Chemotherapy-induced sarcopenia in newly diagnosed cancer patients: Izmir Oncology Group (IZOG) study
Sarcopenia is associated with physical disability, increased post-operative complications, poorer tolerance to chemotherapy, and reduced survival outcome. However, little is known about the changes in body composition during chemotherapy treatment. We aimed to determine whether adjuvant or palliative chemotherapy causes the development of sarcopenia in newly diagnosed cancer patients and to reveal the relationship of sarcopenia with the duration of chemotherapy.
The study included newly diagnosed cancer patients who underwent curative surgery for primary tumor and also cancer patients who were metastatic at diagnosis. Body composition and handgrip strength were assessed by bio-electric impedance analysis (BIA) and handgrip dynamometer tools, respectively. Measurement tests were performed prior to chemotherapy, in the third and sixth months of chemotherapy.
The median age of a total of 276 patients was 57.5 years (range 18–83), and majority of them (55.8%) were women. Among the pre-chemotherapy factors that could be associated with sarcopenia, male gender ≥ 65 years of age, body mass ındex (BMI) < 25, and nutritional risk screening 2002 score < 3 were found to be positively associated with sarcopenia (p < 0.001, p = 0.036, p < 0.001, and p < 0.001, respectively). In the multivariate analysis, male gender (p < 0.001) and BMI < 25 (p = 0.047) were found to be significant. Of 276 patients, 14.5% were sarcopenic prior to chemotherapy. After chemotherapy, 21.4% of them were sarcopenic at the end of the third month and 23.9% were sarcopenic at the end of the sixth month.
The incidence of sarcopenia was found to be increased with chemotherapy itself and its duration in both non-metastatic and metastatic cancer patients which has to be evaluated in detail in disease-specific prospective and randomized studies.
KeywordsSarcopenia Incidence Chemotherapy Body composition Bio-electric impedance analysis
The authors gratefully acknowledge the support from friends Yasemin Payam, Betul Akdogan, Oksan Kacmaz, and Songul Uluc Ozaltaş.
Study concept: A Alacacioglu and U Oflazoglu. Study design: U Oflazoglu and A Alacacioglu. Data acquisition: U Oflazoglu, S Saray, Y Yildiz, and H Taskaynatan. Quality control of data: U Oflazoglu and A Alacacioglu. Data analysis and interpretation: U Oflazoglu and A Alacacioglu. Statistical analysis: U Oflazoglu and A Alacacioglu. Manuscript preparation: U Oflazoglu and U Varol. Manuscript editing: U Varol, A Alacacioglu, and T Salman. Manuscript review: U Varol, A Alacacioglu, Y Kucukzeybek, T Salman, and MO Tarhan
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Institutional Review Board at Izmir Katip Celebi University.
Statement of informed consent
All patients provided written informed consent to participate in the study.
- 1.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al.; 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):412-423.Google Scholar
- 3.Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS, 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):95–101PubMedCrossRefPubMedCentralGoogle Scholar
- 6.Cruz-Jentoft AJ, Bahat G, Bauer J, et al.; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. (2018) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 48(1):16-31 https://doi.org/10.1093/ageing/afy169 PubMedCentralCrossRefGoogle Scholar
- 8.Stene GB, Helbostad JL, Amundsen T, Sorhaug S, Hjelde H, Kaasa S, &Grønberg BH. (2014) Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer. Acta Oncol 54(3):340–348Google Scholar
- 22.Prado CMM, Mourtzakis M, Baracos V, Reiman T, Sawyer M, McCargar LJ (2010) Overweight and obese patients with solid tumors may have sarcopenia, poor prognosis and early features of cachexia. Int J Body Comp Res 8:7–15Google Scholar
- 23.World Health Organisation. Global database on body mass index. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
- 25.Nattenmüller J, Wochner R, Muley T, Steins M, Hummler S, Teucher B, Wiskemann J, Kauczor HU, Wielpütz MO, Heussel CP (2017) Prognostic impact of CT-quantified muscle and fat distribution before and after first-line-chemotherapy in lung cancer patients. PLoS One 12(1):e0169136PubMedPubMedCentralCrossRefGoogle Scholar
- 26.Goey KKH, Elias SG, van Tinteren H, Laclé MM, Willems SM, Offerhaus GJA et al (2017) Maintenance treatment with capecitabine and bevacizumab versus observation in metastatic colorectal cancer: updated results and molecular subgroup analyses of the phase 3 CAIRO3 study. Ann Oncol 28(9):2128–2134PubMedCrossRefPubMedCentralGoogle Scholar
- 34.Ge J, Azria D, Gourgou-bourgade S, Martel-laffay I, Hennequin C, Etienne P et al (2017) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the Phase III Trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644Google Scholar
- 41.Kim EY, Kim K, Kim YS, Ahn HK, Jeong YM, Kim JH, Choi W-J (2017) Prevalence of and factors associated with sarcopenia in Korean cancer survivors: based on data obtained by the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011. Nutr Cancer 69(3):394–401PubMedCrossRefPubMedCentralGoogle Scholar
- 43.U.S. Cancer Statistics Working Group (2013) US cancer statistics: 1999- 2009 incidence and mortality web-based report. USDHHS, CDC, AtlantaGoogle Scholar
- 47.Morishita S, Kaida K, Tanaka T, Itani Y, Ikegame K, Okada M, Ishii S, Kodama N, Ogawa H, Domen K (2012) Prevalence of sarcopenia and relevance of body composition, physiological function, fatigue, and health-related quality of life in patients before allogeneic hematopoietic stem cell transplantation. Support Care Cancer 20(12):3161–3168PubMedCrossRefPubMedCentralGoogle Scholar