The association between geriatric assessment, body composition measures, and treatment-related toxicity in elderly cancer patients: A prospective cohort study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12047-12047
Author(s):  
Shlomit Strulov Shachar ◽  
Gil Barsela ◽  
Avivit Peer ◽  
Mor Tal Moskovitz ◽  
Avital Bareket-Samish ◽  
...  
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Cohort Study ◽  
Geriatric Assessment ◽  
Frailty Index ◽  
Treatment Decisions ◽  
Tumor Type ◽  
Skeletal Muscle Index ◽  
Patients With Cancer

12047 Background: Treatment decisions in older adults with cancer are confounded by limited evidence due to their under-representation in clinical trials and as associations between geriatric assessment findings, body composition measures, treatment-related toxicity, and treatment effectiveness have yet to be fully elucidated. We investigated the relationship between geriatric assessment results, skeletal muscle measures, and treatment-related toxicity in older adults with cancer. Methods: This prospective single-center cohort study included patients with cancer > 65 years of age with advanced lung, breast, or genitourinary (GU) cancer who received systemic treatment (chemotherapy, biologic therapy, immunotherapy, or combination), and had available CT scans. Patients completed the Comprehensive Geriatric assessment (CGA) and 36-item Carolina Frailty Index (CFI) was calculated to classify them as robust ( < 0.2), pre-frail (0.2-0.35), or frail ( > 0.35). For each patient, skeletal muscle area (SMA) and density (SMD) were analyzed from CT scan L3 lumbar segments using Slice-O-Matic software. SMA and height (m2) were used to calculate skeletal muscle index (SMI). Skeletal muscle gauge (SMG) was created by multiplying SMI x SMD. Sarcopenia was defined as having SMI < 41 cm2/m2 for males and < 38 cm2/m2 for females. The associations between study variables and the occurrence of at least one adverse event (AE) grade ≥2 were analyzed using the Pearson's chi-squared test. The study was approved by the IRB of Rambam Health Care Campus. All patients signed an informed consent. Results: Overall, 51 patients (recruited between 5/2015 and 1/2020) were included in the final analysis. Median (interquartile [IQR]) age was 72 (68-76) years; 59% were male; 51%, 28%, and 22% had lung, breast, and GU cancer respectively. The most common treatment received was doublet chemotherapy (49%). All patients except 3 (6%) completed the CGA and CFI was calculated; 29%, 26%, and 39% were classified as robust, pre-frail, and frail, respectively. Median (IQR) SMG was 1251 (1104-1497) AU; median (IQR) SMI was 42 (39-48) cm2/m2; 31% were defined as sarcopenic. Overall, 45% of patients experienced at least one AE grade ≥2; 24% experienced at least one AE grade≥3. No statistically significant association was found between treatment-related toxicity and sex, age, tumor type, treatment, or CFI category. Yet, having low SMG (categorically, by tertile) was significantly associated with having at least one AE grade≥2 (p = 0.03) as was being sarcopenic (p = 0.02). Conclusions: Low SMG and sarcopenia are associated with treatment-related toxicity in older patients with cancer. Further research and better understanding of this association could help optimize treatment decisions (e.g., choice of regimen, dosing) and interventions in this population.

Racial differences in geriatric assessment (GA) impairments, health-related quality of life (HRQOL), and body composition in older adults with gastrointestinal (GI) malignancies: Results from the Cancer and Aging Resilience Evaluation (CARE) registry.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Grant Richard Williams ◽  
Chen Dai ◽  
Carson Foster ◽  
Mustafa Al-Obaidi ◽  
Christian Harmon ◽  
...  
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Racial Differences ◽  
Sex Education ◽  
Cancer Type ◽  
Skeletal Muscle Index ◽  
Black And White ◽  
Patient Reported ◽  
Lower Hrqol

6537 Background: Despite recent cancer advances, racial disparities in outcomes persist. Our objective was to examine racial differences in GA impairments, HRQOL, and body composition metrics as a novel way to understand outcome disparities in older adults with GI malignancies. Methods: The CARE registry at the University of Alabama at Birmingham (UAB) is an ongoing prospective cohort study that consecutively enrolls older adults (≥60y) with GI malignancies. The CARE registry utilizes a patient-reported GA that measures a broad range of aging-related health issues. HRQOL is measured using PROMIS Global-10. Computed-Tomography (CT) images are procured to measure skeletal muscle index (SMI) and skeletal muscle density (SMD) from the L3 cross-section. For this study, we examined the adjusted odds ratio (aOR) for racial differences in GA impairments, HRQOL, sarcopenia (defined as men BMI < 25, SMI ≤43 cm2/m2; men BMI ≥25, SMI < 53 cm2/m2; women SMI < 41 cm2/m2), and myosteatosis (defined as BMI < 25, < 41 Hounsfield Units [HU]; BMI ≥25, < 33 HU), adjusting for age, sex, education, cancer type, cancer stage, and comorbidity. Results: We included 448 patients with GI malignancies, with self-reported race as White or Black, a completed GA and available CT imaging +/- 60 days of GA completion. Mean age at enrollment was 70±7.2y, 58% were male and 25% were Black. Primary cancer diagnoses included colorectal cancer (33%), pancreatic cancer (25%), and other GI malignancies (52%). Black participants had lower education (high school or < 54% vs. 38%, p< 0.01) and were less likely to be married (55% vs 71%, p< 0.01). Black participants reported more limitations in activities of daily living (aOR = 2.0 (95% confidence level [CI] 1.01-3.9, p= 0.03) and frailty (aOR = 1.9, 95% CI 1.1-3.3, p= 0.02). Similarly, Black participants reported lower HRQOL (physical: β coefficient, -2.7; p= 0.03; mental: β coefficient, -2.4; p= 0.03). Conversely, Black participants were less likely to have sarcopenia (aOR = 0.5, 95% CI 0.3-0.9, p= 0.02) and myosteatosis (aOR = 0.12, 95% CI 0.02-0.8, p= 0.02). Conclusions: Differences in frailty, HRQOL, and body composition between Black and White participants present the first step towards understanding disparities in cancer outcomes amongst older adults.

scholarly journals Role of the Appendicular Skeletal Muscle Index for Predicting the Recurrence-Free Survival of Head and Neck Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 309
Author(s):  
Kun-Yun Yeh ◽  
Hang Huong Ling ◽  
Shu-Hang Ng ◽  
Cheng-Hsu Wang ◽  
Pei-Hung Chang ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Head And Neck Cancer ◽  
Mass Loss ◽  
Lean Mass ◽  
Recurrence Free Survival ◽  
Skeletal Muscle Index ◽  
Free Survival ◽  
Prognostic Predictor ◽  
Appendicular Skeletal Muscle

Background: This study investigates whether the appendicular skeletal muscle index (ASMI) was an independent prognostic predictor for patients with locally advanced head and neck cancer (LAHNC) receiving concurrent chemoradiotherapy (CCRT) and whether there were any differences in lean mass loss in different body regions during CCRT. Methods: In this prospective study, we analyzed the clinicopathological variables and the total body composition data before and after treatment. The factors associated with the 2-year recurrence-free survival rate (RFSR) were analyzed via logistic regression analysis. Results: A total of 98 patients were eligible for analysis. The body weight, body mass index, and all parameters of body composition significantly decreased after CCRT. The pretreatment ASMI was the only independent prognostic factor for predicting the 2-year RFSR (hazard ratio, 0.235; 95% confidence interval, 0.062–0.885; p = 0.030). There was at least 5% reduction in total lean and fat mass (p < 0.001); however, the highest lean mass loss was observed in the arms (9.5%), followed by the legs (7.2%), hips (7.1%), waist (4.7%), and trunk (3.6%). Conclusions: The pretreatment ASMI was the only independent prognostic predictor for the 2-year RFSR of LAHNC patients undergoing CCRT. Asynchronous loss of lean mass may be observed in different body parts after CCRT.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

scholarly journals The Influence of Body Composition on the Systemic Exposure of Paclitaxel in Esophageal Cancer Patients

2021 ◽  
Vol 14 (1) ◽  
pp. 47
Author(s):  
Leni van Doorn ◽  
Marie-Rose B. S. Crombag ◽  
Hánah N. Rier ◽  
Jeroen L. A. van Vugt ◽  
Charlotte van Kesteren ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Body Composition ◽  
Dose Range ◽  
Systemic Exposure ◽  
Lumbar Vertebra ◽  
Skeletal Muscle Index ◽  
Mixed Effects Modeling ◽  
Significance Threshold ◽  
A Prospective Study

Changes in body composition are associated with chemotherapy-related toxicities and effectiveness of treatment. It is hypothesized that the pharmacokinetics (PK) of chemotherapeutics may depend on body composition. The effects of body composition on the variability of paclitaxel PK were studied in patients with esophageal cancer. Skeletal muscle index (SMI), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were measured at the third lumbar vertebra on computed tomography (CT) scans performed before treatment. Paclitaxel PK data were collected from a prospective study performed between May 2004 and January 2014. Non-linear mixed-effects modeling was used to fit paclitaxel PK profiles and evaluate the covariates body surface area (BSA), SMI, VAT, and SMD using a significance threshold of p < 0.001. Paclitaxel was administered to 184 patients in a dose range of 50 to 175 mg/m2. Median BSA was 1.98 m2 (range of 1.4 to 2.8 m2). SMI, VAT, and SMD were not superior to BSA in predicting paclitaxel PK. The additive value of SMI, VAT, and SMD to BSA was also negligible. We did not find evidence that paclitaxel dosing could be further optimized by correcting for SMI, VAT, or SMD.

Appendicular skeletal muscle mass to truncal fat mass ratio as a new index for osteosarcopenic obesity syndrome in older adults: emphasizing the role of central obesity

2020 ◽  
Author(s):  
Lazuardhi Dwipa ◽  
Rini Widiastuti ◽  
Alif Bagus Rakhimullah ◽  
Marcellinus Maharsidi ◽  
Yuni Susanti Pratiwi ◽  
...  
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Muscle Mass ◽  
Fat Mass ◽  
Central Obesity ◽  
Skeletal Muscle Mass ◽  
Positive Correlation ◽  
Appendicular Skeletal Muscle ◽  
Appendicular Skeletal Muscle Mass

Abstract Background The relationship between obesity and low bone mineral density (BMD) in older adults is still unclear. Most of the previous study did not account the factor of sarcopenia which is the progressive loss of skeletal muscle mass due to aging, and distribution of fat in obesity. Thus, this study was aimed to explore the correlation between appendicular skeletal muscle mass (ASMM), total fat mass (FM), and truncal fat mass (TrFM) as well as indexes (ASMM/FM and ASMM/TrFM ratio) with BMD in older adults.Methods This was an analytic cross-sectional study. Dual x-ray absorptiometry (DXA) and bioelectric impedance analysis (BIA) were used to assess BMD and body composition, respectively. Appendicular Skeletal Muscle Mass (ASMM) were used in the analysis to reflect sarcopenia, Fat Mass (FM) and Trunkal Fat Mass (TrFM) were used to reflect general and central obesity, respectively. All data were obtained from medical records of Geriatric Clinic of Hasan Sadikin General Hospital Bandung Indonesia from January 2014 to December 2018. The correlation between body compositions variable with BMD were analyzed using Spearman’s test. We also conducted a comparison analysis of body composition variables between low and normal BMD using Mann-Whitney test. Results A total of 112 subjects were enrolled in the study. ASMM and TrFM were positive (rs=0.517, p<0.001) and negative (rS=-0.22, p=0.02) correlated with BMD, respectively. FM were not correlated with BMD, rS=-0.113 (p=0.234). As indexes, ASMM/FM and ASMM/TrFM had positive correlation with BMD, rS=0.277 (p<0.001), and rS=0.391 (p<0.001), respectively. The ASMM, TrFM, and ASMM/TrFM ratio between normal and low BMD also significantly different (p<0.001), meanwhile FM were not (p=0.204).Conclusion ASMM and TrFM have a positive and negative correlation with BMD, respectively. ASMM/TrFM ratio as new sarcopenia-central obesity index has a positive correlation with BMD.

scholarly journals What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

2018 ◽  
Vol 14 (2) ◽  
pp. 85-94 ◽  
Author(s):  
Kah Poh Loh ◽  
Enrique Soto-Perez-de-Celis ◽  
Tina Hsu ◽  
Nienke A. de Glas ◽  
Nicolò Matteo Luca Battisti ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Older Patients ◽  
Geriatric Oncology ◽  
Treatment Decisions ◽  
Position Paper ◽  
Illustrative Case ◽  
Newly Diagnosed ◽  
Patients With Cancer ◽  
Detailed Evaluation ◽  
Oncology Practice

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient’s underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.

scholarly journals Muscle Characteristics Obtained Using Computed Tomography as Prognosticators in Patients with Castration-Resistant Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1864
Author(s):  
Jongsoo Lee ◽  
Jee Soo Park ◽  
Ji Eun Heo ◽  
Hyun Kyu Ahn ◽  
Won Sik Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Survival Rates ◽  
Castration Resistant Prostate Cancer ◽  
Vertebral Level ◽  
Skeletal Muscle Index ◽  
Castration Resistant ◽  
Muscle Attenuation

Limited studies have investigated the correlation between body composition and prostate cancer outcomes. We analyzed the effect of muscle mass and quality on castration-resistant prostate cancer (CRPC) outcomes. Skeletal muscle index (SMI) and skeletal muscle attenuation (SMA) were measured for 411 patients at the L3 vertebral level using computed tomography at CRPC diagnosis and were dived to low and high groups at the value of median. Analysis of the skeletal phenotypes and age (<70 and >70 years) was performed to evaluate the effect of SMI and SMA. The median survival rates for patients with low and high SMI were 19 and 24 months (p = 0.015), and those with low and high SMAs were 15 and 26 months (p < 0.001), respectively. In the subgroup analysis by age, SMA was a significant prognosticator in both groups, while SMI was a significant prognosticator only in patients aged >70 years. Patients with low SMA + low SMI had the worst prognosis. Muscle characteristics seems to be a prognosticator in survival of CRPC patients and may be considered in treatment planning.

scholarly journals Combined Training Enhances Skeletal Muscle Mitochondrial Oxidative Capacity Independent of Age

2015 ◽  
Vol 100 (4) ◽  
pp. 1654-1663 ◽  
Author(s):  
Brian A. Irving ◽  
Ian R. Lanza ◽  
Gregory C. Henderson ◽  
Rajesh R. Rao ◽  
Bruce M. Spiegelman ◽  
...  
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Transcription Factors ◽  
Muscle Strength ◽  
Oxidative Capacity ◽  
Physical Characteristics ◽  
Mitochondrial Proteins ◽  
Combined Training ◽  
Skeletal Muscle Strength

Context: Skeletal muscle from sedentary older adults exhibits reduced mitochondrial abundance and oxidative capacity. Objective: The primary objective was to determine whether 8 weeks of combined training (CT) has a more robust effect than endurance training (ET) or resistance training (RT) on mitochondrial physiology in healthy young (18–30 years) and older (≥65 years) adults. Intervention: Thirty-four young and 31 older adults were randomly assigned to 8 weeks of ET, RT, and control/CT. Control subjects completed 8 weeks of no exercise (control) followed by 8 weeks of CT. Body composition, skeletal muscle strength, and peak oxygen uptake were measured before and after the intervention. Vastus lateralis muscle biopsy samples were obtained before and 48 hours after the intervention. Mitochondrial physiology was evaluated by high-resolution respirometry and expression of mitochondrial proteins and transcription factors by quantitative PCR and immunoblotting. Results: ET and CT significantly increased oxidative capacity and expression of mitochondrial proteins and transcription factors. All training modalities improved body composition, cardiorespiratory fitness, and skeletal muscle strength. CT induced the most robust improvements in mitochondria-related outcomes and physical characteristics despite lower training volumes for the ET and RT components. Importantly, most of the adaptations to training occurred independent of age. Conclusion: Collectively, these results demonstrate that both ET and CT increase muscle mitochondrial abundance and capacity although CT induced the most robust improvements in the outcomes measured. In conclusion, CT provides a robust exercise regimen to improve muscle mitochondrial outcomes and physical characteristics independent of age.

Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

2013 ◽  
Vol 31 (12) ◽  
pp. 1539-1547 ◽  
Author(s):  
Lisa Martin ◽  
Laura Birdsell ◽  
Neil MacDonald ◽  
Tony Reiman ◽  
M. Thomas Clandinin ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Normal Weight ◽  
Cancer Center ◽  
Skeletal Muscle Index ◽  
Patients With Cancer ◽  
C Statistic ◽  
Muscle Attenuation

Purpose Emerging evidence suggests muscle depletion predicts survival of patients with cancer. Patients and Methods At a cancer center in Alberta, Canada, consecutive patients with cancer (lung or GI; N = 1,473) were assessed at presentation for weight loss history, lumbar skeletal muscle index, and mean muscle attenuation (Hounsfield units) by computed tomography (CT). Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test predictive accuracy of survival models. Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave a c statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave a c statistic of 0.92 (95% CI, 0.88 to 0.95; P < .001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). Conclusion CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

Comprehensive Geriatric Assessment for Older Patients With Cancer

2007 ◽  
Vol 25 (14) ◽  
pp. 1824-1831 ◽  
Author(s):  
Martine Extermann ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cancer Care ◽  
Older Patients ◽  
Morbidity And Mortality ◽  
Psychological State ◽  
Future Research ◽  
Oncology Patient ◽  
Patients With Cancer

Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Accumulating data show the benefits of incorporating a CGA in the evaluation of older patients with cancer. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified. Conclusion Growing evidence demonstrates that the variables examined in a CGA can predict morbidity and mortality in older patients with cancer, and uncover problems relevant to cancer care that would otherwise go unrecognized.

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