P-112: Fall risk assessment and fall prevention in patients with multiple myeloma: first results of the MYFALL-trial

Introduction: The risk of falling is increased in elderly cancer patients and might lead to functional decline, loss of independence and hence quality of life. Several disease- and therapy-associated symptoms, for example sarcopenia, impaired mobility, peripheral neuropathy, and fatigue are linked to an increased fall incidence. Aim of the MYFALL-trial is to identify risk factors for falls and underlying causes of gait impairment in patients with multiple myeloma (MM) and includes an individualized exercise intervention for fall prevention.

Methods: In the first part of the MYFALL-trial, a fall risk assessment was conducted. Patients with MM (n=82) who had undergone at least 6 months of systemic treatment were questioned about fall incidents, gait impairment and musculoskeletal pain. Questionnaires were used to assess peripheral neuropathy (EORTC-CIPN-20), fear of falling (FES-I), fatigue (MFI), and sarcopenia (SARC-F). Additionally, three mobility tests (timed-up and go (TUG), 30s chair rise and gait speed) were performed, as well as the MoCA-test to evaluate cognitive impairment.

Results: Patients‘ median age was 68y and 63% were male. Overall, 55% of patients experienced gait impairment. Underlying causes were most often attributed to fear of falling (31%), balance/coordination problems (36%) and numbness of the feet (44%).

In patients with gait impairment questionnaire-results in the following categories were significantly higher: age, peripheral neuropathy (sensory, motor and autonomic symptoms), fear of falling, and sarcopenia (all p < 0.05). Moreover, mobility (TUG) was reduced (mean 11.7s, p < 0.05) and the number of patients experiencing musculoskeletal pain was significantly higher (82%, p < 0.05). Among patients with gait impairment 33% reported falls in the last 12 months. In these patients tests for sarcopenia and mobility differed significantly, as was reflected by SARC-F score ≥4 and increased TUG (mean 15.3s).

Conclusions: Gait impairment occurs frequently in myeloma patients and seems to be of multifactorial etiology. Advanced age, peripheral neuropathy, fear of falling, sarcopenia and reduced mobility are contributing factors. Of note, the incidence of musculoskeletal pain was particulary high in these patients, which is a known risk factor for falls.

According to our results, further deterioration of muscle strength and decline in mobility are the decisive factors which eventually lead to fall incidents in patients with gait impairment. Part 2 of the MYFALL-trial will address these underlying issues by means of an exercise intervention consisting of resistance and balance training (including perturbation-based training) for fall prevention in myeloma patients.