Clinically-Measured Muscular Strength Predicts Quality Of Life And Symptom Burden In Patients With Cancer Cachexia

Abstract

Cancer cachexia is a multifaceted syndrome defined as weight loss >5% in the past six months. Weight loss is associated with decreased quality of life (QoL), increased symptom burden and a worse prognosis following a cancer diagnosis. However, evaluating muscle strength, in addition to weight loss, may help identify patients most at need for supportive care interventions in a cancer cachexia setting. PURPOSE: To explore the relationship between muscle strength, QoL and symptoms in patients with cancer cachexia. METHODS: Adults with cancer who met the criteria for cachexia and attended a cachexia clinic in Geelong, Australia were included in a retrospective analysis. Muscle strength was evaluated via maximal handgrip strength (HGS) and 30s chair rise testing. QoL and symptoms were evaluated using the European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 15 Palliative (score: 0-100). Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA) (score: 0-35). Data are presented as mean±SD. RESULTS: Overall, 187 patients (male: n=109, 58%, female: n=78, 42%) were included (BMI: 22.4±4.7 kg/m2, weight loss: 12.7±7.5%). Most patients had upper gastrointestinal (n=55, 29%) or lung cancer (n=45, 24%) and metastatic disease (n=134, 72%). Weight loss did not predict overall QoL or symptoms. Chair rise repetitions and HGS predicted higher overall QoL (β: 1.36±0.32, p<0.01 and β: 0.45±0.19, p=0.02, respectively) and reduced appetite symptoms (β: -1.01±0.48, p=0.04 and β: -0.61±0.27, p=0.03, respectively). Chair rise repetitions also predicted reduced fatigue (β: -1.43±0.36, p<0.01), dyspnea (β: -1.53±0.42, p<0.01) and a lower PG-SGA score for malnutrition (β: -0.31±0.08, p<0.01). Further, the inability to complete a single unassisted chair rise resulted in lower overall QoL (mean difference (MD): 8.8±4.2, p=0.04), increased fatigue (MD: 12.0±4.7, p=0.01), dyspnea (MD: 11.0±5.5, p<0.05) and insomnia (MD: 13.7±5.8, p=0.02), as well as a higher PG-SGA score (MD: 3.0±1.1, p=0.01). CONCLUSIONS: Clinical measures of muscle strength may be useful screening tools in a cancer cachexia setting. Our findings support the rationale to target muscle strength, alongside weight loss, to manage QoL and symptoms in patients with cancer cachexia.