Meredith Begley

Whether you find yourself walking in a winter wonderland or caught unprepared when the weather outside is frightful, one thing’s for sure: It’s important to be extra careful as you move about in the cold. Studies have shown that falls increase during the winter, when snow and ice can make for treacherous treks, even just out the front door.

People with cancer are at a higher risk for a fall than the general population, says Jillian Hobson, a senior physical therapist at Memorial Sloan Kettering (MSK) who is board-certified in geriatric physical therapy. We spoke to her about why that is and how people can stay safe.

Why are people with cancer prone to falls?

Older adults with a history of cancer have anywhere between a 15% and 20% greater risk of falling compared to the general population of adults age 65 or older. That’s because cancer treatments, such as chemotherapy and radiation, can cause side effects that increase the risk of falls. These include weight loss, muscle weakness, numbness or tingling in the feet, dizziness, changes in eyesight and fatigue. When you lose sensation in your feet, for example, it’s harder to find your balance during challenging situations, such as walking on a slippery sidewalk. It’s harder to know how to find your center of gravity.

Are there warning signs that a person may be at a greater risk for a fall?

There are several behaviors that suggest a person with a history of cancer may be at a greater risk for falling. The person may rely on furniture and walls for support when walking around the house. They may trip or have times when they almost fall. Someone who has fallen in the past or is at risk for falling may also avoid crowded environments, such as busy sidewalks, the grocery store or other people’s homes. At MSK, outpatient physical therapists ask every patient, regardless of age, “Have you fallen in the past 12 months?” If they say yes, we try to prevent it from happening again.

What steps can people take to minimize their risk of falling?

There are many. First, secure throw rugs to the floor with nonslip backing. Clear hallways of clutter, and consider installing handrails in the bathroom or for outdoor stairs. Formulate a plan for snow removal during the winter, preferably before snow starts. During the winter, wear boots with good traction. People who are concerned about falling or have fallen in the past should speak to their doctor to see if physical therapy could help.

What should someone do in the event of a fall?

Today, there are many smartphone apps that can signal a fall to emergency responders. Some smartwatches also have an alert system that can tell when a fall has taken place and can call 911 for you if you are unable. It’s important that your cell phone stays with you at all times and stays on in case of an emergency.

In the event of a fall, people should contact their medical team immediately to determine if they need follow-up care or a referral to physical therapy. If physical therapy is recommended, the physical therapist will identify exercises that promote improved balance, strength and stability. And because falls are not entirely preventable, a physical therapist will also teach strategies for safely getting up from the floor if a fall occurs.

Information provided by MSK (“Information”) is not intended as a substitute for medical professional help or advice but is to be used only as an educational aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. Use of the Information is further subject to 

Articles

Falls are a risk for everyone during slushy winter months, but the risk is especially high for people with cancer. Memorial Sloan Kettering physical therapist Jillian Hobson walks readers through what they can do to minimize the chance of falling.

Winter Is Coming: How People with Cancer Can Prevent Slips and Falls

Getting back into the swing of the school year can be difficult for any child. But for children who have missed school due to 

, returning to the classroom after a long absence can be especially challenging. Memorial Sloan Kettering neuropsychologist and child psychologist 

 regularly works with families readying for this change. At MSK’s 

, he and his team meet with children to see how they’re doing after treatment, both cognitively and emotionally. As part of the comprehensive care available at 

, they offer tools to address any difficulties children may be having.

Here, Dr. Sands shares ideas for how parents can help their child get the school year off to a great start.

 Remember that it’s completely normal for children to have mixed emotions about returning to school. They may be thrilled to be back in a routine with their friends but nervous about looking different or not fitting in. All feelings are welcome. “Create an opportunity for your child to voice whatever concerns they have in an open, nonjudgmental fashion, and then try to support them,” advises Dr. Sands.

 Ask your child how they would like to handle questions about their illness. Some kids may be comfortable talking about it, but others may not.

 Gaining independence is an important step in every young person’s development. “Ask yourself, ‘If my child hadn’t been sick, what would they do right now?’ ” says Dr. Sands. “If they want to be in the theater club or go to a Saturday football game, try not to let your or your child’s anxiety get in the way.”

Students with disabilities can receive structured help with schoolwork through an Individualized Education Program or a 504 plan. Ask your child’s MSK care team or school principal for more information.

Find out who your child’s teachers will be ahead of time and have them meet before the school year starts. “This way, your child will see a familiar face on the first day,” Dr. Sands says.

Members of your child’s MSK care team are happy to speak with school staff about any concerns and may even be able to visit the school to present kid-friendly material to classmates.

Connect with the school’s guidance counselor or psychologist. 

Let your child know there is someone they can talk to if they need a safe space at school.

Going back to school after finishing cancer treatment can be exciting yet anxiety-inducing for a child &mdash; and a parent. Memorial Sloan Kettering neuropsychologist and child psychologist Stephen Sands has tips to help make the transition smoother.

How Parents Can Help Their Kids Get Ready to Go Back to School After Cancer

A lot has changed since the BRCA genes were discovered in the early 1990s. Mutations in 

ncer genes 1 and 2 — were the first specific genetic changes linked to cancers that run in families. These include 

 genes is more available and affordable than ever before.

 mutation status can help guide treatment decisions. It can also raise a red flag about the risk for developing additional cancers. Family members may consider testing as well, to see if they too have an increased cancer risk.

 showed that only about a quarter of women with breast cancer and a third of women with ovarian cancer in Georgia and California had received BRCA testing, it raised eyebrows in the cancer community.

“The rates of genetic testing observed in this study were eye-opening to the cancer genetics and oncology community. Testing rates were much lower than expected,” says 

, Clinical Director of MSK’s Clinical Genetics Service. “Importantly, the study uncovered both racial and socioeconomic disparities in genetic testing rates among women with ovarian cancer. For example, testing rates were far lower for black women than white women. They were also lower for uninsured than insured patients.”

Testing is important because certain targeted drugs may be effective against cancers driven by BRCA mutations.

“With the US Food and Drug Administration’s approval of a class of drugs called PARP inhibitors in both BRCA-associated advanced breast and ovarian cancers, we now know that women with these cancers can benefit from these targeted therapies,” Dr. Stadler says. “Moreover, having a germline

mutation increases the risk of a second cancer, which could be prevented with appropriate enhanced screening or risk-reducing surgery.” (Germline mutations are inherited at birth.)

Women who know they have these mutations may decide to undergo more extensive surgery, for example. This might include the removal of the unaffected ovary or breast.

Experts at MSK say that the study’s low numbers highlight the need for better education among healthcare providers and the general public about the importance of genetic testing and genetic counseling.

However, the numbers seen in this study are not representative of what happens at MSK, says 

. Since 2008, every woman who has come to MSK for 

 has been offered genetic testing. For women with breast cancer, MSK follows the guidelines laid out by the National Comprehensive Cancer Network to determine who would most benefit from genetic testing. Because breast cancer is a more common disease, the guidelines for who should be offered genetic testing are stricter.

The study’s authors noted that obstacles to genetic testing may have influenced low testing rates. These include lack of access to genetic testing, the cost of testing, and 

. Ms. Arnold Ross says that these can be roadblocks for people deciding to get tested no matter where they live. But strides have been made to make testing more accessible.

“These challenges happen everywhere,” she adds. “Out-of-pocket costs can vary, but the cost of genetic testing itself has gone down over the years as the technology has improved and the number of labs competing to run these tests has increased. This is due to peer-reviewed articles documenting the importance of genetic testing for certain people.”

Insurance coverage for genetic tests can also vary, but more and more insurers, including Medicare, are now covering or partially covering this testing. 

 can help ease some of the burden. At MSK, financial assistance is available for people who have genetic testing.

MSK also offers genetic counseling and testing for families that may be at risk. “When a woman has genetic testing and learns that she carries one of these mutations, it can be life-saving for her relatives as well,” Dr. Stadler says. “If they also test positive, they can greatly benefit from enhanced screening and prevention measures.” 

This article was originally published by Memorial Sloan Kettering Cancer Center, and it is subject to these 

A recent study found that only a quarter of women with breast cancer and a third of women with ovarian cancer had undergone genetic testing. Memorial Sloan Kettering experts say these numbers are surprisingly low.

Study Asks: Are Women Missing Out on BRCA Testing?

End-of-life conversations are never easy. 

 at Memorial Sloan Kettering is here to listen to your wishes and validate your feelings.

Not many people are comfortable talking about death. But sometimes, the only way to get more comfortable with something is to face it. On a quarterly basis, people across all walks of Memorial Sloan Kettering — doctors, nurses, patients, caregivers, and more &mdash; do just that when they gather for Death over Dinner, a group conversation centered on end-of-life issues. Sponsored by MSK’s 

Patient and Family Advisory Council for Quality

 (PFACQ), the discussion is quite spirited. People bond over their shared humanity and make space for a topic that some may consider taboo. But “taboo” takes on a new definition in the realm of this conversation, says Frank Licciardi, Co-Chair of the PFACQ.

“It does not mean something is forbidden, but rather sacred,” he says. “And when something is sacred, it should not be avoided — one simply has to be prepared to enter.”

Experts at MSK know how sacred conversations about dying can be. Having such difficult conversations early — perhaps at the point of diagnosis, and even when the outlook is good &mdash; can empower people to make decisions that best suit their needs. That’s because death is a deeply individual experience. “We cannot assume that what is a good death for one patient is a good death for another,” says 

, Director of MSK’s Bereavement Clinic.

Communicate What a Good Death Looks Like for You

Here, Dr. Lichtenthal and other MSK experts offer time-honored wisdom on broaching the subject with family members, loved ones, or your care team.

“The meaning of a ‘good death’ is very personal,” Dr. Lichtenthal says. “It can be about modeling a specific attitude toward dying — and toward living &mdash; for loved ones. It can involve addressing unfinished business, such as having important conversations or doing things one has always wanted to do. It can involve knowing you have made your wishes clear or have taken care of estate issues so others will not have to. It can involve having certain music playing.”

Some people want to die at home, with their family present. Some people prefer hospice care, which is a specific form of 

 that aids people as they near the end of life. Others prefer medical intervention for as long as possible. It’s important to think about what feels right for you, and to make it known. “This can lead to one’s end-of-life wishes being fulfilled, and it also relieves those who may ultimately be in the position of making decisions on behalf of their loved one,” Dr. Lichtenthal says. Having to guess someone’s wishes can be difficult for relatives and loved ones to manage. “Leaving decisions to family puts them in a precarious position,” adds Mr. Licciardi. “They are asked to make vital decisions for those they care most about in a very stressful environment.”

At MSK, it’s not just your doctor wants to know how you’re feeling and what’s on your mind. Nurses, 

, and other professionals are dedicated to sharing in your experience and helping you navigate it. “Only good things can follow when people can connect with their care teams,” says Mr. Licciardi.

In stressful circumstances, it’s helpful to designate one person in a family — usually a caregiver &mdash; as the lead communicator. This way, information remains consistent. There are ways to include other loved ones, especially children, in a conversation. “

, psychologists, and social workers are often instrumental in helping adults navigate decisions about if and how to discuss these matters with children,” says medical oncologist 

“When a family is already coping with the weight of grief, it can be extremely challenging to have to cope with disagreements or distress related to their loved one’s estate,” says Dr. Lichtenthal. “When possible, it can be helpful for people to discuss all the decisions they’ve made about their estate with those who might be involved or affected.” It may also be helpful to talk about tasks you manage around the house. For example, as trivial as it may sound, you could show loved ones how to work the DVR, the air-conditioning, or another tool they may not be too familiar with. Any time you can remove a frustration in the lives of your loved ones, no matter how small, you are empowering them to cope with the many changes they may face.  

Ongoing discussions about your wishes can help you feel more comfortable talking about death. 

 wants to know what you want to know about what lies ahead: a lot of details, some details, only necessary information. “We know just how hard these conversations can be, and we want to hear from people regularly,” says Dr. Epstein. “We’re here to validate concerns people have and provide ongoing, never-ending support.”

End-of-life conversations are never easy. Your care team at Memorial Sloan Kettering is here to listen to your wishes and validate your feelings.

Meredith Begley

Winter Is Coming: How People with Cancer Can Prevent Slips and Falls

How Parents Can Help Their Kids Get Ready to Go Back to School After Cancer

Study Asks: Are Women Missing Out on BRCA Testing?

Hard Conversations: How to Talk to Your Cancer Care Team and Loved Ones about Dying

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