Skip to main content
SpringerLink
Log in

Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS.

Methods

Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale.

Results

LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05).

Conclusion

LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters.

Implications for Cancer Survivors

Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Global Burden of Disease Cancer Collaboration, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2019;5(12):1749–68. https://doi.org/10.1001/jamaoncol.2019.2996.

    Article  PubMed Central  Google Scholar 

  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin. 2021;71(3):209–49.

  3. Magasi S, Marshall HK, Winters C, Victorson D. Cancer Survivors' Disability Experiences and Identities: A Qualitative Exploration to Advance Cancer Equity. Int J Environ Res Public Health. 2022;19(5):3112.

  4. Weis J. Cancer-related fatigue: prevalence, assessment and treatment strategies. Expert Rev Pharmacoecon Outcomes Res. 2011;11(4):441–6.

    Article  PubMed  Google Scholar 

  5. Sharma N, Hansen CH, O'Connor M, Thekkumpurath P, Walker J, Kleiboer A, et al. Sleep problems in cancer patients: prevalence and association with distress and pain. Psycho-Oncology. 2012;21(9):1003–9.

    Article  PubMed  Google Scholar 

  6. Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42.

    Article  PubMed  Google Scholar 

  7. Koo HY, Seo YG, Cho MH, Kim MJ, Choi HC. Weight change and associated factors in long-term breast cancer survivors. PLoS One. 2016;11(7):e0159098.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Krebber AM, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121–30.

    Article  CAS  PubMed  Google Scholar 

  9. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300–22.

    Article  PubMed  Google Scholar 

  10. Quinten C, Coens C, Ghislain I, Zikos E, Sprangers MA, Ringash J, et al. The effects of age on health-related quality of life in cancer populations: a pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients (PDF). Eur J Cancer. 2015;51(18):2808–19.

    Article  PubMed  Google Scholar 

  11. Pollock AS, Durward BR, Rowe PJ, Paul JP. What is the balance? Clin Rehabil. 2000;14(4):402–6.

    Article  CAS  PubMed  Google Scholar 

  12. Winters-Stone KM, Torgrimson B, Horak F, et al. Identifying factors associated with falls in postmenopausal breast cancer survivors: a multi-disciplinary approach. Arch Phys Med Rehabil. 2011;92:646–52.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Niederer D, Schmidt K, Vogt L, et al. Functional capacity and fear of falling in cancer patients undergoing chemotherapy. Gait Posture. 2014;39(3):865–9.

    Article  PubMed  Google Scholar 

  14. Schmitt AC, Repka CP, Heise GD, Challis JH, Smith JD. Comparison of posture and balance in cancer survivors and age-matched controls. Clin Biomech (Bristol, Avon). 2017;50:1–6.

    Article  PubMed  Google Scholar 

  15. Sattar S, Alibhai SM, Spoelstra SL, Fazelzad R, Puts MT. Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer. 2016;24(10):4459–69.

    Article  PubMed  Google Scholar 

  16. Huang MH, Blackwood J, Godoshian M, Pfalzer L. Prevalence of self-reported falls, balance or walking problems in older cancer survivors from Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey. J Geriatr Oncol. 2017;8(4):255–61.

    Article  PubMed  Google Scholar 

  17. Huang MH, Blackwood J, Godoshian M, Pfalzer L. Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage. PLoS One. 2018;13(12):e0208573.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Morishita S, Mitobe Y, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T. Differences in balance function between cancer survivors and healthy subjects: a pilot study. Integr Cancer Ther. 2018;17(4):1144–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Morishita S, Hirabayashi R, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T. Relationship between balance function and QOL in cancer survivors and healthy subjects. Medicine (Baltimore). 2021;100(46):e27822.

    Article  PubMed  Google Scholar 

  20. Hile ES, Fitzgerald GK, Studenski SA. Persistent mobility disability after neurotoxic chemotherapy. Phys Ther. 2010;90:1649–57.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wampler MA, Topp KS, Miaskowski C, et al. Quantitative and clinical description of postural instability in women with breast cancer treated with taxane chemotherapy. Arch Phys Med Rehabil. 2007;88:1002–8.

    Article  PubMed  Google Scholar 

  22. Tough D, Dunning J, Robinson J, et al. Investigating balance, gait, and physical function in people who have undergone thoracic surgery for a diagnosis of lung cancer: a mixed-methods study. Chron Respir Dis. 2021;18:14799731211052299.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.

    Article  CAS  PubMed  Google Scholar 

  24. Goldberg A, Casby A, Wasielewski M. Minimum detectable change for single-leg stance time in older adults. Gait Posture. 2001;33(4):737–9.

    Article  Google Scholar 

  25. Ulus Y, Durmus D, Akyol Y, et al. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr. 2012;54:429–33.

    Article  PubMed  Google Scholar 

  26. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005;34(6):614–9. https://doi.org/10.1093/ageing/afi196.

    Article  PubMed  Google Scholar 

  27. Muff G, Dufour S, Meyer A, Severac F, Favret F, Geny B, et al. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer. J Phys Ther Sci. 2016;28(9):2445–51.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95.

    Article  PubMed  Google Scholar 

  29. Saglam M, Arikan H, Savci S, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111:278–84.

    Article  PubMed  Google Scholar 

  30. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76. https://doi.org/10.1093/jnci/85.5.365.

    Article  CAS  PubMed  Google Scholar 

  31. Cankurtaran ES, Ozalp E, Soygur H, Ozer S, Akbiyik DI, Bottomley A. Understanding the reliability and validity of the EORTC QLQ-C30 in Turkish cancer patients. Eur J Cancer Care (Engl). 2008;17(1):98–104. https://doi.org/10.1111/j.1365-2354.2007.00827.x.

    Article  CAS  PubMed  Google Scholar 

  32. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26(1):153–61.

    Article  CAS  PubMed  Google Scholar 

  33. American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624.

    Article  Google Scholar 

  34. Stenton C. The MRC breathlessness scale. Occup Med (Lond). 2008;8(3):226–7.

    Article  Google Scholar 

  35. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  36. Yang CC, Fong Y, Lin LC, et al. The age-adjusted Charlson comorbidity index is a better predictor of survival in operated lung cancer patients than the Charlson and Elixhauser comorbidity indices. Eur J Cardiothorac Surg. 2018;53(1):235–40.

    Article  PubMed  Google Scholar 

  37. Sweeney C, Schmitz KH, Lazovich D, et al. Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. 2006;98(8):521–9. https://doi.org/10.1093/jnci/djj130.

    Article  PubMed  Google Scholar 

  38. Potter P, Olsen S, Kuhrik M, Kuhrik N, Huntley LR. A DVD program on fall prevention skills training for cancer family caregivers. J Cancer Educ. 2012;27:83–90.

    Article  PubMed  Google Scholar 

  39. Overcash JA, Rivera HR Jr. Physical performance evaluation of older cancer patients: a preliminary study. Crit Rev Oncol Hematol. 2008;68:233–41.

    Article  PubMed  Google Scholar 

  40. Kang GE, Murphy TK, Kunik ME, Badr HJ, Workeneh BT, Yellapragada SV, Sada YH, Najafi B. The detrimental association between fear of falling and motor performance in older cancer patients with chemotherapy-induced peripheral neuropathy. Gait Posture. 2021;88:161–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kocjan J, Gzik-Zroska B, Nowakowska K, Burkacki M, Suchoń S, Michnik R, Czyżewski D, Adamek M. Impact of diaphragm function parameters on balance maintenance. PLoS One. 2018;13(12):e0208697. https://doi.org/10.1371/journal.pone.0208697. PMID: 30592726

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yan AF, Wang Y, Ng AV. Physical activity and annual medical outlay in U.S. colorectal, breast and prostate cancer survivors. Prev Med Rep. 2018;9:118–23. Published 2018 Feb 2. https://doi.org/10.1016/j.pmedr.2018.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90. https://doi.org/10.1249/MSS.0000000000002116.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Schlairet MC, Benton MJ. Quality of life and perceived educational needs among older cancer survivors. J Cancer Educ. 2012;27:21–6.

    Article  PubMed  Google Scholar 

  45. Hale WA, Delaney MJ, Cable T. Accuracy of patient recall and chart documentation of falls. J Am Board Fam Pract. 1993;6:239–42.

    CAS  PubMed  Google Scholar 

  46. Freiberger E, de Vreede P. Falls recall—limitations of the most used inclusion criteria. Eur Rev Aging Phys Act. 2011;8:105–8.

    Article  Google Scholar 

  47. Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston study. Am J Epidemiol. 2010;171:1031–6.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The Scientific Research Projects Coordination Unit supported the study at Izmir Katip Celebi University (2019-GAP-SABF-0010).

Author information

Authors and Affiliations

  1. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey

    Ilknur Naz, Sevtap Gunay Ucurum & Derya Ozer Kaya

  2. Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey

    Büsra Turgut

  3. Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, Yenisehir Mah. Gaziler Cad. No:331 Konak, 35170, Izmir, Turkey

    Berna Komurcuoglu

Authors
  1. Ilknur Naz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Büsra Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sevtap Gunay Ucurum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Berna Komurcuoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Derya Ozer Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

İ.N., S.G.U., and D.Ö.K. were responsible for the study’s original conceptual design and methodology. İ.N., B.T., and B.K. collected the data. İ.N. and B.T. wrote the main manuscript. D.Ö.K. critically revised the manuscript and contributed intellectually to its content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ilknur Naz.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Izmir Katip Celebi University Non-Interventional Research Ethics Committee (approval number: 32).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naz, I., Turgut, B., Gunay Ucurum, S. et al. Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01492-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11764-023-01492-0

Keywords

Search

Navigation