A dynamometer costs very little, takes under a minute, and gives a number that performance status does not. Handgrip strength at baseline tracks with muscle mass, with nutritional reserve, and with how much treatment a patient will tolerate — and unlike ECOG status it is a measurement rather than an impression, so it can be repeated and compared.
Do it at the first visit, before any treatment starts, and record the number. Repeat it at each cycle or each review. A falling grip in a patient who says they are managing is the earliest objective sign that they are not, and it arrives before weight loss becomes obvious and well before performance status is downgraded.
What you do with it is the ordinary set of things that are easy to defer: a dietitian referral, a protein target, a physiotherapy referral if one exists, and a conversation about whether the current regimen is still the right one. None of those are new. The value of the number is that it prompts them at the point where they can still change something.
- Measure grip strength at baseline, before the first cycle
- Record the number rather than a category; the trend is the signal
- Repeat at each cycle and act on a fall before weight loss appears
- Use a fall to trigger dietetic and physiotherapy referral, not just observation
- Note the patient's dominant hand and use the same hand each time
Why it matters
Performance status is an impression recorded once; grip strength is a number that shows deterioration while there is still time to respond.
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