Incidence and associated factors of falls in patients with chemotherapy-induced peripheral neuropathy: a scoping review and evidence mapping.

[OBJECTIVES] Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting more than half of cancer patients. This scoping review aimed to summarize the incidence and factors associated with falls in patients with CIPN and to visually map the distribution of existing evidence, thereby providing a theoretical foundation for the development of preventive measures and intervention strategies.

[METHODS] A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database (CBM), Knowledge Infrastructure (CNKI), Chongqing VIP Information (CQVIP), and Wan Fang Data. The search included articles published from database inception to August 16, 2024. To enhance the synthesis of evidence, a bubble plot-based evidence map was constructed.

[RESULTS] A total of 11,649 records were identified, of which 19 studies were included. Most were quantitative non-randomized studies (n = 17): eight achieved a quality rating of 100%, eight scored 80%, and one scored 60%. Two studies were quantitative descriptive (one scored 80% and one scored 40%). Sixteen studies reported the incidence of fallers among CIPN patients, ranging from 5.6% to 57.4%. Seventeen studies examined fall-related factors in CIPN, which were categorized into 11 groups. Within the evidence map, high-quality and high-OR evidence was observed for CIPN symptoms/severity, advanced or unknown cancer stage, and chronic liver disease. CIPN-related factors were the most frequently reported, followed by demographic factors, suggesting that these domains, particularly those with both high quality and high OR, should be prioritized as targets for future intervention strategies. The adjusted odds ratios (ORs) ranged from 0.997 to 2.67.

[CONCLUSION] Falls are common among patients with CIPN, with high-quality evidence primarily concentrated in the domains of CIPN-related burden, demographic and clinical characteristics of participants, and comorbidities. Future research should (1) conduct multicenter prospective longitudinal cohort studies with time-updated measurements of CIPN and treatment exposures, using standardized definitions of falls and observation windows; (2) strengthen outcome measurement by following COSMIN/Delphi recommendations, including the development of a gold-standard CIPN scale, specification of assessor qualifications, standardized training, and reporting of inter-rater reliability; and (3) re-examine currently unadjusted signals within rigorously controlled multivariable models.