Are Skeletal Muscle Mass and Density Associated with Fatigue In Early-Stage Colorectal Cancer Patients?

Abstract

Abstract Both low skeletal muscle mass and low radiographic muscle density are associated with higher complication rates after surgery for colorectal cancer and with worse survival rates although data are not fully consistent. Whether skeletal muscle mass and density are also associated with patient-reported outcomes, such as fatigue, is less well studied. We hypothesized that low skeletal muscle mass and density may be associated with fatigue in early stage colorectal cancer (CRC) patients. Methods: Within a prospective cohort of 594 early-stage (stage I-III) CRC patients, we collected information on fatigue using the EORTC QLQ-C30 questionnaire 6 months after diagnosis; fatigue was defined as a score of >39 based on literature. Skeletal muscle mass and -density were assessed using pre-operative Computed Tomography (CT) images. Low muscle mass and -density were identified using previously determined cut- off values. Cox regression models were used to calculate prevalence ratios (PRs). All PRs were adjusted for age, sex, stage of disease. Results: The average age of the study population was 65.7 ± 9.0; 37% were women and 67% of the patients had a tumor located in the colon. Low muscle mass was present in 26% of the patients and low muscle density in 25%; 26% of patients had fatigue. Low muscle mass was not associated with prevalence of fatigue (PR for low versus normal muscle mass 0.83 (95%CI 0.56–1.24). Low muscle density was associated with higher prevalence of fatigue: PR for low versus normal muscle density 1.94 (95% CI 1.34–2.81). Conclusion: Among colorectal cancer patients, low skeletal muscle density at diagnosis - indicative for fat infiltration in the muscle- was associated with a higher prevalence of fatigue six months after diagnosis. Future studies should assess how lifestyle interventions can help to prevent or decrease fatigue, and should further clarify whether there is a causal link between fat infiltration in the muscle and fatigue.