Executive function is associated with balance and falls in older cancer survivors treated with chemotherapy: A cross-sectional study

Brendan L McNeish; Kim Dittus; Jurdan Mossburg; Nicholas Krant; John A Steinharter; Kendall Feb; Hunter Cote; Michael K Hehir; Rebecca Reynolds; Mark S Redfern; Caterina Rosano; James K Richardson; Noah Kolb

doi:10.1016/j.jgo.2023.101637

Executive function is associated with balance and falls in older cancer survivors treated with chemotherapy: A cross-sectional study

J Geriatr Oncol. 2023 Nov;14(8):101637. doi: 10.1016/j.jgo.2023.101637. Epub 2023 Sep 28.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: mcneishbl@upmc.edu.
² University of Vermont Cancer Center, Burlington, VT, USA; Department of Medicine, University of Vermont, Burlington, VT, USA. Electronic address: kim.dittus@uvmhealth.org.
³ Department of Physical Therapy, University of Vermont, Burlington, VT, USA. Electronic address: jamossburg@gmail.com.
⁴ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: Nicholas.krant@med.uvm.edu.
⁵ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: john.steinharter@med.uvm.edu.
⁶ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: Feb.Kendall@gmail.com.
⁷ Department of Physical Therapy, University of Vermont, Burlington, VT, USA. Electronic address: hunter.cote@uvm.edu.
⁸ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: Michael.Hehir@uvmhealth.org.
⁹ University of Vermont Cancer Center, Burlington, VT, USA. Electronic address: Rebecca.reynolds@uvmhealth.org.
¹⁰ Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: mredfern@pitt.edu.
¹¹ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: RosanoC@edc.pitt.edu.
¹² Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. Electronic address: jkrich@med.umich.edu.
¹³ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: noah.kolb@uvmhealth.org.

PMID: 37776612
PMCID: PMC10841675 (available on 2024-11-01)
DOI: 10.1016/j.jgo.2023.101637

Abstract

Introduction: Balance decrements and increased fall risk in older cancer survivors have been attributed to chemotherapy-induced peripheral neuropathy (CIPN). Cognition is also affected by chemotherapy and may be an additional contributing factor to poor balance through changes in executive functioning. We examined the association of executive function with balance and falls in older cancer survivors who had been treated with chemotherapy.

Materials and methods: Fifty cancer survivors (aged 65.6 ± 11.5 years; 88% female) who were all treated with chemotherapy were included in this cross-sectional study at a tertiary medical center. Executive function was measured by Trails-B, Stroop, and rapid reaction accuracy, a measure emphasizing rapid inhibitory function. Balance was measured by five sit-to-stand time (5STS), repetitions of sit-to-stand in thirty seconds (STS30), and unipedal stance time (UST), which was the primary balance outcome measure. Self-reported falls in the past year were also recorded and was a secondary outcome. Bivariate analyses were conducted between executive function measures and balance variables. Multivariable models were constructed for UST and falls outcomes and included covariates of age and chemotherapy induced peripheral neuropathy status.

Results: Pearson correlations demonstrated significant relationships between two executive function measures (rapid reaction accuracy, Trails-B) and all the balance measures assessed (UST, STS30, and 5STS). Rapid reaction accuracy correlations were stronger than Trails-B. The Stroop measure correlated solely with UST. In multivariable models, rapid reaction accuracy was associated with better UST (standardized regression coefficient: 64.1, p < 0.01), decreased any fall (odds ratio = 0.000901, p = 0.04), and decreased recurrent falls (odds ratio = 0.0000044, p = 0.01). The interaction of CIPN with the inhibitory measures in the prediction of balance was not significant.

Discussion: Measures of executive function were associated with balance, but among the executive function tests, rapid reaction accuracy had the strongest correlations to balance and was independently associated with falls. The findings suggest that executive function should be considered when assessing fall risk and developing interventions intended to reduce fall risk in older chemotherapy-treated cancer survivors.

Keywords: Accidental falls; Aged; Cancer survivor; Chemotherapy-related cognitive impairment; Executive function.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Accidental Falls
Aged
Cancer Survivors*
Cross-Sectional Studies
Executive Function
Female
Humans
Male
Neoplasms* / drug therapy
Peripheral Nervous System Diseases* / chemically induced

Grants and funding

P30 AG024824/AG/NIA NIH HHS/United States