-13, 00:00 authored by April Toomey
Among all unintentional injuries, falls are the number one cause of death in the elderly. Cancer patients have shown an increased risk of in-hospital mortality after a trauma (e.g., a fall). We are not aware of any studies that have explored the role of cancer spread/advanced cancer in this relationship. In addition, patients with certain cancer types are more prone to bone injury than other types. We uniquely explored in-hospital mortality after a fall by cancer type. Lastly, we focused only on falls and utilized a broader patient database than previously published studies. A total of 4,201 cancer patients from 2000-2009 in the Illinois Hospital Discharge and Illinois Trauma Registry and 4,201 patients without cancer met eligibility criteria (e.g., fell and were injured; 50-96 years old). To determine cancer status, extent and type (if applicable), ICD-9 billing codes were utilized. Cancer types were: gastrointestinal, lung/bronchus, prostate, female breast, other genitourinary, and lymphatic and hematologic. A myriad of variables, including injury severity and type, comorbid conditions, and trauma complications were examined. We completed the analysis using multiple logistic regression. Cancer versus non-cancer patients did not differ meaningfully on demographics, injury severity or type, or comorbid conditions but did differ on trauma complications. After controlling for variables (including cancer spread) patients with any cancer were 2.21 times more likely to die in-hospital after a fall than patients without cancer (p < .0001). All cancer types except prostate and breast were also more significantly likely to die. Versus patients without cancer, cancer patients with or without spread were 3.83 and 2.28 times more likely, respectively, to die in this study. Cancer types except breast and other genitourinary with spread and prostate and breast without spread were significantly more likely to die in-hospital after a fall-related injury in a highly adjusted model. Cancer patients with and without spread are more likely to die in-hospital after a fall than elderly patients without cancer. However, this relationship may exist only for patients with specific cancer types. Additional research is needed to further examine these relationships.