Advertisement

Cancer-related fatigue and biochemical parameters among cancer patients with different stages of sarcopenia

  • Bangyan Wang
  • Sudip Thapa
  • Ting Zhou
  • Huiquan Liu
  • Lu Li
  • Guang Peng
  • Shiying YuEmail author
Original Article

Abstract

Purpose

Cancer-related fatigue (CRF) is a pervasive symptom experienced by cancer patients. Sarcopenia has been suggested as a treatment target of CRF. This study aims to assess the differences of CRF and biochemical markers among different stages of sarcopenia which remain poorly delineated.

Methods

A total of 187 patients were included in this cross-sectional study. Based on muscle mass (skeletal muscle index, SMI), muscle strength (handgrip strength), and physical performance (SARC-F score), patients were divided into four groups (non-sarcopenia, pre-sarcopenia, sarcopenia, and severe sarcopenia). Cancer-related fatigue was measured by the Brief Fatigue Inventory (BFI). Biochemical markers were measured by routine blood tests.

Results

The BFI score was significantly associated with sarcopenia stage (r=0.500; P<0.001). Cancer patients in severe sarcopenia group suffered from worse CRF than those in non-sarcopenia, pre-sarcopenia, and sarcopenia groups (P<0.001). In the multivariate linear regression model (R2=0.542), CRF was significantly correlated with SARC-F score (standardized B=0.519; P<0.001) and high-sensitivity C-reactive protein (standardized B=0.389; P=0.004). Serum albumin and cholinesterase were statistically correlated with both sarcopenia stage and CRF.

Conclusions

The significantly increased occurrence and severity of CRF in cancer patients with sarcopenia suggest that sarcopenia may be a crucial target to improve the management of CRF. Circulating albumin and cholinesterase have the potential to predicting sarcopenia as biomarkers.

Keywords

Cancer Sarcopenia Muscle Fatigue Albumin Cholinesterase 

Notes

Acknowledgements

This study was supported by the National Natural Science Foundation of China (grant number. 81572961).

Compliance with ethical standards

Demographic and clinical data were obtained from the patients’ medical records. Each patient filled in a questionnaire which consists of SARC-F scale and Brief Fatigue Inventory (BFI). The Eastern Cooperative Oncology Group (ECOG) performance status (PS) of patient was assessed by a clinician. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Berger AM, Mitchell SA, Jacobsen PB, Pirl WF (2015) Screening, evaluation, and management of cancer-related fatigue: ready for implementation to practice? CA Cancer J Clin 65(3):190–211CrossRefGoogle Scholar
  2. 2.
    Minton O, Berger A, Barsevick A, Cramp F, Goedendorp M, Mitchell SA, Stone PC (2013) Cancer-related fatigue and its impact on functioning. Cancer 119(Suppl 11):2124–2130CrossRefGoogle Scholar
  3. 3.
    Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G (2013) Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment. J Pain Symptom Manag 45(2):213–222CrossRefGoogle Scholar
  4. 4.
    Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 5(5):353–360CrossRefGoogle Scholar
  5. 5.
    Glaus A, Crow R, Hammond S (1996) A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Support Care Cancer 4(2):82–96CrossRefGoogle Scholar
  6. 6.
    Mustian KM, Morrow GR, Carroll JK, Figueroa-Moseley CD, Jean-Pierre P, Williams GC (2007) Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 12(Suppl 1):52–67CrossRefGoogle Scholar
  7. 7.
    Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, Donnelly J, Eisenberger MA, Escalante C, Hinds P, Jacobsen PB, Kaldor P, Knight SJ, Peterman A, Piper BF, Rugo H, Sabbatini P, Stahl C, National Comprehensive Cancer Network (2000) NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park) 14(11a):151–161Google Scholar
  8. 8.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495CrossRefGoogle Scholar
  9. 9.
    Cohen S, Nathan JA, Goldberg AL (2015) Muscle wasting in disease: molecular mechanisms and promising therapies. Nat Rev Drug Discov 14(1):58–74CrossRefGoogle Scholar
  10. 10.
    Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–1547CrossRefGoogle Scholar
  11. 11.
    Kim TN, Choi KM (2013) Sarcopenia: definition, epidemiology, and pathophysiology. J Bone Metab 20(1):1–10CrossRefGoogle Scholar
  12. 12.
    Karthikeyan G, Jumnani D, Prabhu R, Manoor UK, Supe SS (2012) Prevalence of fatigue among cancer patients receiving various anticancer therapies and its impact on quality of life: a cross-sectional study. Indian J Palliat Care 18(3):165–175CrossRefGoogle Scholar
  13. 13.
    Bower JE (2014) Cancer-related fatigue--mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 11(10):597–609CrossRefGoogle Scholar
  14. 14.
    Ahlberg K, Ekman T, Gaston-Johansson F, Mock V (2003) Assessment and management of cancer-related fatigue in adults. Lancet 362(9384):640–650CrossRefGoogle Scholar
  15. 15.
    Neefjes ECW, van den Hurk RM, Blauwhoff-Buskermolen S, van der Vorst M, Becker-Commissaris A, de van der Schueren MAE, Buffart LM, Verheul HMW (2017) Muscle mass as a target to reduce fatigue in patients with advanced cancer J Cachexia Sarcopenia Muscle 8(4):623–629Google Scholar
  16. 16.
    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(2):177–185CrossRefGoogle Scholar
  17. 17.
    Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 97(6):2333–2338CrossRefGoogle Scholar
  18. 18.
    Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JSW, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H (2014) Sarcopenia in Asia: consensus report of the Asian working group for Sarcopenia. J Am Med Dir Assoc 15(2):95–101CrossRefGoogle Scholar
  19. 19.
    Malmstrom TK, Morley JE (2013) SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 14(8):531–532CrossRefGoogle Scholar
  20. 20.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39(4):412–423CrossRefGoogle Scholar
  21. 21.
    Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196CrossRefGoogle Scholar
  22. 22.
    Wang XS, Hao XS, Wang Y, Guo H, Jiang YQ, Mendoza TR, Cleeland CS (2004) Validation study of the Chinese version of the Brief Fatigue Inventory (BFI-C). J Pain Symptom Manag 27(4):322–332CrossRefGoogle Scholar
  23. 23.
    Butt Z, Rosenbloom SK, Abernethy AP, Beaumont JL, Paul D, Hampton D, Jacobsen PB, Syrjala KL, Von Roenn JH, Cella D (2008) Fatigue is the most important symptom for advanced cancer patients who have had chemotherapy. J Natl Compr Cancer Netw 6(5):448–455CrossRefGoogle Scholar
  24. 24.
    de Raaf PJ, de Klerk C, van der Rijt CC (2013) Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature. Psychooncology 22(9):1919–1929CrossRefGoogle Scholar
  25. 25.
    Yavuzsen T, Davis MP, Ranganathan VK, Walsh D, Siemionow V, Kirkova J, Khoshknabi D, Lagman R, LeGrand S, Yue GH (2009) Cancer-related fatigue: central or peripheral? J Pain Symptom Manag 38(4):587–596CrossRefGoogle Scholar
  26. 26.
    Neefjes EC, van der Vorst MJ, Blauwhoff-Buskermolen S, Verheul HM (2013) Aiming for a better understanding and management of cancer-related fatigue. Oncologist 18(10):1135–1143CrossRefGoogle Scholar
  27. 27.
    Wagner LI, Cella D (2004) Fatigue and cancer: causes, prevalence and treatment approaches. Br J Cancer 91(5):822–828CrossRefGoogle Scholar
  28. 28.
    al-Majid S, McCarthy DO (2001) Cancer-induced fatigue and skeletal muscle wasting: the role of exercise. Biol Res Nurs 2(3):186–197CrossRefGoogle Scholar
  29. 29.
    Morgado PC, Giorlando A, Castro M, Navigante A (2016) Relationship between weight loss and parameters of skeletal muscle function in patients with advanced cancer and fatigue. Support Care Cancer 24(9):3961–3966CrossRefGoogle Scholar
  30. 30.
    Kisiel-Sajewicz K, Davis MP, Siemionow V, Seyidova-Khoshknabi D, Wyant A, Walsh D, Hou J, Yue GH (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 Symptom Manag 44(3):351–361CrossRefGoogle Scholar
  31. 31.
    Bruera E, Brenneis C, Michaud M, Jackson PI, MacDonald RN (1988) Muscle electrophysiology in patients with advanced breast cancer. J Natl Cancer Inst 80(4):282–285CrossRefGoogle Scholar
  32. 32.
    Paiva CE, Paiva BS (2013) Prevalence, predictors, and prognostic impact of fatigue among Brazilian outpatients with advanced cancers. Support Care Cancer 21(4):1053–1060CrossRefGoogle Scholar
  33. 33.
    Temel JS, Pirl WF, Recklitis CJ, Cashavelly B, Lynch TJ (2006) Feasibility and validity of a one-item fatigue screen in a thoracic oncology clinic. J Thorac Oncol 1(5):454–459CrossRefGoogle Scholar
  34. 34.
    Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM (2017) Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol 3(7):961–968CrossRefGoogle Scholar
  35. 35.
    Goedendorp MM, Gielissen MF, Verhagen CA, Peters ME, Bleijenberg G (2008) Severe fatigue and related factors in cancer patients before the initiation of treatment. Br J Cancer 99(9):1408–1414CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cancer Center of Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  2. 2.Department of Clinical Cancer PreventionThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations