Advertisement

The association between geriatric assessment, muscle measures, and treatment-related toxicity in older adults with cancer: An Israeli prospective study

Published:August 18, 2022DOI:https://doi.org/10.1016/j.jgo.2022.08.007

      Abstract

      Introduction

      We investigated the associations among frailty, as determined via the comprehensive geriatric assessment (CGA), muscle measures (i.e., sarcopenia), and treatment-related toxicity in older adults with cancer in Israel.

      Materials and methods

      This prospective cohort study enrolled patients ≥65 years with newly-diagnosed stage IV lung, breast, or genitourinary cancer. Patients were enrolled and completed CGA before their first line of systemic therapy (chemotherapy, biologic therapy, immunologic therapy, or a combination thereof). CGA was used to classify patients as robust, pre-frail, or frail, and routine pre-treatment computed tomography (CT) images were used to quantify skeletal muscle index (SMI) and skeletal muscle density (SMD) at L3 cross-section. Two sarcopenia definitions were used: i. for women SMI <41 cm2/m2 regardless of body mass index (BMI), and for men SMI <43 cm2/m2 for those with BMI of <25 and < 53 cm2/m2 for those with BMI ≥25; and ii. SMI <38 cm2/m2 for women and < 41 cm2/m2 for men, regardless of BMI. The associations between frailty and muscle measures with the occurrence of at least one adverse event (AE) grade ≥ 2 were examined using the chi-square test, and logistic regression to determine odds ratio (OR) and 95% confidence interval (CI).

      Results

      In total, 51 patients were included in the analysis. The median (interquartile range) age was 72 (68–76) years, 30 (59%) were male, and 26 (51%) had lung cancer. CGA data were available for 48 patients: fifteen (31%), thirteen (27%), and twenty (42%) were defined as robust, pre-frail, and frail, respectively. Overall, 33 (65%) were sarcopenic by the first aforementioned definition, and sixteen (31%) by the second. No statistically significant associations were identified between frailty and having at least one AE grade ≥ 2, or between frailty and sarcopenia. Statistically significant associations were found between having sarcopenia (the second definition) and having at least one AE grade ≥ 2 (P = 0.0217). The corresponding odds ratio (95% CI) was 4.2 (1.2–15.0), P = 0.026.

      Discussion

      Our findings suggests that sarcopenia is significantly associated with treatment-related toxicity. Further studies with larger sample sizes are warranted.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • United Nation Department of Economic and Social Affairs: Population Division
        World Population Ageing 2019: Highlights (ST/ESA/SER.A/430).
        ([accessed 6 July, 2022])
        • Naito T.
        • Okayama T.
        • Aoyama T.
        • Ohashi T.
        • Masuda Y.
        • Kimura M.
        • et al.
        Skeletal muscle depletion during chemotherapy has a large impact on physical function in elderly Japanese patients with advanced non-small-cell lung cancer.
        BMC Cancer. 2017; 17: 571https://doi.org/10.1186/s12885-017-3562-4
        • Pilleron S.
        • Sarfati D.
        • Janssen-Heijnen M.
        • Vignat J.
        • Ferlay J.
        • Bray F.
        • et al.
        Global cancer incidence in older adults, 2012 and 2035: a population-based study.
        Int J Cancer. 2019; 144: 49-58https://doi.org/10.1002/ijc.31664
        • Welsh T.J.
        • Gordon A.L.
        • Gladman J.R.
        Comprehensive geriatric assessment--a guide for the non-specialist.
        Int J Clin Pract. 2014; 68: 290-293https://doi.org/10.1111/ijcp.12313
        • Pilotto A.
        • Cella A.
        • Pilotto A.
        • Daragjati J.
        • Veronese N.
        • Musacchio C.
        • et al.
        Three decades of comprehensive geriatric assessment: evidence coming from different healthcare settings and specific clinical conditions.
        J Am Med Dir Assoc. 2017; 18 (192 e1–192 e11)https://doi.org/10.1016/j.jamda.2016.11.004
        • Guerard E.J.
        • Deal A.M.
        • Chang Y.
        • Williams G.R.
        • Nyrop K.A.
        • Pergolotti M.
        • et al.
        Frailty index developed from a cancer-specific geriatric assessment and the association with mortality among older adults with cancer.
        J Natl Compr Canc Netw. 2017; 15: 894-902https://doi.org/10.6004/jnccn.2017.0122
        • Cohen H.J.
        • Smith D.
        • Sun C.L.
        • Tew W.
        • Mohile S.G.
        • Owusu C.
        • et al.
        Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy.
        Cancer. 2016; 122: 3865-3872https://doi.org/10.1002/cncr.30269
        • Hurria A.
        • Mohile S.
        • Gajra A.
        • Klepin H.
        • Muss H.
        • Chapman A.
        • et al.
        Validation of a prediction tool for chemotherapy toxicity in older adults with cancer.
        J Clin Oncol. 2016; 34: 2366-2371https://doi.org/10.1200/JCO.2015.65.4327
        • Marhold M.
        • Topakian T.
        • Unseld M.
        Sarcopenia in cancer—a focus on elderly cancer patients.
        Memo - Mag Eur Med Oncol. 2021; 14: 20-23
        • Dunne R.F.
        • Loh K.P.
        • Williams G.R.
        • Jatoi A.
        • Mustian K.M.
        • Mohile S.G.
        Cachexia and sarcopenia in older adults with cancer: a comprehensive review.
        Cancers (Basel). 2019; 11: 1861https://doi.org/10.3390/cancers11121861
        • Williams G.R.
        • Dunne R.F.
        • Giri S.
        • Shachar S.S.
        • Caan B.J.
        Sarcopenia in the older adult with cancer.
        J Clin Oncol. 2021; 39: 2068-2078https://doi.org/10.1200/JCO.21.00102
        • Williams G.R.
        • Rier H.N.
        • McDonald A.
        • Shachar S.S.
        Sarcopenia & aging in cancer.
        J Geriatr Oncol. 2019; 10: 374-377https://doi.org/10.1016/j.jgo.2018.10.009
        • Rier H.N.
        • Jager A.
        • Sleijfer S.
        • Maier A.B.
        • Levin M.D.
        The prevalence and prognostic value of low muscle mass in cancer patients: a review of the literature.
        Oncologist. 2016; 21: 1396-1409https://doi.org/10.1634/theoncologist.2016-0066
        • Hurria A.
        • Gupta S.
        • Zauderer M.
        • Zuckerman E.L.
        • Cohen H.J.
        • Muss H.
        • et al.
        Developing a cancer-specific geriatric assessment: a feasibility study.
        Cancer. 2005; 104: 1998-2005https://doi.org/10.1002/cncr.21422
        • Williams G.R.
        • Deal A.M.
        • Jolly T.A.
        • Alston S.M.
        • Gordon B.B.
        • Dixon S.A.
        • et al.
        Feasibility of geriatric assessment in community oncology clinics.
        J Geriatr Oncol. 2014; 5: 245-251https://doi.org/10.1016/j.jgo.2014.03.001
        • Williams G.R.
        • Deal A.M.
        • Sanoff H.K.
        • Nyrop K.A.
        • Guerard E.J.
        • Pergolotti M.
        • et al.
        Frailty and health-related quality of life in older women with breast cancer.
        Support Care Cancer. 2019; 27: 2693-2698https://doi.org/10.1007/s00520-018-4558-6
        • Weinberg M.S.
        • Shachar S.S.
        • Muss H.B.
        • Deal A.M.
        • Popuri K.
        • Yu H.
        • et al.
        Beyond sarcopenia: characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population.
        Breast J. 2018; 24: 278-284https://doi.org/10.1111/tbj.12952
        • Shachar S.S.
        • Deal A.M.
        • Weinberg M.
        • Nyrop K.A.
        • Williams G.R.
        • Nishijima T.F.
        • et al.
        Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane-based chemotherapy.
        Clin Cancer Res. 2017; 23: 658-665https://doi.org/10.1158/1078-0432.CCR-16-0940
        • Martin L.
        • Birdsell L.
        • Macdonald N.
        • Reiman T.
        • Clandinin M.T.
        • McCargar L.J.
        • et al.
        Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index.
        J Clin Oncol. 2013; 31: 1539-1547https://doi.org/10.1200/JCO.2012.45.2722
        • Kimura M.
        • Naito T.
        • Kenmotsu H.
        • Taira T.
        • Wakuda K.
        • Oyakawa T.
        • et al.
        Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer.
        Support Care Cancer. 2015; 23: 1699-1708https://doi.org/10.1007/s00520-014-2534-3
        • Prado C.M.
        • Baracos V.E.
        • McCargar L.J.
        • Reiman T.
        • Mourtzakis M.
        • Tonkin K.
        • et al.
        Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment.
        Clin Cancer Res. 2009; 15: 2920-2926https://doi.org/10.1158/1078-0432.CCR-08-2242
        • Ueno A.
        • Yamaguchi K.
        • Sudo M.
        • Imai S.
        Sarcopenia as a risk factor of severe laboratory adverse events in breast cancer patients receiving perioperative epirubicin plus cyclophosphamide therapy.
        Support Care Cancer. 2020; 28: 4249-4254https://doi.org/10.1007/s00520-019-05279-x
        • Guo J.
        • Cai P.
        • Li P.
        • Cao C.
        • Zhou J.
        • Dong L.
        • et al.
        Body composition as a predictor of toxicity and prognosis in patients with diffuse large B-cell lymphoma receiving R-CHOP immunochemotherapy.
        Curr Oncol. 2021; 28: 1325-1337https://doi.org/10.3390/curroncol28020126
        • Ruiz J.
        • Miller A.A.
        • Tooze J.A.
        • Crane S.
        • Petty W.J.
        • Gajra A.
        • et al.
        Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age.
        J Geriatr Oncol. 2019; 10: 48-54https://doi.org/10.1016/j.jgo.2018.06.007
        • Baracos V.E.
        • Reiman T.
        • Mourtzakis M.
        • Gioulbasanis I.
        • Antoun S.
        Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis.
        Am J Clin Nutr. 2010; 91: 1133S-1137Shttps://doi.org/10.3945/ajcn.2010.28608C
        • The.Israeli.Health.Ministry
        Health behaviors: Prevention and treatment of obesity.
        ([accessed 6 July, 2022])