Abstract
BackgroundCachexia, characterized by involuntary muscle mass loss, negatively impacts survival outcomes, treatment tolerability, and functionality in cancer patients. However, there is a limited appreciation of the true prevalence of low muscle mass due to inconsistent diagnostic methods and limited oncologist awareness.MethodsTwenty-nine French healthcare establishments participated in this cross-sectional study, recruiting patients with those metastatic cancers most frequently encountered in routine practice (colon, breast, kidney, lung, prostate). The primary outcome was low skeletal muscle mass prevalence, as diagnosed by estimating the skeletal mass index (SMI) in the middle of the third-lumbar vertebrae (L3) level via computed tomography (CT). Other objectives included an evaluation of nutritional management, physical activity, and toxicities related to ongoing treatment.ResultsSeven hundred sixty-six patients (49.9% males) were enrolled with a mean age of 65.0 years. Low muscle mass prevalence was 69.1%. Only one-third of patients with low skeletal muscle mass were receiving nutritional counselling and only 28.4% were under nutritional management (oral supplements, enteral or parenteral nutrition). Physicians highly underdiagnosed those patients identified with low skeletal muscle mass, as defined by the primary objective, by 74.3% and 44.9% in obese and non-obese patients, respectively. Multivariate analyses revealed a lower risk of low skeletal muscle mass for females (OR: 0.22, P < 0.01) and those without brain metastasis (OR: 0.34, P < 0.01). Low skeletal muscle mass patients were more likely to have delayed treatment administration due to toxicity (11.9% versus 6.8%, P = 0.04).ConclusionsThere is a critical need to raise awareness of low skeletal muscle mass diagnosis among oncologists, and for improvements in nutritional management and physical therapies of cancer patients to curb potential cachexia. This calls for cross-disciplinary collaborations among oncologists, nutritionists, physiotherapists, and radiologists.
Highlights
Cancer cachexia is a complex metabolic syndrome characterized by involuntary muscle loss with or without loss of fat mass, systemic inflammation, and negative protein and energy balance
The primary objective was to determine the prevalence of low skeletal muscle mass in patients with metastatic cancer of the lung, kidney, colon, breast, or prostate, by estimating on computed tomography (CT) the skeletal muscle index (SMI) in the middle of the L3 level, with cut-off values < 5 5cm2/m2 and < 39 cm2/m2 indicating low muscle mass in males and females, respectively [3]
Other outcomes included (1) an evaluation of the level of agreement between CT measurements and oncologists’ evaluations of low muscle mass (for the total study population, and for obese and non-obese sub-groups (BMI < 30 kg/m2); (2) a description of nutritional care in cancer patients; (3) weekly physical activity of cancer patients, and daily hours spent in bed as reported by the patient; and (4) an evaluation of toxicities related to ongoing anti-cancer treatment and their impact on dosage modifications, treatment delays due to toxicity, treatment interruptions, and the occurrence of adverse events (AE) ≥ grade 3
Summary
Cancer cachexia is a complex metabolic syndrome characterized by involuntary muscle loss with or without loss of fat mass, systemic inflammation, and negative protein and energy balance. Estimations of the skeletal mass index (SMI) at the third-lumbar vertebra (L3) level via computed tomography (CT) have been used to define low muscular mass [11,12,13] This particular application of CT is not yet routinely implemented in France, it has been proposed as an objective measure for the identification of low skeletal muscle mass among cancer patients [14]. Conclusions There is a critical need to raise awareness of low skeletal muscle mass diagnosis among oncologists, and for improvements in nutritional management and physical therapies of cancer patients to curb potential cachexia. This calls for cross-disciplinary collaborations among oncologists, nutritionists, physiotherapists, and radiologists
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