Sarcopenia was linked to severe toxicity and shorter survival in older adults starting cancer treatment

Design

Secondary analysis of the usual-care arm of a randomised trial of geriatric assessment

Population

161 adults aged 70 or over with advanced cancer starting a new treatment regimen

Primary outcome

Severe (grade 3 to 5) non-haematological toxicity and survival by sarcopenia status

Effect

Severe toxicity OR 2.24 (95% CI 1.12 to 4.47); first-line one-year survival 46% vs 60%, HR 2.12 (1.14 to 3.93)

This secondary analysis of a trial of geriatric assessment used the usual-care arm: 161 adults aged 70 or over with advanced cancer starting a new regimen in US community oncology practices. Sarcopenia was defined as reduced strength (slow chair rises) plus low muscle quantity or quality on routine CT; severe sarcopenia added impaired physical performance on the timed up and go test.

Sarcopenia was present in 57% (91 of 161), and 59% of these were severe. It was linked to deficits in nutrition, daily living, instrumental activities and cognition. In adjusted models, sarcopenia was associated with severe (grade 3 to 5) non-haematological toxicity (OR 2.24, 95% CI 1.12 to 4.47) and, among those on first-line therapy, worse one-year survival (46% against 60%; HR 2.12, 95% CI 1.14 to 3.93). Muscle quantity on CT alone was not significantly associated with either.

The cohort was small, 94% non-Hispanic white, and this was an observational analysis within a trial. It suggests that measuring strength and performance, not only CT muscle mass, adds information, but it does not show that treating sarcopenia improves tolerance.

• Sarcopenia (strength plus muscle quantity or quality) affected 57% of older adults starting cancer treatment.
• It was associated with severe non-haematological toxicity (OR 2.24, 95% CI 1.12 to 4.47).
• First-line patients with sarcopenia had worse one-year survival (46% vs 60%; HR 2.12).
• CT muscle mass alone did not show a significant association; add chair-rise and walking tests.
• Consider geriatric assessment, nutrition and exercise support before and during treatment.

Why it matters

It shows that muscle mass on a scan misses part of the picture that a chair-rise test captures.

Don't overread it

This is an observational secondary analysis of 161 mostly white patients and does not show that treating sarcopenia reduces toxicity.

The statistics, in plain English

An odds ratio of 2.24 with an interval of 1.12 to 4.47 means more than double the odds of severe toxicity, but the lower bound is near 1, so the size is uncertain with only 161 patients. Sicker patients are likelier to be both sarcopenic and toxic, so the link may partly reflect overall frailty.

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