Why does cancer or cancer treatment put me at a greater risk for a fall?

Cancer, and its treatments, increases the risk of sustaining a fall. Research has found that falls occur in 30-50 per cent of people with cancer over the age of 65.

Various chemotherapy medicines affect physical functioning and can cause vision changes, nerve issues (that can cause decreased sensation in your feet), muscle weakness and loss. There’s also a risk of osteoporosis. Both chemotherapy and radiation cause fatigue, which puts you at higher risk for a fall.

After cancer surgery you might feel fatigue or dizzy, and you may have muscle weakness or loss.

Anti-nausea and pain medications can cause drowsiness and sedation, increasing the risk of falls.

Is a fall something serious? Why?

According to the Public Health Agency of Canada, falls are the leading cause of injury among older adults in Canada:

• 20-30% of seniors experience at least one fall each year
• 95% of all hip fractures are due to a fall
• 50% of all falls causing hospitalization happen at home

Falls can also cause head injuries, hand and arm fractures, all of which can affect an individual’s ability to manage their day-to-day activities.

What can I do to reduce my risk of falling?

• Wear footwear that has good support, low/no heels and a good tread, even inside your home. Avoid wearing stocking/sock feet or going barefoot.
• Inspect your home for falls risks. Ensure that your home is well lit, inside and out. Use night lights. Ensure you have a handrail for use on all stairs. Keep your home tidy and remove any clutter that might cause you to trip — cords, boxes, pet toys. Consider removing all area rugs as they pose a falls risk. If they are not removed, ensure they are well secured with either non-skid backing or double-sided tape. Clear outdoor walkways of leaves, snow and ice.
• Many medications used to treat common health issues like sleep problems, anxiety, depression, blood pressure, pain, arthritis, bladder control, colds and dementia can affect your balance. Talk with your doctor and pharmacist about side effects of your medication, including all prescription medications, over-the-counter medicines and herbal products. Have a medication review with your pharmacist. Make sure you are taking your medications as prescribed. Consider the use of a medication dosette or a blister pack.
• Consider the use of assistive devices. Canes, walkers and rollaters can provide support for people with balance issues or weakness in their legs. Ensure that the rubber tip on the cane is not cracked or worn down. If using a cane outdoors in the winter, use an ice tip for the end of the cane to grip ice and snow. Other equipment that can help prevent falls, particularly in the bathroom which is a common spot for falls, include grab bars, bath chairs, hand-held showers, non-slip tub mats and raised toilet seats. Consider the use of an emergency response system, which will help you and your family feel more secure about being home alone.

What should I do if I do fall? 

Stay calm and don’t rush to get up off the floor. Ensure that you are not injured before trying to get up or letting others help you up. If you aren’t injured and can get up, roll onto your side and slowly push up so that you are on your hands and knees. Crawl to a sturdy chair. By grabbing the seat of the chair and bringing one foot forward with your knee bent and foot flat on the ground, slowly push up from the kneeling position, rise, and turn your body to sit in the chair.

If you cannot get up, shout for help. Call 911 if your phone is nearby. Use an Emergency Response System.

Now that I hear all this, I’m scared I’m going to fall. Should I just reduce my activity and stay home and stay put?

No! Being inactive actually can increase your risk for falls.

• Exercise: Cardiovascular and resistance exercises can help increase muscular strength, flexibility and power, and can also improve balance.
• Consider a Home Safety Assessment with an Occupational Therapist. The therapist can identify areas in your home where falls risks exist and can provide recommendations to reduce your risk of falling. Take to your care team.
• Falls Prevention Clinics in the community. The Sunnybrook Falls Prevention Program involves consultation with a geriatrician and a physiotherapist to assess people over the age of 65 who are having falls or are at risk of falling. This six-week group exercise program is designed to improve strength, balance and gait, and is run by a registered physiotherapist. Education sessions include information about home safety, home exercises and safe medication practices.
• Have regular medical appointments with your physician. Talk to your doctor about any drowsiness, dizziness, blurred vision, unsteadiness or falls you have experienced.

Find more information about falls prevention:

8 winter safety tips for pedestrians

8 tips to prevent falls at home

The post Cancer treatment increases risk of falling. Here’s help. appeared first on Your Health Matters.

The Question: I had radiation and chemo at Sunnybrook three years ago. I want my medical records from the cancer treatment and I am not sure how to go about this.

The Answer: You would think, as a patient, that your information is all in one file. But in fact, some physicians run their practice independently, maintaining their own records. Consequently, information contained in the hospital record may differ from that record maintained by the physician.

Though the information in your medical record belongs to you, the doctor and hospital must keep the original. The physician and hospital also bear the responsibility for keeping it confidential and not allowing any unauthorized use.

Ask for the hospital record. The records department will review the request and the chart. If any information is missing, a request for information will be made from the physician’s office.

Each month, 1,200 to 1,500 requests for medical records are made at Sunnybrook. Current patients can request their information over the telephone or fax, according to Sarina Cheng, director of health data resources, eHealth strategies and operations at Sunnybrook. Requested records are photocopied and provided to patients; soon release of patient information will be provided on a CD.

Patients can also access their hospital record information using MyChart, an online personal health record service, provided they have registered for it – saving travel time to pick up hard copies.  Though chemotherapy reports are not currently available in MyChart, they can be obtained by making a request to health records.

“With MyChart, patients can access hospital record information and share with multiple care providers and personal health participants electronically. Patients can access their information quicker,” said Ms. Cheng. “They can share their information and always have it accessible to them. That satisfies them.”

Another technique is to form the habit of asking for a copy of the record every time you have a health encounter as you can build your own record as you go, saving yourself some money in the end.

At Sunnybrook, patients are provided with a few options to access their personal health information:

• In Person: Patients can come to Sunnybrook’s health records office and make the request.

• By Fax: Patients can download the Authorization for Release of Personal Health Information form through this link https://sunnybrook.ca/content/?page=care-stay-priv-hr. The completed form along with 2 pieces of government issued photo ID can be faxed to 416-480-6123 for processing. By law, hospitals have 30 days to complete this type of request. There is $30, non-refundable administrative fee for the processing of each request, which includes copies of the first 20 pages, plus 25 cents per page thereafter.

• MyChart, https://www.mychart.ca  allows access to more than 1.4 million hospital records in the electronic patient record system at no cost. It has been available to all Sunnybrook patients are since early 2006 and can be accessed anywhere by searching on the Internet.

“Patients can have online access from home to their own medical record – the patient has huge control,” said Ms. Cheng. “If they share access with their physicians, they can identify a family doctor, that physician can see their lab work, emergency notes and medication.”

There are also sections where patients are able to enter their own information, such as symptoms, other personal health appointments such as exercise plans, community services such as nurse care visits, add supplements, diet, family medical history etc. As well, they can invite others to join, including dieticians, physiotherapists and even personal fitness trainers who wish to stay connected to your health status.

Here is what I think you should do: Go to the Odette Cancer Cent which has a health records department or fax Sunnybrook the authorization for release of information form. If in person, please visit the hospital’s Release of Information service desk (located in T2-201) and request copies of your information. We now also have an express desk located in the M-wing main entrance.

The authorization for release of information form is available online and can be downloaded through this link https://sunnybrook.ca/content/?page=care-stay-priv-hr. and fax it to health records at 416-480-4639 with photocopies of two pieces of photo ID for processing. You may also want to explore joining MyChart for ease of access to your record.

The post Three years out of cancer treatment, a patient seeks medical records appeared first on Your Health Matters.

The Answer: I am sorry to hear that your wife’s colorectal cancer has spread. And I can understand why you are looking at different options outside of standard chemotherapy. Sunnybrook has been offering the DEBIRI treatment (intra-arterial infusion of irinotecan-loaded drug-eluting beads) for about two years and while it extends survival significantly, it is not a cure. On average, the Sunnybrook team performs this procedure once or twice a month.

Eligible patients are those with cancer that has spread to the liver that is not surgically operable and has not responded to at least two standard systemic chemotherapy drugs. Typically, these patients have diffuse tumours on their liver – sometimes in a rain shower pattern – making surgical removal impossible.

With DEBIRI, also known as liver chemoembolization, beads are threaded through a small catheter line from the blood vessel into the artery, located in the groin, that supplies blood to the liver. These tiny beads contain a very highly concentrated dose of the chemotherapy drug irinotecan. With this treatment, the blood vessels are partly blocked with the beads, starving the tumor of its blood supply, while concentrating chemotherapy in high doses to the tumours. This devastating “one-two punch” slows, and in some cases, even halts tumor growth.

A small, single institution phase III of a clinical trial of 74 patients randomly assigned to receive DEBIRI (36) versus systemic irinotecan, fluorouracil and leucovorin (FOLFIRI, 38), found a survival advantage for patients who use the treatment, compared to those who use standard intravenous therapy, according to a 2012 study published in the journal, Anticancer Research. The study, while limited, demonstrates the potential DEBIRI has in the treatment of metastatic colorectal cancer.

“It is hard for me to say whether she is a candidate or not without more details,” said Calvin Law, head of the cancer surgery program at Sunnybrook. “We really think that DEBIRI should be examined on a case-by-case basis.”

A team that includes a radiologist, medical oncologist, radiation oncologist and surgical oncologist select what patients would benefit from the treatment.

“If we all agree,” said Dr. Law, “then the interventional radiologist will look at the picture and tell us if they can put the beads in the right place.”

If the treatment is recommended, it takes place in two sessions, usually weeks apart. Each time, the patient is in hospital for two nights and three days. Return to work is widely variable – from as low to a week to a month or longer.

“Typically, there is more than one treatment and occasionally, there are more than three treatments,” said Dr. Law.

The post When Cancer Spreads and Standard Therapy No Longer Works appeared first on Your Health Matters.

The Answer: There are more than 40 different types of lymphoma, a cancer of the lymphatic system, that are typically divided into two main types: Hodgkin lymphoma and Non Hodgkin lymphoma. Since the medical protocols for treating these forms of cancer are standard, most can be easily managed in community and teaching hospitals, according to Eugenia Piliotis, a hematologist who specializes in lymphoma at Sunnybrook.

“In the majority of cases there is no need to be sent to a teaching hospital for treatment,” said Dr. Piliotis, who is also associate professor in University of Toronto’s department of medicine. “Exceptions to that would be if there is a potential for a clinical trial you may be eligible for that you and your physician think you would be a good fit.”

The other exception is if you have a rare type of cancer, such as cutaneous t-cell lymphoma, high-grade lymphomas, or other rare, aggressive types of lymphoma that require super specialized treatment by clinicians as well as pharmacists and nurses most familiar with them.

What I am wondering, though, is if this is a treatment issue or one if you are lacking confidence or are having trouble trusting the oncologist. When a patient has been diagnosed with cancer, it is almost always the worst thing that has ever happened to them. It’s not a surprise, then, if you are wondering whether the treatment your father is obtaining represents the best possible care.

If your father does not have a favorable response that may be due to a cancer that is not responding to treatment and requires another protocol, rather than a clinician who is not providing the best care.

Having said all that, it is reasonable to ask for a second opinion if you are having doubts or you want to confirm the diagnosis and treatment plan. However, to obtain that second opinion, it is best to ask the treating oncologist to arrange it – not your family physician. Just having this conversation with the oncologist may help dissolve some of your concerns.

If you want a second opinion and you are concerned about offending the oncologist, don’t be. So long as you word it politely, it should not be an issue – oncologists are used to being asked for second opinions.

You may want to word your question something along these lines: “I have faith in you but I’m anxious. This is a big diagnosis and I want to make sure I’m doing the right thing for myself. Is it possible to get a second opinion?”

That oncologist is the best person to facilitate the second opinion as she or he can tell the other cancer specialist what treatments, tests and scans you have had.

“Most often patients get here and we tell them the exact same thing that their primary oncologist has already explained, so usually we are just reassuring,” said Dr. Piliotis. “Everyone deserves a second opinion if they have concerns.”

The post What Should I Do if My Father’s Cancer Treatment Doesn’t Work, a Patient Asks appeared first on Your Health Matters.