Fall burden among patients with chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis

Chemotherapy-induced peripheral neuropathy (CIPN) is associated with an increased risk of falls; however, the proportion of patients experiencing falls and the factors associated with falls in this population remain uncertain. This review aimed to estimate the proportion of patients with CIPN who experienced at least one fall during study-specific assessment windows and to synthesize factors associated with falls. A systematic review of PubMed, CINAHL, Embase, Web of Science, the Cochrane Library, Wan Fang, and CNKI from inception through January 9, 2026 was performed. Study-specific fall proportions were pooled using a logit-transformed random-effects meta-analysis. Factors associated with falls were synthesized narratively because their definitions, measurement methods, and statistical adjustment varied across studies. This review followed the PRISMA 2020 statement and MOOSE recommendations and was registered with PROSPERO (CRD420251247323). Eleven observational studies involving 2,274 participants with CIPN were included in the meta-analysis; of those, 588 participants reported at least one fall. The pooled fall proportion was 26% (95% confidence interval [CI], 17%–37%; I²=94.69%). Subgroup analysis indicated that studies with assessment windows shorter than 6 months had a pooled fall proportion of 16% (95% CI, 10%–25%), whereas studies with assessment windows of 6 months or longer had a pooled proportion of 36% (95% CI, 24%–51%; P for subgroup difference < 0.001). No significant differences were noted between subgroups for other factors. Leave-one-out estimates ranged from 23% to 28%. Greater CIPN symptom burden and impaired physical function were reported as factors associated with falls; however, the certainty of evidence was very low. Approximately one quarter of patients with CIPN experienced at least one fall, but substantial heterogeneity and very-low-certainty evidence limit the generalizability of this estimate. Studies using longer assessment windows reported higher fall proportions, possibly because longer windows provide more opportunity to record a fall, although other between-study differences may also have contributed. Greater CIPN symptom burden and impaired physical function were reported as factors associated with falls. Prospective studies using standardized fall definitions and assessment windows are needed.