Sarcopenia measured with handgrip strength and skeletal muscle mass to assess frailty in older patients with head and neck cancer

Christiaan D.A Meerkerk,Najiba Chargi,Pim A De Jong,Frederiek Van Den Bos,Remco De Bree

doi:10.1016/j.jgo.2020.10.002

Christiaan D.A Meerkerk, Najiba Chargi + Show 3 more

Open Access

https://doi.org/10.1016/j.jgo.2020.10.002

Copy DOI

Abstract

ObjectivesPatients with head and neck cancer (HNC) have a risk of sarcopenia which is associated with adverse health outcomes. Frailty is also associated with adverse outcomes and is diagnosed by a comprehensive geriatric assessment (CGA). Because a CGA is time-consuming and not all patients benefit from it, frailty screening questionnaires are used to select patients for CGA. Sarcopenia measurement may be a biomarker for frailty. Our objective was to examine the association between sarcopenia and a frailty screening questionnaire. Materials and MethodsIn this single-center retrospective study, 150 patients (≥ 60-years old) with HNC were reviewed. Sarcopenia was defined as the combination of reduced handgrip strength and loss of skeletal muscle mass, calculated as skeletal muscle index (SMI), according to the EWGSOP-criteria. Frailty screening was performed using the Geriatrics 8 (G8) questionnaire. ResultsThe 150 patients included 101 men and 49 women. Frail patients were more likely to be sarcopenic at diagnosis. G8 frailty score showed a significant though weak correlation with SMI. Univariate regression analysis with frailty as a dependent variable distinguished comorbidity score, handgrip strength, SMI, and sarcopenia as significant. These variables were subjected to a multivariate analysis in which comorbidity score and SMI remained significant. ConclusionThere is an association between sarcopenia and the G8 frailty screening questionnaire. Therefore, sarcopenia measurement could be interchangeable with the G8 frailty screening questionnaire. Further research should compare the gold standard for frailty, i.e. CGA, with sarcopenia.

Highlights

Worldwide the annual incidence of head and neck cancer (HNC) accounts for more than 650,000 cases and 330,000 deaths [1]
Previous studies showed that sarcopenia based on loss of skeletal muscle mass is present in 35.5–54.5% of patients with HNC and is related to adverse health outcomes [4,5]
Skeletal muscle mass was measured in all patients at the level of the third cervical vertebrae (C3) as cross-sectional muscle area (CSMA) on CT or MRI imaging before initiating treatment

Summary

Introduction

Worldwide the annual incidence of head and neck cancer (HNC) accounts for more than 650,000 cases and 330,000 deaths [1]. Compared to patients with other malignancies, patients with HNC have a higher risk of severe malnutrition, mostly due to swallowing problems [2]. Previous studies showed that sarcopenia based on loss of skeletal muscle mass is present in 35.5–54.5% of patients with HNC and is related to adverse health outcomes [4,5]. Low skeletal muscle mass is associated with chemotherapy dose-limiting toxicity [6], increased incidence of postoperative complications, and decreased survival in

Objectives

Methods

Results