Sarcopenia in Advanced Serous Ovarian Cancer Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non–Small Cell Lung Cancer The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Sarcopenia as a predictor of survival and chemotoxicity in patients with epithelial ovarian cancer receiving platinum and taxane-based chemotherapy. Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery. Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study Muscle strength in breast cancer patients receiving different treatment regimes Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial
Objective Cancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion ( sarcopenia ) . Although weight loss has been associated with poor clinical outcome , there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far . Methods Total skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer . Longitudinal change of muscle mass was studied in  209 consecutive computed tomography scans  from 43 patients . Association with survival was determined using Cox proportional hazards model . Results The prevalence of sarcopenia at first diagnosis was 11 % ( 12/105 ; 95 % confidence interval [ CI ] , 6%–20 % ) . Sarcopenic patients had a significantly reduced progression-free ( hazard ratio , 2.64 ; 95 % CI , 1.24–5.64 ; P = 0.012 ) and overall survival ( hazard ratio , 3.17 ; 95 % CI , 1.29–7.80 ; P = 0.012 ) . On multivariable analysis , these prognostic effects remained significant after adjustment for age , International Federation of Gynecology and Obstetrics stage , and postsurgical residual disease . Longitudinal analyses identified both patients with loss and gain of muscle mass . However , change in muscle mass over time was not associated with survival . Conclusions Baseline sarcopenia is a prognostic factor in advanced serous ovarian cancer . Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospect i ve clinical trials BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article Purpose Preoperative chemo(radio)therapy for oesophageal cancer ( OC ) may have an attritional impact on body composition and functional status , impacting postoperative outcome . Physical decline with skeletal muscle loss has not been previously characterised in OC and may be amenable to physical rehabilitation . This study characterises skeletal muscle mass and physical performance from diagnosis to post-neoadjuvant therapy in patients undergoing preoperative chemo(radio)therapy for OC . Methods Measures of body composition ( axial computerised tomography ) , muscle strength ( h and grip ) , functional capacity ( walking distance ) , anthropometry ( weight , height and waist circumference ) , physical activity , quality -of-life and nutritional status were captured prospect ively . Sarcopenia status was defined as pre-sarcopenic ( low muscle mass only ) , sarcopenic ( low muscle mass and low muscle strength or function ) or severely sarcopenic ( low muscle mass and low muscle strength and low muscle function ) . Results Twenty-eight participants were studied at both time points ( mean age 62.86 ± 8.18 years , n = 23 male ) . Lean body mass reduced by 4.9 ( 95 % confidence interval 3.2 to 6.7 ) kg and mean grip strength reduced by 4.3 ( 2.5 to 6.1 ) kg from pre- to post-neoadjuvant therapy . Quality -of-life scores capturing gastrointestinal symptoms improved . Measures of anthropometry , walking distance , physical activity and nutritional status did not change . There was an increase in sarcopenic status from diagnosis ( pre-sarcopenic n = 2 ) to post-treatment ( pre-sarcopenic n = 5 , severely sarcopenic n = 1 ) . Conclusions Despite maintenance of body weight , functional capacity and activity habits , participants experience declines in muscle mass and strength . Interventions involving exercise and /or nutritional support to build muscle mass and strength during preoperative therapy , even in patients who are functioning normally , are warranted Purpose This study aim ed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer ( stages I – IIIA ) . Methods A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospect i ve Health , Eating , Activity , and Lifestyle Study were included in this study . Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception , on average , 12 months after diagnosis . Sarcopenia was defined as two st and ard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared ( < 5.45 kg/m2 ) . Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries . Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality . Results Median follow-up was 9.2 years ; 75 women were classified as sarcopenic , and among 92 deaths , 46 were attributed to breast cancer . In multivariable models that included age , race-ethnicity/ study site , treatment type , comorbidities , waist circumference , and total body fat percentage , sarcopenia was independently associated with overall mortality ( hazard ratio ( HR ) = 2.86 ; 95 % CI , 1.67–4.89 ) . Sarcopenic women had increased risk of breast-cancer-specific mortality , although the association was not statistically significant ( HR = 1.95 , 95 % CI , 0.87–4.35 ) . ConclusionS arcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality . The development of effective interventions to maintain and /or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study . Implication s for Cancer SurvivorsSuch interventions may help breast cancer patients live longer Background : Muscle wasting is a component of the diagnosis of cancer cachexia and has been associated with poor prognosis . However , recommended tools to measure sarcopenia are limited by poor sensitivity or the need to perform additional scans . We hypothesized that pectoralis muscle area ( PMA ) measured objective ly on chest CT scan may be associated with overall survival ( OS ) in non – small cell lung cancer ( NSCLC ) . Methods : We evaluated 252 cases from a prospect ively enrolling lung cancer cohort . Eligible cases had CT scans performed prior to the initiation of surgery , radiation , or chemotherapy .  PMA was measured in a semi-automated fashion while blinded to characteristics of the tumor , lung , and patient outcomes . Results : Men had a significantly greater PMA than women ( 37.59 vs. 26.19 cm2 , P < 0.0001 ) . In univariate analysis , PMA was associated with age and body mass index ( BMI ) . A Cox proportional hazards model was constructed to account for confounders associated with survival . Lower pectoralis area ( per cm2 ) at diagnosis was associated with an increased hazard of death of 2 % ( HRadj , 0.98 ; confidence interval , 0.96–0.99 ; P = 0.044 ) while adjusting for age , sex , smoking , chronic bronchitis , emphysema , histology , stage , chemotherapy , radiation , surgery , BMI , and ECOG performance status . Conclusions : Lower PMA measured from chest CT scans obtained at the time of diagnosis of NSCLC is associated with a worse OS . Impact : PMA may be a valuable CT biomarker for sarcopenia-associated lung cancer survival . Cancer Epidemiol Biomarkers Prev ; 26(1 ) ; 38–43 . © 2016 AACR . See all the articles in this CEBP Focus section , “ The Obesity Paradox in Cancer : Evidence and New Directions . BACKGROUND : Computed tomography-derived body composition parameters are emerging prognostic factors in colorectal cancer . OBJECTIVE : This study aim ed to determine the roles of sarcopenia , myosteatosis , and obesity as independent and overlapping parameters in stage I to III colorectal cancer . DESIGN : This is a retrospective cohort study from a prospect ively collected data base . Multivariate Cox proportional hazards models were performed to assess the associations between body composition parameters and survival . SETTING S : All patients were seen in a tertiary care cancer center . PATIENTS : Adult patients with stage I to III colorectal cancer , undergoing curative resection from 2007 to 2009 , were included . INTERVENTION : Computed tomography-derived quantification of skeletal muscle and adipose tissues was used to determine population -specific cutoffs for sarcopenia , myosteatosis , and total adiposity . MAIN OUTCOME MEASURES : Primary outcome measures were overall , recurrence-free , and cancer-specific survival . RESULTS : In the 968 patients included , there were a total of 254 disease  recurrences and 350 deaths . Body mass index and CT-derived measures of adiposity did not result in worse survival outcomes . Sarcopenia was independently predictive of worse overall ( HR , 1.45 ; 95 % CI , 1.16 - 1.84 ) , recurrence-free ( HR , 1.32 ; 95 % CI , 1.00–1.75 ) , and cancer-specific survival ( HR , 1.46 ; 95 % CI , 1.09–1.94 ) in a multivariate model . Myosteatosis was also independently predictive of overall survival ( HR , 1.53 ; 95 % CI , 1.19–1.97 ) . In a model considering joint effects of sarcopenia and myosteatosis , the presence of both predicted the worst overall ( HR , 2.23 ; 95 % CI , 1.62–3.06 ) , recurrence-free ( HR , 1.53 ; 95 % CI , 1.06–2.21 ) , and cancer-specific survival ( HR , 2.40 ; 95 % CI , 1.69–3.42 ) in a multivariate model . LIMITATIONS : The limitations of this study are inherent in retrospective observational studies . CONCLUSIONS : Sarcopenia and myosteatosis are independent predictors of worse survival in stage I to III colorectal cancer , and their joint effect is highly predictive of reduced overall , recurrence-free , and cancer-specific survival . See Video Abstract at http://links.lww.com/DCR/A923 PURPOSE Effects of specific antineoplastic therapies on progression of cancer-associated wasting remain uncharacterized . We selected a targeted therapy , sorafenib , because of its reported association with weight loss . PATIENTS AND METHODS Patients with metastatic renal cell cancer ( RCC ) who were resistant to st and ard therapy ( N = 80 ) received sorafenib 400 mg twice daily or placebo in a r and omized , double-blinded clinical trial . Computed tomography image analysis , which has high precision and specificity for evaluation of specific muscles and adipose tissues , was used to define change in total skeletal muscle and adipose tissue . Results At inclusion , 51 % of patients were overweight or obese ( ie , body mass index [ BMI ] > 25 kg/m(2 ) ) . Only 5 % were underweight .  Advanced muscle wasting ( ie , sarcopenia ) was present in 72 % of patients with BMI less than 25 and in 34 % of those with a BMI greater than 25 . Patients received placebo for an average of 6 months and received sorafenib for 1 year . Patients in the placebo group had stable body weight during 6 months ( 0.8 kg + /- 0.7 kg ) , with no significant alteration of muscle or fat . Patients who received sorafenib  lost 2.1 kg + /- 0.6 kg ( P < .01 ) in 6 months and lost 4.2 kg + /- 0.7 kg ( P < .01 ) by 1 year . Sorafenib-treated patients lost skeletal muscle progressively at 6 months ( decrease of 4.9 % ; P < .01 ) and 12 months ( decrease of 8.0 % ; P < .01 ) . CONCLUSION Sarcopenia is prevalent in patients with metastatic RCC and is an occult condition in patients with normal or high BMI . Muscle loss is specifically exacerbated by sorafenib , consistent with the evidence for a role of kinases in regulating muscle mass . Muscle loss is a sorafenib adverse effect that may relate to asthenia , fatigue , and physical disability INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic OBJECTIVES Severe skeletal muscle loss ( sarcopenia ) is associated with poor cancer outcomes , including reduced survival and increased treatment toxicity . Our goal was to evaluate if sarcopenia was associated with worse survival outcomes and chemotoxicity in EOC patients undergoing primary platinum and taxane-based chemotherapy .  METHODS EOC patients diagnosed between 06/2000 and 02/2017 who received treatment with platinum and taxane-based chemotherapy were included .  CT abdominal images closest to the time of diagnosis were retrospectively evaluated for skeletal muscle area at the 3rd lumbar vertebrae . Measurements were obtained with use of TomoVision ® radiological software ( SliceOmatic - version 5.0 , Quebec , Canada ) . Sarcopenia was defined as Skeletal Muscle Index ( SMI ) ≤ 41 . Data analysis included Kaplan-Meier plots to assess survival , and unpaired t-tests were used to compare the means by groups . RESULTS 201 EOC patients were evaluated . Sixty-four percent ( 128/201 ) met criteria for sarcopenia ( SMI ≤ 41 ) at time of diagnosis . The mean overall survival did not differ between patients with SMI > 41 and SMI ≤ 41 ( 36.5 vs 40.8 months , p = 0.4 , respectively ) . No difference in frequency of dose reduction , dose delay , hospital admissions , changes in regimen , blood transfusion , or toxicity was noted . There was no difference in distribution of toxicity grade . CONCLUSION Sarcopenia was not associated with worse survival outcomes or chemotoxcity in EOC patients receiving first-line platinum and taxane-based chemotherapy  in this cohort . Future prospect i ve studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival , performance status , and quality of life Background Despite the positive survival results of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) , criticisms have been put forward regarding the safety of this treatment as a result of a high morbidity rate . Muscle depletion ( sarcopenia ) is associated with the occurrence of postoperative complications . The purpose of this study was to determine the association between sarcopenia and postoperative morbidity after  CRS-HIPEC for peritoneal carcinomatosis from colorectal cancer by distinguishing the complications linked to CRS itself and those associated with chemotherapy ( HIPEC ) toxicities . Methods Data concerning 97 consecutive patients who had undergone CRS-HIPEC were recorded . We analyzed the events occurring within 30 days after surgery that were prospect ively recorded in a data base . Sarcopenia was assessed using the L3 muscle index on computed tomography performed during the 2 months preceding surgery . Results The sarcopenic patients experienced significantly more chemotherapy toxicities ( 57 vs. 26 % ; p = 0.004 ) and especially neutropenia ( 36 vs. 17 % ; p = 0.04 ) than their nonsarcopenic counterparts . There was no difference in complications linked to the CRS procedure between sarcopenic and nonsarcopenic patients . In the multivariate analysis , sarcopenia was the only parameter independently associated with the risk of chemotherapy toxicity ( odds ratio 3.97 ; 95 % confidence interval 1.52–10.39 ; p = 0.005 ) . Conclusions Despite the local administration of chemotherapy , systemic toxicity was observed in sarcopenic patients after CRS-HIPEC . This relationship favors new treatment strategies with white blood cell growth factors or chemotherapy dosing based on muscle value BACKGROUND Sarcopenia , severe skeletal muscle loss , has been identified as a prognostic factor in various malignancies . This study aims to investigate whether sarcopenia is associated with overall survival ( OS ) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery ( PDS ) .  METHODS Ovarian cancer patients ( n = 216 ) treated with PDS were enrolled retrospectively .  Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra . Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia ( ≤38.73 cm2/m2 ) . Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS . The effect of sarcopenia on the development of major surgical complications was studied with logistic regression . RESULTS Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia ( p = 0.010 ) . Sarcopenia univariably predicted OS ( HR 1.536 ( 95 % CI 1.105 - 2.134 ) , p = 0.011 ) but was not significant in multivariable Cox-regression analysis ( HR 1.362 ( 95 % CI 0.968 - 1.916 ) , p = 0.076 ) . Significant predictors for OS in multivariable Cox-regression analysis were complete PDS , treatment in a specialised centre and the development of major complications . Sarcopenia was not predictive of major complications . CONCLUSION Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery . However a strong trend towards a survival disadvantage for patients with sarcopenia was seen . Future prospect i ve studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival . Complete cytoreduction remains the strongest predictor of ovarian cancer survival Purpose Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival . The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origins , and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer . The purpose of our prospect i ve study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer ( NSCLC ) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction . A secondary aim was to compare several biochemical markers ( CRP , IL-6 , protein , and albumin ) with time to tumor progression in order to assess prognostic value or to guide a treatment . Methods Between December 2013 and April 2015 , the prospect i ve cohort study of 100 Caucasian patients with advanced NSCLC stage IIIB or IV , who were referred consecutively to Department for Respiratory Diseases “ Jordanovac , ” was evaluated . Anthropometric measurements and biochemical data ( CRP , albumin , protein , IL-6 , haemoglobin ) together with body composition measurements ( total muscle cross-sectional area , lumbar skeletal muscle index ) were obtained for each patient before starting with platinum-doublet therapy . Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography , and sarcopenia was defined using a previously published cutoff point . Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospect ively . Results One hundred patients with advanced lung cancer were recruited : 67 were male and median age was 64 years . The median time to disease progression was 187 days . The prevalence of cachexia and sarcopenia in study cohort was 69 and 47 % , respectively . CRP , IL-6 , and albumin concentration in cachectic compared to non-cachectic patients demonstrated statistically significant difference ( p = 0.020 , p = 0.040 , p = 0.003 ) . Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor was time to tumor progression . On the contrary , albumin concentration with established cutoff point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity ( OR ( 95 % CI ) = 0.85 ; p < 0.001 ) and survival ( HR ( 95 % CI ) = 0.55 ) . Conclusions Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are . This approach in clinical setting s can be used to guide the choice of oncologic treatment Purpose One-year mortality is vital for elderly oncologic patients undergoing surgery . Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries , but the association of sarcopenia and 1-year mortality has never been investigated in a prospect i ve study . Methods We conducted a prospect i ve study of elderly patients ( ≥65 years ) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015 . Sarcopenia was determined by the measurements of muscle mass , h and grip strength , and gait speed . Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality . Results A total of 173 patients were included , in which 52 ( 30.1 % ) patients were identified as having sarcopenia . Twenty-four ( 13.9 % ) patients died within 1 year of surgery . Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality . Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia , from 0.835 to 0.868 . Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis . Conclusions Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery . The measurement of muscle function is important for sarcopenia as a preoperative assessment tool Abstract Background Muscle dysfunction and sarcopenia have been associated with poor performance status , an increased mortality risk , and greater side effects in oncologic patients . However , little is known about how performance is affected by cancer therapy . We investigated muscle strength in breast cancer patients in different adjuvant treatment setting s and also compared it with data from healthy individuals . Methods Breast cancer patients ( N = 255 ) from two r and omized controlled exercise trials , staged 0–III and aged 54.4 ± 9.4 years , were categorized into four groups according to their treatment status . In a cross‐sectional design , muscle function was assessed bilaterally by isokinetic dynamometry ( 0 ° , 60 ° , 180 ° /s ) as maximal voluntary isometric contraction ( MVIC ) and maximal isokinetic peak torque ( MIPT ) in shoulder rotators and knee flexors and extensors .  Additionally , muscular fatigue index ( FI% ) and shoulder flexibility were evaluated . Healthy women ( N = 26 ) , aged 53.3 ± 9.8 years , were tested using the same method . Analysis of covariance was used to estimate the impact of different cancer treatments on skeletal muscle function with adjustment for various clinical and socio‐demographic factors . Results Consistently , lower muscle strength was measured in shoulder and knee strength in patients after chemotherapy . On average , patients had up to 25 % lower strength in lower extremities and 12–16 % in upper extremities in MVIC and MIPT during cancer treatment compared with healthy women . No substantial difference between patient groups in shoulder strength , but significantly lower shoulder flexibility in patients with radical mastectomy was measured . Chemotherapy‐treated patients had consistently higher FI% . No serious adverse events were reported . Conclusions Breast cancer patients showed markedly impaired muscle strength and joint dysfunctions before and after anticancer treatment . The significant differences between patients and healthy individuals underline the need of exercise therapy as early as possible in order to prevent or counteract the loss of muscle function after curative surgery as well as the consequences of neo‐/adjuvant chemotherapy BACKGROUND AND OBJECTIVES Reduced muscle mass and strength are prevalent conditions in dialysis patients . However , muscle strength and muscle mass are not congruent ; muscle strength can diminish even though muscle mass is maintained or increased . This study addresses phenotype and mortality associations of these muscle dysfunction entities alone or in combination ( i.e. , concurrent loss of muscle mass and strength/mobility , here defined as sarcopenia ) . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This study included 330 incident dialysis patients ( 203 men , mean age 53±13 years , and mean GFR 7±2 ml/min per 1.73 m(2 ) ) recruited between 1994 and 2010 and followed prospect ively for up to 5 years . Low muscle mass ( by dual-energy x-ray absorptiometry appendicular mass index ) and low muscle strength ( by h and grip ) were defined against young reference population s according to the European Working Group on Sarcopenia in Older People . RESULTS Whereas 20 % of patients had sarcopenia , low muscle mass and low muscle strength alone were observed in a further 24 % and 15 % of patients , respectively . Old age , comorbidities , protein-energy wasting , physical inactivity , low albumin , and inflammation associated with low muscle strength , but not with low muscle mass ( multivariate ANOVA interactions ) . During follow-up , 95 patients ( 29 % ) died and both conditions associated with mortality as separate entities . When combined , individuals with low muscle mass alone were not at increased risk of mortality ( adjusted hazard ratio [ HR ] , 1.23 ; 95 % confidence interval [ 95 % CI ] , 0.56 to 2.67 ) . Individuals with low muscle strength were at increased risk , irrespective of their muscle stores being appropriate ( HR , 1.98 ; 95 % CI , 1.01 to 3.87 ) or low ( HR , 1.93 ; 95 % CI , 1.01 to 3.71 ) . CONCLUSIONS Low muscle strength was more strongly associated with aging , protein-energy wasting , physical inactivity , inflammation , and mortality than low muscle mass . Assessment of muscle functionality may provide additional diagnostic and prognostic information to muscle-mass evaluation BACKGROUND & AIMS Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer ( OC ) . Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers , with worser effects in sarcopenic obesity . In this study the association between sarcopenia and /or sarcopenic obesity and dose limiting toxicity ( DLT ) during cycle one chemotherapy in resectable OC patients was evaluated . METHODS Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients . Lean body mass and body fat mass were estimated . Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia , and as underweight/normal ( BMI < 25 ) or overweight/obese ( BMI ≥ 25 ) . Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity . DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects . Odds ratios for developing toxicity were ascertained using multiple logistic regression . RESULTS Of 72 patients , 85 % ( n = 61 ) were males . Sarcopenia and sarcopenic obesity were present in 31 ( 43 % ) and 10 ( 14 % ) , respectively , prior to chemotherapy . Sarcopenic patients had significantly lower adipose tissue index ( p = 0.02 ) compared to non-sarcopenic patients . Patients with DLT ( n = 24 ) had lower skeletal muscle mass ( p = 0.04 ) than those without DLT . Sarcopenic patients ( OR = 2.47 ; 95 % CI : 0.88 - 6.93 ) showed a trend towards increased DLT risk ( p < 0.10 ) . Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI ( OR = 1.60 ; 95 % CI 0.30 - 8.40 ) , but was non-significant . In the sarcopenic obese , risk of DLT increased significantly ( OR = 5.54 ; 95 % CI 1.12 - 27.44 ) . CONCLUSIONS Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients The purpose of this study was to conduct an exploratory analysis of the START examining the effects of resistance exercise training ( RET ) and aerobic exercise training ( AET ) on sarcopenia , dynapenia , and associated quality of life ( QoL ) changes in breast cancer ( BC ) patients receiving adjuvant chemotherapy . Participants were r and omized to usual care ( UC ) ( n = 70 ) , AET ( n = 64 ) , or RET ( n = 66 ) for the duration of chemotherapy . Measures of sarcopenia [ skeletal muscle index ( SMI ) ] and dynapenia [ upper extremity ( UE ) and lower extremity ( LE ) muscle dysfunction ( MD ) ] were normalized relative to age-/sex-based clinical cut-points . QoL was assessed by the Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) scales . At baseline , 25.5 % of BC patients were sarcopenic and 54.5 % were dynapenic with both conditions associated with poorer QoL. ANCOVAs showed significant differences favoring RET over UC for SMI ( 0.32 kg/m2 ; p = 0.017 ) , UE-MD ( 0.12 kg/kg ; p < 0.001 ) , and LE-MD ( 0.27 kg/kg ; p < 0.001 ) . Chi-square analyses revealed significant effects of RET , compared to UC/AET combined , on reversing sarcopenia ( p = 0.039 ) and dynapenia ( p = 0.019 ) . The reversal of sarcopenia was associated with clinical ly relevant improvements in the FACT-An ( 11.7 points [ 95 % confidence interval ( CI ) −4.2 to 27.6 ] ) , the Trial Outcome Index-Anemia ( 10.0 points [ 95 % CI −4.0 to 24.1 ] ) , and fatigue ( 5.3 points [ 95 % CI −1.5 to 12.1 ] ) . Early-stage BC patients initiating adjuvant chemotherapy have higher than expected rates of sarcopenia and dynapenia which are associated with poorer QoL. RET during adjuvant chemotherapy result ed in the reversal of both sarcopenia and dynapenia ; however , only the reversal of sarcopenia was associated with clinical ly meaningful improvements in
Sarcopenia , as defined by reduced muscle mass alone , was found to be very prevalent in patients with lung cancer , regardless of body mass index , and where present was associated with poorer functional status and overall survival .
The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results .
There are very limited data on the correlation between degree of sarcopenia and muscle function , which has a non-linear relationship in older non-cancer population s. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer .
OBJECTIVES There is growing awareness of the relationship between sarcopenia ( loss of muscle mass and function ) , and outcomes in cancer , making it a potential target for future therapies .
In order to inform future research and practice , we undertook a systematic review of factors associated with loss of muscle mass , and the relationship between muscle function and muscle mass in lung cancer , a common condition associated with poor outcomes .