The incidence of colorectal cancer (CRC) increases with age. In combination with an ageing population, the number of older patients undergoing surgical treatment for CRC is therefore expected to increase. Sarcopenia and cachexia are potentially modifiable risk factors of a negative surgical outcome. Sarcopenia can be categorized into primary (age-related) and secondary where diseases, such as malignancy, are influential factors. We aimed to investigate the prevalence of preoperative sarcopenia and cachexia in older (≥65 years) vulnerable patients with localized CRC.
Materials and Methods
Patients included in the randomized study “Geriatric assessment and intervention in older vulnerable patients undergoing resection for colorectal cancer,” were screened for sarcopenia and cachexia prior to surgery. All patients in the present cohort were considered vulnerable with Geriatric 8 ≤ 14 points. Sarcopenia was defined according to European Guidelines (EWGSOP2), based on low muscle strength—low handgrip-strength and/or slow 5xChair-Stand-Test—and low appendicular lean mass assessed by dual-energy X-ray absorptiometry. Cachexia was defined as self-reported unintended weight loss >5% within three months or 2–5% with body mass index <20 kg/m2.
Sixty-four patients (mean age 79.6 years ±6.4 years, 36 women) were assessed. Of these, 28% (n = 18, 11 women) had low muscle strength and 13% (n = 8, 4 women) fulfilled the criteria for sarcopenia, however, 33% (n = 21, 13 women) had low muscle mass. There was no correlation between low muscle strength and low muscle mass (r = 0.16, P = 0.22). The prevalence of cachexia was 36% (n = 23, 16 women). Low muscle mass was associated with cachexia (φ = 0.38, P = 0.005), but there was no association between sarcopenia and cachexia (φ = 0.01, P = 1.0).
Despite the included patients who fulfilled the criteria for vulnerability according to G8, relatively few (28%) had low muscle strength. Moreover, there was poor overlap between the prevalence of sarcopenia according to the EWGSOP2 guidelines (13%) and prevalence of low muscle mass (33%) in older patients with CRC. Of note also, there was no association between sarcopenia and cachexia, but an association between cachexia and low muscle mass, which highlights the importance of assessing muscle mass in patients with cancer.
Trial registration: The GEPOC trial has been prospectively registered at http://clinicaltrials.gov (NCT03719573).
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
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424
- Cancer statistics for adults aged 85 years and older, 2019.CA Cancer J Clin. 2019; 69: 452-467
- Short-term outcomes after surgical resection for colorectal cancer in South Australia.J Eval Clin Pract. 2017; 23: 316-324
- Association between specific presurgical anthropometric indexes and morbidity in patients undergoing rectal cancer resection.Nutrition. 2020; 75-76110779
- Frailty consensus: a call to action.J Am Med Dir Assoc. 2013; 14: 392-397
- Frailty and post-operative outcomes in older surgical patients: a systematic review.BMC Geriatr. 2016; 16: 157
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Frailty measurement in research and clinical practice: a review.Eur J Intern Med. 2016; 31: 3-10
- Physical frailty: ICFSR international clinical practice guidelines for identification and management.J Nutr Health Aging. 2019; 23: 771-787
- Screening older cancer patients: first evaluation of the G-8 geriatric screening tool.Ann Oncol. 2012; 23: 2166-2172
- The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.Nutrition. 1999; 15: 116-122
- International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.J Clin Oncol. 2014; 32: 2595-2603
- Screening for frailty among older patients with cancer that qualify for abdominal surgery.J Geriatr Oncol. 2015; 6: 52-59
- Usefulness of eight screening tools for predicting frailty and postoperative short- and long-term outcomes among older patients with cancer who qualify for abdominal surgery.Eur J Surg Oncol. 2020; 46: 2091-2098
- Sarcopenia: revised European consensus on definition and diagnosis.Age Ageing. 2019; 48: 16-31
- The Copenhagen sarcopenia study: lean mass, strength, power, and physical function in a Danish cohort aged 20-93 years.J Cachexia Sarcopenia Muscle. 2019; 10: 1316-1329
- Strength, power and related functional ability of healthy people aged 65-89 years.Age Ageing. 1994; 23: 371-377
- Assessment of sarcopenia measures, survival, and disability in older adults before and after diagnosis with cancer.JAMA Netw Open. 2020; 3e204783
- Sarcopenia & aging in cancer.J Geriatr Oncol. 2019; 10: 374-377
- Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis.J Cachexia Sarcopenia Muscle. 2019; 10: 485-500
- Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis.Ann Surg. 2018; 268: 58-69
- Definition and classification of cancer cachexia: an international consensus.Lancet Oncol. 2011; 12: 489-495
- Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies.Annu Rev Med. 2011; 62: 265-279
- Pitfalls in the measurement of muscle mass: a need for a reference standard.J Cachexia Sarcopenia Muscle. 2018; 9: 269-278
- Prevalence of sarcopenia in older patients with colorectal cancer.J Geriatr Oncol. 2015; 6: 442-445
- Geriatric assessment and intervention in older vulnerable patients undergoing surgery for colorectal cancer: a protocol for a randomised controlled trial (GEPOC trial).BMC Geriatr. 2021; 21: 88
- Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale.Psychiatry Res. 1992; 41: 237-248
- Senior Fitness Test Manual-2nd Edition. Human Kinetics.2001
- Impact of using the updated EWGSOP2 definition in diagnosing sarcopenia: a clinical perspective.Arch Gerontol Geriatr. 2020; 90104125
- Assessment of sarcopenia in patients with upper gastrointestinal tumors: prevalence and agreement between computed tomography and dual-energy x-ray absorptiometry.Clin Nutr (Edinburgh, Scotland). 2021; 40: 2809-2816
- Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies.BMC Geriatr. 2021; 21: 574
- Preoperative handgrip strength is not associated with complications and health-related quality of life after surgery for colorectal cancer.Sci Rep. 2020; 10: 13005
- The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults.J Aging Phys Act. 1998; 6: 363-375
- Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications.Eur J Surg Oncol. 2021; 47: 874-881
- Ethical principles for medical research involving human subjects.Jama. 2013; 310: 2191-2194
Published online: November 21, 2022
Accepted: November 4, 2022
Received in revised form: October 17, 2022
Received: May 7, 2022
© 2022 Published by Elsevier Ltd.