Supportive Care in Cancer

, Volume 21, Issue 12, pp 3261–3270

Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients

  • R. D. Kilgour
  • A. Vigano
  • B. Trutschnigg
  • E. Lucar
  • M. Borod
  • J. A. Morais
Original Article

Abstract

Purpose

Handgrip strength (HGS) has been shown to predict survival and is associated with changes in body composition, nutritional status, inflammation, and functional ability in several chronic disease conditions. Whether similar relationships exist between HGS and clinical outcomes in patients with advanced cancer are currently unknown. We evaluated the association between HGS and survival as well as several key markers of body composition (e.g., sarcopenia), subjective performance measures (e.g., quality of life), and muscle strength (e.g., isokinetic torque of the quadriceps) in patients with advanced forms of non-small cell lung and gastrointestinal cancers.

Methods

A consecutive cohort of 203 patients with advanced cancer was enrolled and categorized into three HGS percentiles (e.g., ≥50th, 25th, and ≤10th) according to published normative values. Multivariate regression analyses were used to test for independent associations between HGS and survival, sarcopenia, quality of life (QoL), and lower extremity muscle strength as well as key biological markers (e.g., hemoglobin, albumin, and C-reactive protein) while controlling for age, gender, cancer diagnosis, treatment (chemotherapy/radiotherapy), medications, and time from diagnosis to assessment.

Results

When compared to HGS ≥50th, patients in the HGS ≤10th percentile had lower BMI (B, −2.5 kg/m2; 95% CI, −4.5 to −0.45), shorter survival (hazard ratio, 3.2; 2.0–5.1), lower hemoglobin (−19.70 g/L; −27.28 to −12.13) and albumin (−4.99 g/L; −7.85 to −2.13), greater occurrence of sarcopenia (odds ratio, 9.53; 1.95–46.55), lower isokinetic torque of the quadriceps at both 60°/s (−30.6 Nm; −57.9 to −3.3) and 120°/s (−25.1 Nm; −46.4 to −3.7), lower QoL (−1.6 on McGill Quality of Life Questionnaire scale; −2.5 to −0.6), higher levels of fatigue (18.8 on Brief Fatigue Inventory scale; 4.7 –32.9), poorer performance status (0.75 on Eastern Cooperative Oncology Group Performance Status scale; 0.34–1.15), lower fat mass (−7.4 kg; −14.4 to −0.5), and lower lean body mass (−6.5 kg; −10.3 to −2.8).

Conclusions

HGS is independently associated with survival and important biological, functional, and quality of life characteristics in advanced cancer patients. Patients presenting with very low percentiles with respect to their handgrip assessment may require timely referral to supportive and/or palliative care services.

Keywords

Handgrip Survival Sarcopenia Quality of life Strength Advanced cancer 

References

  1. 1.
    Evans WJ, Morley JE, Argiles J, Bales C et al (2008) Cachexia: a new definition. Clin Nutr 27:793–799PubMedCrossRefGoogle Scholar
  2. 2.
    Vigano A, Del Fabbro E, Bruera E, Borod M (2012) The Cachexia Clinic: from staging to managing nutritional and functional problems in advanced cancer patients. Crit Rev Oncogenesis 17:293–304PubMedCrossRefGoogle Scholar
  3. 3.
    Prado CMM, Liefferes JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635PubMedCrossRefGoogle Scholar
  4. 4.
    Rantanen T, Volpato S, Ferrucci L et al (2003) Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc 51:636–641PubMedCrossRefGoogle Scholar
  5. 5.
    Trutschnigg B, Kilgour RD, Reinglas J et al (2008) Precision and reliability of strength (Jamar vs. Biodex handgrip) and body composition (dual-energy X-ray absorptiometry vs. bioimpedance analysis) measurements in advanced cancer patients. Appl Physiol Nutr Metab 33:1232–1239PubMedCrossRefGoogle Scholar
  6. 6.
    Metter EJ, Talbot LA, Schrager M et al (2002) Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J Gerontol: Biol Sci 57A:B359–B365CrossRefGoogle Scholar
  7. 7.
    Newman AB, Kupelian V, Visser M et al (2006) Strength, but not muscle mass, is associated with mortality in the Health, Aging and Body Composition Study cohort. J Gerontol: Med Sci 61A:72–77CrossRefGoogle Scholar
  8. 8.
    Norman K, Stobäus N, Smoliner C et al (2010) Determinants of hand grip strength, knee extension strength and functional status in cancer patients. Clin Nutr 29:586–591PubMedCrossRefGoogle Scholar
  9. 9.
    Burden ST, Hill J, Shaffer JL, Todd C (2010) Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet 23:402–407PubMedCrossRefGoogle Scholar
  10. 10.
    Wang AY-M, Sea MM-M, Ho ZS-Y et al (2005) Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr 81:79–86PubMedGoogle Scholar
  11. 11.
    Sasaki H, Kasagi F, Yamada M et al (2007) Grip strength predicts cause-specific mortality in middle-aged and elderly persons. Am J Med 120:337–342PubMedCrossRefGoogle Scholar
  12. 12.
    Gale CR, Martyn CN, Cooper C et al (2007) Grip strength, body composition, and mortality. Int J Epidemiol 36:228–235PubMedCrossRefGoogle Scholar
  13. 13.
    Chang Y-T, Wu H-L, Guo H-R et al (2011) Handgrip strength is an independent predictor of renal outcomes in patients with chronic kidney diseases. Nephrol Dial Transplant 26:3588–3595PubMedCrossRefGoogle Scholar
  14. 14.
    Yoda M, Inaba M, Okuno S et al (2012) Poor muscle quality as a predictor of high mortality independent of diabetes in hemodialysis patients. Biomed Pharmacother 66:266–270PubMedCrossRefGoogle Scholar
  15. 15.
    Silva LF, Matos CM, Lopes GB et al (2011) Handgrip strength as a simple indicator of possible malnutrition and inflammation in men and women on maintenance hemodialysis. Journal of Renal Nutr 21:235–245CrossRefGoogle Scholar
  16. 16.
    Leal VO, Stockler-Pinto MP, Farage NE, Aranha LN et al (2011) Handgrip strength and its dialysis determinants in hemodialysis patients. Nutrition 27:1125–1129PubMedCrossRefGoogle Scholar
  17. 17.
    Beenakkera K, Linga CH, Meskersb CG, de Craena AJM (2010) Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev 9:431–436CrossRefGoogle Scholar
  18. 18.
    Cheung C-L, Nguyen UDTAE et al (2012) Association of handgrip strength with chronic diseases and multimorbidity. Age. doi:10.1007/s11357-012-9385-y Google Scholar
  19. 19.
    Bruera E, Kuehn N, Miller MJ et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9PubMedGoogle Scholar
  20. 20.
    Mathiowetz V, Weber K, Volland G et al (1984) Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 9:222–226PubMedCrossRefGoogle Scholar
  21. 21.
    Rantanen I, Era P, Kauppinen M, Heikkinen E (1994) Maximal isometric muscle strength and socio-economic status, health, and physical activity in 75-year-old persons. J Aging Phys Act 2:206–220Google Scholar
  22. 22.
    Mathiowetz V (1990) Grip and pinch strength measurements. In: Amundsen LR (ed) Muscle strength testing; instrumented and non-instrumented systems. Churchill Livingstone, New York, pp 163–177Google Scholar
  23. 23.
    Cleeland CS, Wang XS (1999) Measuring and understanding fatigue. Oncology 13:91–97Google Scholar
  24. 24.
    Mendoza TR, Wang XS, Cleeland CS et al (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85:1186–1196PubMedCrossRefGoogle Scholar
  25. 25.
    Cohen SR, Mount BM, Strobel MG et al (1995) The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med 9:207–219PubMedCrossRefGoogle Scholar
  26. 26.
    Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763PubMedCrossRefGoogle Scholar
  27. 27.
    Simmonds MJ (2002) Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery. J Pain Symptom Management 24:404–414CrossRefGoogle Scholar
  28. 28.
    Drouin JM, Valovich-McLeod TC, Shultz SJ et al (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91:22–29PubMedCrossRefGoogle Scholar
  29. 29.
    Symons TB, Vandervoort AA, Rice CL et al (2005) Reliability of a single-session isokinetic and isometric strength measurement protocol in older men. J Gerontol A Biol Sci Med Sci 60:114–119PubMedCrossRefGoogle Scholar
  30. 30.
    Weber MA, Krakowski-Roosen H, Schroder L et al (2009) Morphology, metabolism, microcirculation, and strength of skeletal muscles in cancer-related cachexia. Acta Oncol 48:116–124PubMedCrossRefGoogle Scholar
  31. 31.
    SPSS Inc. (2005) SPSS 14.0 for Windows. Chicago, ILGoogle Scholar
  32. 32.
    Mathiowetz V, Kashman N, Volland G et al (1985) Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66:69–74PubMedGoogle Scholar
  33. 33.
    Valentini L, Schaper L, Buning C et al (2008) Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition 24:694–702PubMedCrossRefGoogle Scholar
  34. 34.
    Álvares-da-Silva MR, Reverbel da Silveira T (2005) Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 21:113–117PubMedCrossRefGoogle Scholar
  35. 35.
    Ruiz JR, Xue MS, Lobelo F et al (2008) Association between muscular strength and mortality in men: prospective cohort study. BMJ 337:92–95CrossRefGoogle Scholar
  36. 36.
    Xue Q-L, Beamer BA, Chaves PHM et al (2010) Heterogeneity in rate of decline in grip, hip, and knee strength and the risk of all-cause mortality: the Women's Health and Aging Study II. J Am Geriatr Soc 58:2076–2084PubMedCrossRefGoogle Scholar
  37. 37.
    Innes E (1999) Handgrip strength testing: a review of literature. Aust Occup Therap J 46:120–140CrossRefGoogle Scholar
  38. 38.
    Stephens NA, Gray C, MacDonald AJ et al (2012) Sexual dimorphism modulates the impact of cancer cachexia on lower limb muscle mass and function. Clin Nutri 31:499–505CrossRefGoogle Scholar
  39. 39.
    Kilgour RD, Vigano A, Trutschnigg B, Hornby L, Lucar E, Bacon SL, Morais JA (2010) Cancer- related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer. J Cachexia Sarcopenia Muscle 1:177–185PubMedCrossRefGoogle Scholar
  40. 40.
    Jakobsen LH, Rask IK, Kondrup J (2010) Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients. Nutrition 26:542–550PubMedCrossRefGoogle Scholar
  41. 41.
    Norman K, Kirchner H, Freudenreich M et al (2008) Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease—a randomized controlled trial. Clin Nutr 27:48–56PubMedCrossRefGoogle Scholar
  42. 42.
    Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495PubMedCrossRefGoogle Scholar
  43. 43.
    Kisiel-Sajewicz K, Davis MP, Siemionow V et al (2012) Lack of muscle contractile property changes at the time of perceived physical exhaustion suggests central mechanisms contributing to early motor task failure in patients with cancer-related fatigue. J Pain Symp Manag 44:351–361CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • R. D. Kilgour
    • 1
    • 2
  • A. Vigano
    • 1
    • 3
  • B. Trutschnigg
    • 1
  • E. Lucar
    • 1
  • M. Borod
    • 3
  • J. A. Morais
    • 1
    • 4
  1. 1.McGill Nutrition and Performance LaboratoryMcGill University Health Centre (MUHC)MontrealCanada
  2. 2.Department of Exercise Science, The Richard J. Renaud Science ComplexConcordia UniversityMontrealCanada
  3. 3.Supportive and Palliative Care ProgramMUHCMontrealCanada
  4. 4.Division of GeriatricsMUHCMontrealCanada

Personalised recommendations