Abstract
BackgroundElderly patient with advanced cancer is one of the most vulnerable populations. Skeletal muscle depletion during chemotherapy may have substantial impact on their physical function. However, there is little information about a direct relationship between quantity of muscle and physical function. We sought to explore the quantitative association between skeletal muscle depletion, and muscle strength and walking capacity in elderly patients with advanced non–small cell lung cancer (NSCLC).MethodsThirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to initiate first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. Lumbar skeletal muscle index (LSMI, cm2/m2), incremental shuttle walking distance (ISWD, m), and hand-grip strength (HGS, kg) were assessed at baseline, and 6 ± 2 weeks (T2) and 12 ± 4 weeks (T3) after study enrollment. Associations were analyzed using linear regression.ResultsAltogether, 11 women and 19 men with a median age of 74 (range, 70–82) years were included in the study; 24 received cytotoxic chemotherapy and 6, gefitinib. Mean ± standard deviation of LSMI, ISWD and HGS were 41.2 ± 7.8 cm2/m2, 326.0 ± 127.9 m, and 29.3 ± 8.5 kg, respectively. LSMI and ISWD significantly declined from baseline to T2 and T3. HGS significantly declined from baseline to T2 and T3 only in men. Change in LSMI was significantly associated with change in HGS (β = 0.3 ± 0.1, p = 0.0127) and ISWD (β = 8.8 ± 2.4, p = 0.0005).ConclusionsSkeletal muscle depletion accompanied with physical functional decline started in the early phase of the chemotherapy in elderly patients with advanced NSCLC. Our results suggest that there may be a need for early supportive care in these patients to prevent functional decline during chemotherapy.Trial registrationTrial registration number: UMIN000009768Name of registry: UMIN (University hospital Medical Information Network).URL of registry: Date of registration: 14 January 2013.Date of enrolment of the first participant to the trial: 23 January 2013.
Highlights
Patient with advanced cancer is one of the most vulnerable populations
Limited information exists on the quantitative association between loss of skeletal muscle mass and physical dysfunction in elderly patients with advanced non–small cell lung cancer (NSCLC)
There was no statistical association between treatment modification and reduction in Lumbar skeletal muscle index (LSMI). To our knowledge, this is the first prospective study to show longitudinal changes in skeletal muscle mass associated with physical function in elderly patients with advanced NSCLC receiving chemotherapy
Summary
Patient with advanced cancer is one of the most vulnerable populations. Skeletal muscle depletion during chemotherapy may have substantial impact on their physical function. We sought to explore the quantitative association between skeletal muscle depletion, and muscle strength and walking capacity in elderly patients with advanced non–small cell lung cancer (NSCLC). Patients with advanced non-small-cell lung cancer (NSCLC) frequently have cancer cachexia [4, 5] and skeletal muscle depletion [5, 6]. Skeletal muscle depletion may cause physical dysfunction [11,12,13,14] and develop disability [15,16,17] before and during cancer treatment in NSCLC.
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