Severe sarcopenia may be a clinically relevant marker for predicting physical outcomes after chemotherapy among older patients with cancer, according to study findings published in Supportive Care in Cancer.
Previous studies have shown that low skeletal mass is a negative prognostic factor for survival and treatment tolerability among older adults, but the association between severity of sarcopenia before chemotherapy and physical independence after treatment has not been elucidated.
For this prospective study, researchers evaluated 131 patients older than 65 years who received chemotherapy for cancer at least 3 months before the start of the study. Patients underwent 5 functional tests — walking speed, the five-times-sit-to-stand test (FTSTS), handgrip strength, steep ramp test, and ‘timed up and go’ (TUG) — before, at the halfway point, and on completion of chemotherapy. CT-imaging was obtained during routine care to determine muscle mass and diagnose sarcopenia, classified as presarcopenia, sarcopenia, and severe sarcopenia. Findings were correlated to the functional tests. The instrumental activities of daily life (IADL) assessment was used to determine physical independence.
Of the 131 study participants, 47.7% of patients had presarcopenia, 18.5% had sarcopenia, and 7.7% had severe sarcopenia.
Approximately 64% of patients reported having an IADL score of 8, indicating full physical independence, but only 56.3% of patients reported maintaining independence after therapy. A significant decline in physical independence was observed in 11.5% of patients.
Refractory or progressive disease was the only statistically significant variable associated with the decline of physical independence during chemotherapy (univariable odds ratio [OR], 7.54; 95% CI, 1.95-29.14; P =.003). Other measures, such as complete and partial disease response, tumor type, palliative treatment purpose, physical function at baseline, and the presence of distant metastases of solid malignancy were insignificant.
The reduction of physical independence after chemotherapy was not significantly associated with pretreatment presarcopenia (OR, 1.82; 95% CI, 0.63-5.24; P =.0.27) or sarcopenia (OR, 2.56; 95% CI, 0.72-9.08; P =0.15); however, severe sarcopenia was found to trend positively towards postchemotherapy decline in physical independence (OR, 5.95; 95% CI, 0.76-46.48; P =.09).
Severe sarcopenia may be a promising new marker for identifying patients with a higher risk for reduced physical independence after chemotherapy, but the researchers note that studies with larger patient groups are needed to validate these findings.
Rier HN, Jager A, Meinardi MC, et al. Severe sarcopenia might be associated with a decline of physical independence in older patients undergoing chemotherapeutic treatment [published online December 15, 2017]. Support Care Canc. doi: 10.1007/s00520-017-4018-8