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 ◽  
...  

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.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22503-e22503
Author(s):  
Aman Wadhwa ◽  
Kandice Barnett ◽  
Chen Dai ◽  
Joshua Richman ◽  
Andrew Michael McDonald ◽  
...  

e22503 Background: Body composition is an emerging predictor of toxicity and survival in older adults with cancer ( Shachar, Eur J Can, 2016); however, its role in pediatric cancer is not known. We examined body composition (using computed-tomography [CT] scans at the 3rd lumbar level) in children with lymphoma (Hodgkin [HL] and non-Hodgkin [NHL]) at cancer diagnosis and examined its association with treatment-related toxicities. Methods: We constructed a retrospective cohort of 87 consecutive children (HL: n = 45; NHL: n = 42) diagnosed between 2000 and 2015 (2-21y at diagnosis) with pretreatment abdominal CT scans. Body composition was assessed using sliceOmatic (TomoVision) and included skeletal muscle index (SMI, cm2/m2), skeletal muscle density (SMD: Hounsfield units [HU]), and height-adjusted total adipose tissue (hTAT: sum of visceral, intramuscular and subcutaneous adipose tissue, cm2/m2). For the analysis, we used skeletal muscle gauge (SMG = SMI x SMD, expressed per 1000 in arbitrary units [AU]) and hTAT. Sociodemographics, disease and treatment details, as well as toxicities (CTCAE v5) were abstracted from medical records. Proportion of chemotherapy cycles with grade 4 hematologic or grade 3-4 non-hematologic toxicities were calculated (percent toxicity). Generalized linear regression models were constructed to examine associations between body composition metrics and toxicities, adjusting for age at diagnosis, gender, race/ethnicity and lymphoma subtype. Results: Median age at diagnosis was 12.9y (range, 2-18.5y); 60.9% males; 60.4% non-Hispanic white. Median BMI%ile was 62 (0-99), median SMG was 2.2AU (0.9-3.7) and median hTAT was 20.1 cm2/m2 (0.04-226.7). Overall, the mean percent toxicity for grade 4 hematologic and grade 3-4 non-hematologic toxicity was 38.9% (±32.6) and 31.4% (±32.6) respectively. Correlation was poor between SMG and BMI%ile ( R2= 0.04), SMG and hTAT ( R2= -0.01) and moderate between hTAT and BMI%ile ( R2= 0.4). SMG was significantly associated with grade 4 hematologic percent toxicity ( β= -18, P= 0.007) after adjusting for hTAT and cancer type. BMI%ile was not associated with grade 4 hematologic percent toxicity ( β= -0.09, P= 0.5). Non-hematologic percent toxicity was not associated with BMI%ile, hTAT or SMG. Conclusions: In this first study of its kind, we find that children with poorer muscle quality are more likely to experience grade 4 hematologic toxicities. These findings form the basis for larger studies to incorporate body composition when developing prediction models for chemotherapy-related toxicity and disease outcomes.


Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2629
Author(s):  
Jie Lee ◽  
Tze-Chien Chen ◽  
Ya-Ting Jan ◽  
Chi-Jung Li ◽  
Yu-Jen Chen ◽  
...  

Pelvic radiotherapy is associated with gastrointestinal toxicities and deterioration of nutritional status. This study aimed to investigate the association of patient-reported outcomes (PROs) and nutritional status with body composition changes in women who underwent hysterectomy and post-operative radiotherapy for gynecologic cancer. We analyzed data of 210 patients treated with post-operative pelvic radiotherapy for gynecologic cancer between 2013 and 2018. The PRO version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was used for gastrointestinal toxicity assessment. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment. Skeletal muscle index was measured from computed tomography scans at the L3 vertebral level. A reduction in skeletal muscle index ≥ 5% was classified as muscle loss. Odds ratios were calculated through logistic regression models. The PG-SGA score increased from the beginning to the end of radiotherapy (1.4 vs. 3.7, p < 0.001). Patients with PRO-CTCAE scores ≥ 3 had significantly higher PG-SGA scores at the end of radiotherapy than those with PRO-CTCAE scores ≤ 2 (8.1 vs. 2.3, p < 0.001). On multivariable analysis, PRO-CTCAE scores ≥ 3 and PG-SGA scores ≥ 4 at the end of radiotherapy were independently associated with increased risk of muscle loss (odds ratio: 8.81, p < 0.001; odds ratio: 72.96, p < 0.001, respectively). PROs and PG-SGA may be considered as markers of muscle loss after post-operative pelvic radiotherapy for gynecologic cancer.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12047-12047
Author(s):  
Shlomit Strulov Shachar ◽  
Gil Barsela ◽  
Avivit Peer ◽  
Mor Tal Moskovitz ◽  
Avital Bareket-Samish ◽  
...  

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.


Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 309
Author(s):  
Kun-Yun Yeh ◽  
Hang Huong Ling ◽  
Shu-Hang Ng ◽  
Cheng-Hsu Wang ◽  
Pei-Hung Chang ◽  
...  

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.


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 ◽  
...  

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.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Virginia J Howard ◽  
Paul Muntner ◽  
Brett M Kissela ◽  
Bhupesh Panwar ◽  
...  

Objective: Black Americans are at greater risk of both stroke and vitamin D deficiency than white Americans. We have previously shown that both higher dietary vitamin D and sunlight exposure are associated with decreased risk of stroke; however, serum 25(OH) is thought to be a better marker of vitamin D status. Methods: Using a case cohort design, we examined the association of plasma 25(OH)D with incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white participants from across the United States enrolled between 2003 and 2007. Medical records were reviewed by physicians and strokes were classified on the basis of symptoms and neuroimaging. Strokes through July 1, 2011 were included. A stratified cohort sample was selected to ensure approximately equal numbers of black and white participants and an equal distribution across ages. We used Cox proportional hazards models weighted back to the original 30,239 participants, excluding those with history of stroke. Serum 25(OH)D was measured by Immunodetection Systems ELISA. Results: Over mean follow-up of 4.4 years, there were 539 ischemic and 71 hemorrhagic strokes. The stroke-free sub-cohort included 939 participants. After adjustment for age, race, sex, education, diabetes, hypertension, smoking, atrial fibrillation, heart disease, physical activity, kidney function, calcium and phosphorous, 25(OH)D level 30 ng/mL. The direction of association was similar for hemorrhagic stroke though not statistically significant (HR=1.59; 95%CI=0.78, 3.24). Vitamin D deficiency was associated with an increased risk of all stroke (HR=1.54; 95%CI=1.05, 2.23). This effect was greater in blacks (HR=2.09; 95%CI=1.09, 3.99) than whites (HR=1.38; 95%CI=0.78, 2.42). Results were not as strong when we modeled 25(OH)D as a continuous variable (HR=0.99 per 1 ng/ml change in 25(OH)D; 95%CI=0.98, 1.01). Discussion: Similar to low vitamin D intake, vitamin D deficiency is a risk factor for incident stroke. These findings support evidence from cardiovascular and cancer epidemiology that treating low 25(OH)D may prevent strokes.


2020 ◽  
Author(s):  
Lazuardhi Dwipa ◽  
Rini Widiastuti ◽  
Alif Bagus Rakhimullah ◽  
Marcellinus Maharsidi ◽  
Yuni Susanti Pratiwi ◽  
...  

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.


Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1864
Author(s):  
Jongsoo Lee ◽  
Jee Soo Park ◽  
Ji Eun Heo ◽  
Hyun Kyu Ahn ◽  
Won Sik Jang ◽  
...  

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.


2015 ◽  
Vol 100 (4) ◽  
pp. 1654-1663 ◽  
Author(s):  
Brian A. Irving ◽  
Ian R. Lanza ◽  
Gregory C. Henderson ◽  
Rajesh R. Rao ◽  
Bruce M. Spiegelman ◽  
...  

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.


2018 ◽  
Vol 7 (1) ◽  
pp. 83 ◽  
Author(s):  
Dennis Hunt ◽  
Sareen S. Gropper ◽  
Kelly A. Miller ◽  
Barbara Tymczyszyn ◽  
Deborah Chapa

Muscle mass, strength, and function have been shown to decline with aging, and if of sufficient magnitude can result in sarcopenia. This study’s objective was to determine the prevalence of low muscle mass in a group of adults living in a “premier” Florida residential continuing care retirement community. The sample consisted of 80 older adults, ranging from young old (65-74 years) to the oldest old (85+ years) with the oldest participant being 94 years. Skeletal muscle mass was assessed via bioelectrical impedance analysis. Skeletal muscle index values were calculated and compared with established cut-off values to classify each individual’s muscle mass as normal or low (sarcopenic). The prevalence of sarcopenia among the males was 66% and among females was 73%. When examined by age, 56% of those in their 70s, 73% of those in their 80s, and 79% of adults in their 90s had low muscle mass indicative of sarcopenia. This study found a higher prevalence for sarcopenia in females and males, especially among the oldest groups, than previously reported in a nationally representative sample of adults. This study’s findings also suggest the need for further studies examining whether the prevalence of low muscle mass among adults in either classification varies with socioeconomic status and ethnicity. Continuing care retirement communities may provide excellent environments for the screening, diagnosis, and implementation of exercise and nutritional programs for residents to help prevent or attenuate sarcopenia’s deleterious effects. Nurse practitioners must incorporate screening for sarcopenia in their wellness package for their patients. Screening, nutritional education and support and exercise prescriptions are vital to prevent associated decline from sarcopenia.


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