Functional Capacity Of Gastrointestinal Cancer Patients - A Pre-therapy Comparison To Breast Cancer Patients And Healthy Women

Abstract

PURPOSE: Many studies of cancer patients report that frailty, cachexia and decreased physical function during chemotherapy (CT) predict a higher mortality risk. Although a high prevalence of these symptoms in gastrointestinal (GI) cancer patients is known, there is almost no data on functional status and body composition in this population. The aim of the study is to asses and compare the pre-therapy motor performance of advanced GI cancer patients in contrast to breast cancer patients and healthy controls. METHODS: In a 3-arm cross-sectional study female patients with advanced cancer (UICC ≥ III) (GI: n=17; 70.1±3.1 yrs; BMI 23.6±5.3 kg/m2; breast: n=17; 66.9±2.3 yrs; BMI 23.6±3.8 kg/m2) before first-line CT and 17 healthy age-matched women (69.4±1.4 yrs; BMI 24.2±3.3 kg/m2) are examined. Body composition was obtained from bioelectrical impedance analysis. The amount of daily physical activity (steps; MVPA/min·wk-1) was calculated from accelerometer (Actigraph) readings. A capacitive force platform (Zebris) was used for gait speed recordings during free level walking. Maximal isometric voluntary contraction force (MIVF) of the quadriceps muscle was assessed by a strain gauge force transducer (ASYS). RESULTS: ANOVA with post-hoc test and Bonferroni correction show significant differences in outcome measures of GI cancer patients compared to breast cancer patients and healthy women. GI cancer patients show lower values in phase angle (4.5±0.8°; 5.4±0.4°; 5.3±0.5°; p<.01) and isometric strength (5.5±2.2; 9.1±3.3; 8.4±1.8 N/kg; p<.01). Steps per day (3125±2396; 8703±4104 stp, p<.001), moderate to vigorous activity (7.3±11.9; 36.9±28.5 MVPA/min·wk-1; p=.001) and gait speed (3.5±1.1; 4.9±0.6 km/h; p<.001) are decreased compared to healthy women. CONCLUSIONS: Patients with advanced GI cancers demonstrate sufficient deficits in functional status and motor performance before CT compared to advanced breast cancer patients and healthy women. Gait speed, phase angle and force are below cut-off values for low prognosis of survival and may reflect a diminished tolerance of CT. Measures to improve muscle status, physical function and its effects on treatment is warranted in patients with advanced GI cancers.