Skip to main content
SpringerLink
Log in

Relationship between weakness and phase angle in advanced cancer patients with fatigue

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

This study aims to determine the relationship between weakness and bioimpedance analysis (BIA)-derived phase angle in a population of untreated cancer patients with fatigue.

Methods

We prospectively evaluated 41 treatment-naive cancer patients of several origins that presented with performance status 1–2, weight loss >5 % in the last 6 months, and Fatigue Numeral Scale score >4. Weakness was considered a physical component of the multidimensional fatigue syndrome and was evaluated through several parameters utilizing hand grip strength technique by dinamometry. The same assessment was also performed on a healthy control population (n = 20). BIA-derived phase angle was also determined by BIA.

Results

Compared to healthy controls, cancer patients exhibited significant differences in all the parameters: median fatigue was 6 (range 5–9), evaluated maximal strength mean was 27 ± 10.71 vs. 42 ± 10.74 kg (p < 0.0001 for patients vs. control, respectively), and muscle strength difference (max–min muscle strength) was also statistically different (p < 0.0001). We also determined parameter associations within the patient population. We found statistical significant correlations between median phase angle score and endurance muscle with percentage of weight loss (r = 0.43, p = 0.03) for head and neck cancer patients, and in non-small cell lung cancer patients, grip work correlated significantly with normal or decreased phase angle (r = 0.85), p = 0.006 (Spearman Rank Correlation).

Conclusions

Weakness could be correlated with normal or decreased phase angle in a population with ambulatory advanced cancer with fatigue naive of treatment. We also found a significant relationship between median phase angle score and endurance muscle with percentage of weight loss in the subpopulation of patients with head and neck carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Comprehensive Cancer Network. Cancer-related fatigue. http://www.nccn.Org/professionals/physician-gls/PDF/fatigue_pdf. Accessed 11 Jan 2013

  2. Berger AM, Bruera E, Cimprich B (2010) Recognition and treatment of the symptom of cancer-related fatigue. Educational Book. ISSN 1548–8748. American Society of Clinical Oncology. pp. 350–355

  3. Luthy C, Cedraschi C, Pugliesi A, Di Silvestro K, Mugnier-Konrad B, Rapiti E, Allaz AF (2011) ‘Patients’ views about causes and preferences for the management of cancer-related fatigue—a case for non-congruence with the physicians? Support Care Cancer 19:363–370

    Article  PubMed  Google Scholar 

  4. Marx J (2002) Ubiquitin lives up to its name. Science 297:1792–1794

    Article  PubMed  Google Scholar 

  5. Strasser F (2008) Diagnostic criteria of cachexia and their assessment: decreased muscle strength and fatigue. Curr Opin Clin Nutr Metab Care 11:417–421

    Article  PubMed  Google Scholar 

  6. Cerchietti L, Navigante A, Castro M (2007) Effects of eicosapentaenoic and docosahexaenoic n-3 fatty acid from fish oil and preferential Cox-2 inhibition on systemic syndromes in patients with advanced lung cancer. Nutr Cancer 54(1):14–20

    Article  Google Scholar 

  7. Whitehouse A, Smith H, Drake J, Tisdale M (2001) Mechanism of attenuation of skeletal muscle protein catabolism in cancer cachexia by eicosapentaenoic acid. Cancer Res 61:3604–3609

    PubMed  CAS  Google Scholar 

  8. Wieland B, Stewart G, Skipworth R, Sangster K, Fearon K et al (2007) Is there a human homologue to the murine proteolysis-inducing factor? PIF is not a proper molecule. Clin Cancer Res 13:4984–4992

    Article  PubMed  CAS  Google Scholar 

  9. Barbosie-Silva MG, Barrios A (2005) Bioelectrical impedance analysis-part1: review of principles and methods. Clin Nutr 23:1226–1243

    Google Scholar 

  10. Wang A, See M, Ho Z, Lui S, Li P, Won J (2005) Evaluation of handgrip strength as nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr 81:79–86

    PubMed  CAS  Google Scholar 

  11. Kyle U, Bosacus I, De Lorenzo A, Bleurenberg P, Elia M, Gomez M et al (2004) Bioelectrical impedance analysis-part1: review of principles and methods. Clin Nutr 23:1226–1243

    Article  PubMed  Google Scholar 

  12. Okuzama T, Tanaka K, Kugarge A, Okanura H, Nushiwaki S, Hasaka T et al (2001) Fatigue in ambulatory patients with advanced lung cancer: prevalence-correlated factors and screening. J Pain Symptom Manag 22:554–561

    Article  Google Scholar 

  13. Morrow G (2007) Cancer-related fatigue: causes, consequences, and management. Oncologist 12(1):1–3

    Article  PubMed  Google Scholar 

  14. Bower JE (2008) Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol 27:768–777

    Article  Google Scholar 

  15. Richardson A (1995) Fatigue in cancer patients: a review of the literature. Eur J Cancer Care 4:20–32

    Article  CAS  Google Scholar 

  16. Bautmans I, Gorus E, Njemini R, Mets T (2007) Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 elderly persons without inflammation. BMC Geriatrics 7(5):1–8

    Google Scholar 

  17. Dy SM, Lorenz KA, Naeim A, Sanati H, Walling A, Asch SM (2008) Evidence-based recommendations for cancer fatigue, anorexia, depression and dyspnea. J Clin Oncol 26:3886–3895

    Article  PubMed  Google Scholar 

  18. Hauser K, Rybicki L, Walsh D (2010) What’s in a name? Word descriptors of cancer-related fatigue. Palliat Med 24(7):724–730

    Article  PubMed  Google Scholar 

  19. Martínez L, Ramírez E, Tejeda A, Lafuente E, Rosales L, Gonzalez V et al (2007) Bioelectrical impedance and strength measurements in patients with heart failure: comparison with functional class. Nutrition 23:412–418

    Article  Google Scholar 

  20. Tugba Y, Mellar D, Walsh D, Lagman R, Le Grand S (2006) Bioelectrical impedance analysis (BIA) during hydration in advanced cancer. Support Care Cancer 14(6):594, 03–011

    Google Scholar 

  21. Callahan DM, Kent-Braun JA (2011) Effect of old age on human skeletal muscle force–velocity and fatigue properties. J Appl Physiol 111:1345–1352

    Article  PubMed  Google Scholar 

  22. Miyatani M, Kanehisa H, Masuo Y, Ito M, Fukunaga T (2001) Validity of estimating limb muscle volume by bioelectrical impedance. J Appl Physiol 91:386–394

    PubMed  CAS  Google Scholar 

  23. Fukunaga T, Miyatani M, Tachi M, Kouzaki M, Kawakami Y, Kanehisa H (2001) Muscle volume is a major determinant of joint torque in humans. Acta Physiol Scand 172:249–255

    Article  PubMed  CAS  Google Scholar 

  24. Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111:1805–1812

    PubMed  CAS  Google Scholar 

  25. Jeejeebhoy K (1988) Rhoads lecture—1988. Bulk or bounce—the object of nutritional support. JPEN J Parenter Enter Nutr 12:539–549

    Article  CAS  Google Scholar 

  26. Jensen GL, Hsiao YP, Wheeler D (2012) Adult nutrition assessment tutorial. JPEN J Parenter Enter Nutr 36:267–274

    Article  CAS  Google Scholar 

  27. Baldwin C (2011) Nutritional support for malnourished patients with cancer. Curr Opin Support Palliat Care 5:29–36

    Article  PubMed  Google Scholar 

  28. Kubrak C, Olson K, Jha N, Jensen L, Mc Cagar L, Scikaly H et al (2010) Nutritional impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32(3):290–300

    PubMed  Google Scholar 

  29. Scott H, Mc Millan D, Watson W, Milroy R, Mc Ardle C (2001) Longitudinal study of resting energy expenditure, body cell mass and the inflammatory response in male patients with non-small cell lung cancer. Lung Cancer 32:307–312

    Article  PubMed  CAS  Google Scholar 

  30. Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF et al (2010) Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enter Nutr 34:156–159

    Article  Google Scholar 

  31. Minton O, Strasser F, Rabruch L, Stone P (2012) Identification of factors associated with fatigue in advanced cancer: a subset analysis of the European Palliative Care Research Collaborative Computerized Symptom Assessment Date Set. J Pain Symptom Manag 43:226–235

    Article  Google Scholar 

  32. Kisiel-Sajewicz K, Mellar PD, Siemionow V, Sediyova-Khoshknabi D, Wyant A, Walsh D 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 Symptom Manag 44:351–361

    Article  Google Scholar 

  33. Yavuzsen T, Mellar PD, Ranganathan VK, Walsh D, Siemionow V, Kirkova J et al (2009) Cancer-related fatigue: central or peripheral? J Pain Symptom Manag 38(4):587–596

    Article  Google Scholar 

  34. Khoshknabi DS, Mellar PD, Ranganathan VK, Siemionow V, Walsh D, Kirkova J, Yue GH (2008) Combining objective and subjective outcomes in cancer-related fatigue: illustrations from a single case report. J Palliat Med 11(6):829–833

    Article  PubMed  Google Scholar 

  35. Mellar PD, Walsh D (2010) Mechanisms of fatigue. J Support Oncol 8(4):587–596

    Google Scholar 

Download references

Acknowledgments

The authors thank Monica Castro, MD, for the contribution to this paper.

Conflict of interest

None

Author information

Authors and Affiliations

  1. Translational Research Unit, Angel H. Roffo Cancer Institute, Av. San Martín 5481, Buenos Aires, Argentina

    A. Navigante, P. Cresta Morgado & O. Casbarien

  2. Department of Central Laboratory, Angel H. Roffo Cancer Institute, Buenos Aires, Argentina

    N. López Delgado

  3. Service of Head and Neck, Angel H. Roffo Cancer Institute, Buenos Aires, Argentina

    R. Giglio

  4. Parenteral, and Enteral Nutrition Argentina Association, Buenos Aires, Argentina

    M. Perman

Authors
  1. A. Navigante
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Cresta Morgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Casbarien
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. López Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Giglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Perman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Navigante.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Navigante, A., Morgado, P.C., Casbarien, O. et al. Relationship between weakness and phase angle in advanced cancer patients with fatigue. Support Care Cancer 21, 1685–1690 (2013). https://doi.org/10.1007/s00520-012-1714-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1714-2

Keywords

Search

Navigation