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

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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.

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Disclosures

This work was supported by the Canadian Foundation for Innovation (CFI)-New Opportunities Award (AV), Canadian Institute for Health Research (CIHR)-Operating Grant (AV), McGill University Health Centre Research Institute-Pilot project Competition (AV), Canada Graduate Scholarships-CIHR Master's Award (BT), and the Academic Unit Head Research Fund of Concordia University (RK)

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Authors and Affiliations

  1. McGill Nutrition and Performance Laboratory, McGill University Health Centre (MUHC), Montreal, QC, Canada

    R. D. Kilgour, A. Vigano, B. Trutschnigg, E. Lucar & J. A. Morais

  2. Department of Exercise Science, The Richard J. Renaud Science Complex, Concordia University, 7141 Sherbrooke Street West, Montreal, QC, H4B 1R6, Canada

    R. D. Kilgour

  3. Supportive and Palliative Care Program, MUHC, Montreal, QC, Canada

    A. Vigano & M. Borod

  4. Division of Geriatrics, MUHC, Montreal, QC, Canada

    J. A. Morais

Authors
  1. R. D. Kilgour
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  2. A. Vigano
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  3. B. Trutschnigg
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  4. E. Lucar
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  5. M. Borod
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  6. J. A. Morais
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Corresponding author

Correspondence to R. D. Kilgour.

Additional information

This study was presented as a poster at the 2012 MASCC/ISOO International Symposium, New York City, NY, USA on 28–30 June 2012.

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Kilgour, R.D., Vigano, A., Trutschnigg, B. et al. Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients. Support Care Cancer 21, 3261–3270 (2013). https://doi.org/10.1007/s00520-013-1894-4

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  • DOI: https://doi.org/10.1007/s00520-013-1894-4

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