Loss of muscle mass and strength in patients with cancer – not as harmless as it sounds

26 March 2019

Lindsey Otten is a nutrition scientist completing her dissertation in the working group of Nutrition and Body Composition within the Research Group on Geriatrics at the Charité Universitätsmedizin Berlin. Here she discusses her Age and Ageing paper “Impact of Sarcopenia on 1-year Mortality in Older Patients with Cancer”.

Nearly 40 years ago, in the late 1980s, the frequently observed decline in muscle mass with increasing age was termed sarcopenia. Since then, sarcopenia has become a hot topic for researchers and clinicians as they work to identify its place in age and disease-related processes. Despite the ongoing search for a clinical definition and diagnostic criteria for sarcopenia, it has become clear that reduced muscle mass leads to functional and metabolic impairment and reduced quality of life leading to increased morbidity and mortality.

In order to distinguish between the contributing mechanisms of muscle depletion, two categories of sarcopenia have emerged. Primary or age-related sarcopenia refers to the changes associated with ageing, for example hormonal and neuromuscular changes, that lead to muscle depletion. Secondary sarcopenia describes the loss of muscle mass as a result of physical inactivity, inadequate nutrition or disease. Thus, particularly older patients with chronic disease, such as cancer, are particularly vulnerable to developing sarcopenia. In addition to physiological age-related changes, older patients with cancer are confronted with the physical and metabolic effects of the cancer disease itself as well as its treatment, which often exacerbates muscle depletion. On the other hand, low muscle mass negatively impacts therapy tolerance and prognosis in patients with cancer.

In our study including 439 older patients with cancer, we identified 27.1% as sarcopenic, defined as having both low muscle mass and strength (assessed with simple, bedside methods). Men were affected more than women and patients with sarcopenia were older than those without. Sarcopenic patients also had a higher number of comorbidities and had a higher intake of medications per day. No difference was found with regard to disease duration, tumour stage and treatment type between patients with and without sarcopenia. Within one year of study entry, more patients with sarcopenia than without had died. Additionally, we found that sarcopenia was nearly as predictive for 1-year mortality as an advanced tumor stage IV.

Our findings show that sarcopenia is prevalent in older patients with cancer – 30% compared to 10% of the healthy, older population worldwide – and was associated with increased 1-year mortality. The fact that sarcopenia was nearly as predictive for 1-year mortality as an advanced disease stage underscores the importance of the timely identification and monitoring of sarcopenia in older patients with cancer and the preservation of muscle mass and function as a crucial target of intervention. Considering the easy-to-use and portable assessment methods available, it is high time to implement widespread screening and monitoring of sarcopenia in order to provide or adjust therapy accordingly and improve prognosis.

Read the Age and Ageing paper Impact of Sarcopenia on 1-year Mortality in Older Patients with Cancer.

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