Background <p>Fall related injuries are a clinically important survivorship concern among older adults with cancer because treatment related neuropathy, frailty, muscle weakness, bone loss, fatigue, and functional decline may increase injury vulnerability. Limited evidence has examined whether EHR documented fall related injury risk differs by race among older adult cancer survivors. This study assessed the incidence and prevalence of documented fall related injuries among older adult cancer survivors, with a focus on differences between Black and White cohorts.</p> Methods <p>We conducted a retrospective cohort study using deidentified EHR data from the TriNetX network at Virginia Commonwealth University Health System. The study included 19,370 cancer survivors aged 65 years and older between January 1, 2013, and December 31, 2023. Demographic characteristics, cancer history, and fall related injuries were identified using structured EHR data and ICD 10 diagnosis codes. Incidence proportion, prevalence, and incidence rate per person day were calculated. Comparative measures between Black and White cancer survivor cohorts included risk difference, risk ratio, odds ratio, 95% confidence intervals, Z values, and p values.</p> Results <p>Among 19,370 older adult cancer survivors, 7% experienced a new documented fall related injury, and 8% had any documented fall related injury during the study period. The incidence rate was 0.00005432 cases per person day. Black or African American survivors had a higher EHR documented fall related injury risk than White survivors, 4.915% versus 4.048%, with an absolute risk difference of 0.867%, 95% CI 0.199% to 1.534%, <i>p</i> = 0.008.</p> Discussion <p>Documented fall related injuries were common among older adult cancer survivors and increased with age. The observed higher documented injury risk among Black cancer survivors should be interpreted cautiously and not as evidence that race itself causes falls. Because this study captured EHR documented fall related injuries rather than all falls or self reported falls, the observed difference may reflect clinical risk, injury severity, healthcare utilization, survivorship care, structural factors, or documentation patterns.</p> Conclusions <p>EHR documented fall related injuries represent an important survivorship outcome among older adult cancer survivors. Future research should incorporate detailed clinical, functional, treatment related, and social risk data to clarify the mechanisms underlying observed racial differences and support equitable fall prevention strategies in oncology survivorship care.</p>