Sarcopenia - independent predictor of severe toxicity
Sarcopenia is significantly and independently associated with:
Therapy-induced toxicity2,4
Unplanned readmissions5
Post-operative complications6,7
Poor survival2,4,6,7
Sarcopenia – progressive and generalized skeletal muscle disorder
Sarcopenia is characterized by low muscle strength, low muscle quality or quantity and low physical performance1. Nearly 40% of cancer patients are sarcopenic already at diagnosis2. The highest prevalence of pre-therapeutic sarcopenia is seen in esophageal and small-cell lung cancers2. Cancer treatments may worsen existing sarcopenia but may also induce sarcopenia3. Sarcopenia can occur independently of BMI and fat mass4.
Progressive muscle breakdown may be caused by multiple factors3
Age
Cachexia / inflammation
Direct effects of chemotherapy of targeted agents on muscle
Immobility / physical inactivity
Impaired food intake / malnutrition
Causes of cancer anorexia are multifactorial1,5,6
- Anti-tumour treatments such as chemotherapy or radiotherapy
- Inflammatory response caused by the tumour
- Distress and reduced desire to eat due to cancer diagnosis
have a negative effect on appetite.
Diagnostic criteria according to GLIM consensus8
Reduced muscle mass / muscle function
As indicated by validated body composition measuring techniques* or functional tests, e.g. muscle strength and physical performance
Several tools are simple to implement e.g. “Timed up and go Test (TUG)” measures the time a person needs to stand up from a chair and walk 3 meters, turn and walk back to sit again; originally proposed by Mathias 19869
* dual-energy absorptiometry, bioelectrical impedance, ultrasound, computed tomography or magnetic resonance imaging
Unintentional weight loss
- >5% within past 6 months, or
- >10% beyond 6 months
Low BMI
- <20 if <70 years or <22 if >70 years
- for Asia only: <18.5 is <70 years or <20 if >70 years
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Reduced food intake of assimilation
- 50% of estimated requirements >1 week, or
- any reduction for >2 weeks, or
- any chronic GI condition that adversely impacts food assimilation or absorption
Inflammation
- Acute disease/injury, or
- chronic disease-related
Diagnosis of malnutrition: At least one phenotypic and one etiologic criterion applicable8
Reduced muscle mass is a phenotypic criterion with strong evidence for the outcome of patients8
To counteract loss of body weight and muscle mass a multimodal approach is most effective10
Adequate protein intake
Adequate energy intake
Physical activity / resistance training
Omega 3 fatty acids
Nutrition support in cancer patients – ESPEN guideline recommendations
Proven effect on maintenance of muscle mass
High protein, omega-3 fatty acid-enriched oral nutritional supplements (ONS) correlate with attenuation of lean body mass loss during chemotherapy / radio therapy in a meta-analysis.12
Adequate quantity and quality of protein is fundamental to slow down loss of muscle mass10
Resources
For detailed information about cancer-related sarcopenia and useful knowledge about nutritional support in sarcopenic cancer patients please download:
Sarcopenia HCP Folder.pdf
- Filename
- Sarcopenia HCP Folder.pdf
- Size
- 7 MB
- Format
Many patients suffer from taste fatique – They might cook with ONS to enrich their meals and improve their nutritional status. A recipe collection can be found here.
Combining nutrition support with exercise is an effective strategy to manage muscle loss.
Preparation for training
Exercise to maintain strength
Exercise to stay flexible
Exercise to improve balance
References:
1) Cruz-Jentoft AJ et al. Age Ageing. 2019;48(1):16–31.
2) Pamoukdjian F et al. Clin Nutr. 2018;37(4):1101–13.
3) Bozzetti F. Ann Oncol. 2017 Sep 1;28(9):2107–2118.
4) Prado CM et al. Proc Nutr Soc. 2016;75(2):188–98.
5) Makiura D et al. Ann surg oncol. 2018;25(2):456–64.
6) Rinninella E et al. Clin Nutr. 2020;39(7):2045–2054.
7) Hua H et al. Support Care Cancer. 2019;27(7):2385–2394.
8) Cederholm T et al. J Cachexia Sarcopenia Muscle. 2019;10(1):207–17.
9) Mathias, S.; Nayak, U.; Isaacs, B. Balance in elderly patients: the “get-up and go” test. Arch. Phys. Med. Rehabil. 1986, 67, 387–389.
10) Prado CM et al. J Cachexia Sarcopenia Muscle. 2020;11(2):366–380.
11) Arends J et al. Clin Nutr. 2017;36(1):11–48.
12) de van der Schueren MAE et al. Ann Oncol. 2018;29(5):1141–53.