Sedative-hypnotic use peri-chemotherapy and short-term fall and fracture risk in older adults with cancer.

Abstract

e13765 Background: Falls and fractures are high-impact geriatric adverse events during chemotherapy. Sedative-hypnotics are potentially modifiable yet frequently used around treatment initiation. We evaluated whether early sedative-hypnotic exposure after chemotherapy start is associated with short-term falls and fractures in older adults with cancer. Methods: We performed a retrospective cohort study using the TriNetX Global Collaborative Network (de-identified EHR data) from January 1, 2015 through December 31, 2025. During this period, 1,520,192 adults aged ≥65 years with a broad range of solid and hematologic malignancies initiating first-line systemic chemotherapy were identified. Exposure was defined as benzodiazepines and/or Z-drugs recorded within 0–7 days on/after chemotherapy initiation, with no documented sedative-hypnotic use prior to chemotherapy. Comparators had no sedative-hypnotic use before chemotherapy and none within 0–7 days after chemotherapy. The index date was chemotherapy initiation. Outcomes were falls and fractures assessed over a 90-day follow-up period from day 8 through day 98 post-index. Propensity score matching was performed using baseline demographics, malignancy category, osteoporosis, chronic kidney disease, neuropathy, dementia, anxiety/depression diagnoses, and baseline opioid and systemic corticosteroid use. Patients with outcomes documented prior to the follow-up window were excluded. Results: In the matched analytic cohorts, falls occurred in 1.2% of exposed patients (1,027/84,402) versus 0.86% of unexposed patients (744/85,824) (absolute risk difference 0.35%, RR 1.404, 95% CI 1.278–1.542, p < 0.0001). Fractures occurred in 0.51% of exposed patients (450/86,826) versus 0.42% of unexposed patients (372/87,429) (absolute risk difference 0.093%, RR 1.218, 95% CI 1.062–1.397, p = 0.0047). Conclusions: Among older adults with cancer initiating chemotherapy, sedative-hypnotic exposure in the first week after chemotherapy initiation was associated with increased risks of falls and fractures during the subsequent 90 days of follow-up. Sedative-Hypnotic use screening in older adults with cancer should be incorporated into pre-chemotherapy evaluation in order to mitigate short-term falls and fractures. Clinicians should consider non-pharmacologic alternatives for sleep/anxiety symptoms and, when medications are necessary, use the lowest effective dose and shortest feasible duration during the peri-chemotherapy period. Association of peri-chemotherapy sedative-hypnotic exposure with risk of falls and fractures. Outcome Peri-chemotherapy sedative-hypnotic exposure No peri-chemotherapy sedative-hypnotic exposure Risk of Falls RR 1.404 (95% CI 1.278–1.542), p < 0.0001 Reference Risk of Fractures RR 1.218 (95% CI 1.062–1.397), p = 0.0047 Reference