Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Cancer cachexia is a syndrome characterized by weight loss with accompanying loss of muscle and/or fat mass and leads to impaired patient function and physical performance and is associated with a poor prognosis. It is prevalent in older adults with cancer; age-associated physiologic muscle wasting and weakness, also known as sarcopenia, can compound deficits associated with cancer cachexia in older adults and makes studying this condition more complex in this population. Multiple measurement options are available to assess the older patient with cancer and cachexia and/or sarcopenia including anthropometric measures, imaging modalities such as Dual X-ray absorptiometry (DEXA) and Computed Tomography (CT), muscular strength and physical performance testing, and patient-reported outcomes (PROs). A geriatric assessment (GA) is a useful tool when studying the older patient with cachexia given its comprehensive ability to capture aging-sensitive PROs. Interventions focused on nutrition and increasing physical activity may improve outcomes in older adults with cachexia. Efforts to develop targeted pharmacologic therapies with cachexia have not been successful thus far. Formal treatment guidelines, an updated consensus definition for cancer cachexia and the development of a widely adapted assessment tool, much like the GA utilized in geriatric oncology, could help advance the field of cancer cachexia over the next decade.

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Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

Gerontology and Geriatric Medicine ◽

10.1177/2333721420980313 ◽

2020 ◽

Vol 6 ◽

pp. 233372142098031

Author(s):

Stephen C. Jennings ◽

Kenneth M. Manning ◽

Janet Prvu Bettger ◽

Katherine M. Hall ◽

Megan Pearson ◽

...

Keyword(s):

Older Adults ◽

Physical Performance ◽

Exercise Program ◽

Performance Testing ◽

Group Exercise ◽

Health Maintenance ◽

Functional Assessments ◽

Wide Scale ◽

Rapid Transition ◽

Exercise Classes

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants’ physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

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Utility of a Patient-Reported Symptom and Functioning Assessment Tool for Geriatric Oncology Care in China

Value in Health Regional Issues ◽

10.1016/j.vhri.2021.08.001 ◽

2022 ◽

Vol 29 ◽

pp. 28-35

Author(s):

Dong Xue ◽

Pingping Li ◽

Tsun Hsuan Chen ◽

Qiuling Shi ◽

Xin Shelley Wang

Keyword(s):

Assessment Tool ◽

Geriatric Oncology ◽

Patient Reported ◽

Oncology Care ◽

Functioning Assessment

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Comparison of Self-Report of Dysphagia Using the Eating Assessment Tool and the Sydney Swallowing Questionnaire in Community Dwelling Older Adults

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2021_persp-21-00101 ◽

2021 ◽

pp. 1-7

Author(s):

Aarthi Madhavan ◽

Nicole Shuman ◽

Claire Snyder ◽

Nicole Etter

Keyword(s):

Older Adults ◽

Assessment Tool ◽

Community Dwelling ◽

Self Report ◽

Screening Tools ◽

Medical Diagnoses ◽

Age Related ◽

Swallowing Problems ◽

Patient Reported ◽

Community Dwelling Older Adults

Purpose Patient-reported outcomes (PROs) are an important feature in clinical evaluation of swallowing. The Eating Assessment Tool (EAT-10) and the Sydney Swallow Questionnaire (SSQ) are two validated dysphagia PROs commonly used in healthy older adult populations as screening tools for swallowing problems. The purpose of this study is to compare the consistency of the EAT-10 and SSQ scores for self-reported swallowing difficulties in a group of community-dwelling older adults (CDOA) completing both questionnaires. Method A total of 316 individuals over the age of 60 years completed the EAT-10, SSQ, and provided demographic data, including a self-report of any medical diagnoses. Participants were excluded if they had any diagnoses known to cause dysphagia. Questionnaire responses were analyzed for frequencies of responses across all participants. Results Seventy-five participants were identified as having dysphagia by the EAT-10 (23.7%), while 30 participants were identified by the SSQ (9.49%). When comparing the results of the two assessments, the scales agreed on 289 out of 316 participants (91%). There was a disagreement on the results in 27 of the 316 participants, with 26 of these self-reporting dysphagia symptoms on the EAT-10 but not on the SSQ. Conclusions Two commonly used dysphagia PROs resulted in different prevalence rates of self-reported dysphagia in a group of CDOA. CDOAs may need questionnaires specifically validated for them with special consideration for specific age-related risk factors, to ensure accurate early identification.

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American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Blood Advances ◽

10.1182/bloodadvances.2020001920 ◽

2020 ◽

Vol 4 (15) ◽

pp. 3528-3549 ◽

Cited By ~ 3

Author(s):

Mikkael A. Sekeres ◽

Gordon Guyatt ◽

Gregory Abel ◽

Shabbir Alibhai ◽

Jessica K. Altman ◽

...

Keyword(s):

Older Adults ◽

Acute Myeloid Leukemia ◽

Health Care Professionals ◽

Myeloid Leukemia ◽

Intensive Therapy ◽

Geriatric Oncology ◽

Patient Reported ◽

American Society ◽

Supportive Management ◽

Acute Myeloid

Abstract Background: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. Methods: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE’s Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy. Conclusions: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient’s disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

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46 The Relationship between Cognitive Function and Physical Performance among Older Adults Attending a Falls and Syncope Service in Kuala Lumpur

Age and Ageing ◽

10.1093/ageing/afz164.46 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv9-iv12

Author(s):

Sun Zek Jong ◽

Norizzati Saedon ◽

Sarah Kiyu ◽

Pey June Tan ◽

Maw Pin Tan

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Grip Strength ◽

Physical Performance ◽

Cognitive Assessment ◽

Assessment Tool ◽

Timed Up And Go ◽

Functional Reach ◽

The Mean ◽

The Relationship

Abstract Introduction Recent studies identified a relationship between gait difficulties and risk of developing dementia, a condition now termed motoric cognitive risk. We interrogated a clinical dataset to determine the relationship between cognitive assessment scores and physical performance scores to identify the strength of association between these two types of measures. Methods Consecutive patients referred to the falls and syncope service and the University of Malaya Medical Centre were recruited. The cognitive function of consenting individuals was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Tool (VCAT). Physical performance was assessed using hand grip strength (HGS), timed-up-and-go (TUG) and functional reach (FR). Results One hundred and forty-seven individuals, mean age (standard deviation,SD)=76.1 (7.8) years, 85 (58%) women were included. The mean (SD) for right and left HGS, FR and TUG scores for the overall population were 19.1 (7.0)kg, 19.0 (12.1)kg, 28.9 (39.7)cm, TUG 19.2 (11.0)s respectively. The mean MoCA and VCAT scores were 21.1 (7.1) and 20.3 (6.3) respectively. Right HGS correlated moderately with MoCA (r=0.367) and VCAT scores (r=0.397). Left HGS had a weak to moderate correlation with MoCA (r=0.281) and VCAT (0.271). FR, however, was not correlated with either MoCA (r=0.073) and VCAT (0.020). TUG scores were moderately negatively correlated with MoCA (-0.3206) but weakly correlated with VCAT (-0.175) Conclusion Our evaluation of the relationship between cognitive scores and physical performance in a falls and syncope clinic setting found that a relationship exists between muscle strength measured with grip strength and composite assessment of gait and balance using the TUG. Dynamic balance measured with functional reach, however, was not associated with cognitive function. Future studies will need to identify the possible mechanisms linking cognitive function with strength and gait in order to establish cognitive function as a modifiable risk factor for falls in older adults.

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Toward Modernization of Geriatric Oncology by Digital Health Technologies

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_279505 ◽

2020 ◽

pp. 209-215 ◽

Cited By ~ 1

Author(s):

Armin Shahrokni ◽

Kah Poh Loh ◽

William A. Wood

Keyword(s):

Older Adults ◽

Wireless Sensors ◽

Patient Reported Outcomes ◽

Digital Health ◽

Geriatric Oncology ◽

Proper Selection ◽

Health Technologies ◽

The Past ◽

Oncology Research ◽

Patient Reported

The number of older adults with cancer is increasing. Over the past 3 decades, geriatric oncology research has focused on improving the assessment of frailty and fitness of older adults with cancer as well as methods of improving their outcomes. At the same time, advances in digital health technologies have opened new frontiers for reaching this goal. Digital health technologies encompass a variety of solutions, from electronic patient-reported outcomes (ePROs) to big data and wireless sensors. These solutions have the potential to further advance our understanding of patients’ experiences during cancer treatment. Whereas the data on the feasibility and utility of such solutions in the care of older adults with cancer are limited, interest from digital health oncology researchers to further explore the benefits of these products is increasing. In this article, we describe the focus of geriatric oncology, the rationale behind the need to explore digital health technologies in this setting, and emerging data and ongoing studies, as well as provide guidelines for proper selection, implementation, and testing of digital health solutions in the context of geriatric oncology.

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OBESITY DEFINITIONS IN SARCOPENIC OBESITY: DIFFERENCES IN PREVALENCE, AGREEMENT AND ASSOCIATION WITH MUSCLE FUNCTION

Journal of Frailty & Aging ◽

10.14283/jfa.2019.28 ◽

2019 ◽

pp. 1-7

Author(s):

E.Q. Khor ◽

J.P. Lim ◽

L. Tay ◽

A. Yeo ◽

S. Yew ◽

...

Keyword(s):

Older Adults ◽

Body Composition ◽

Physical Performance ◽

Gait Speed ◽

Muscle Function ◽

Handgrip Strength ◽

Community Dwelling ◽

Sarcopenic Obesity ◽

Consensus Definition ◽

The Impact

Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in its reported prevalence, poor inter-definitional agreement, and disagreement on its impact on physical performance, impeding further development in the field. While sarcopenia definitions have been compared, the impact of obesity definitions in SO has been less well-studied. Objectives: To compare 3 widely-adopted definitions of obesity in terms of SO prevalence, inter-definitional agreement, and association with muscle function. Design: Cross-sectional. Setting: GERILABS study, Singapore Participants: 200 community-dwelling, functionally-independent older adults. Measurements: We utilized three commonly-used definitions of obesity: body mass index (BMI), waist circumference (WC) and DXA-derived fat mass percentage (FM%). Sarcopenia was defined using Asian Working Group for Sarcopenia criteria. For muscle function, we assessed handgrip strength, gait speed and Short Physical Performance Battery (SPPB). Subjects were classified into 4 body composition phenotypes (normal, obese, sarcopenic and SO), and outcomes were compared between groups. Results: The prevalence rate for SO was lowest for BMI (0.5%) compared to FM% (10.0%) and WC (10.5%). Inter-definitional agreement was lowest between BMI and WC (κ=0.364), and at best moderate between FM% and WC (κ=0.583). SO performed the worst amongst body composition phenotypes in handgrip strength, gait speed and SPPB (all p<0.01) only when defined using WC. In regression analyses, SO was associated with decreased SPPB scores (β=-0.261, p=0.001) only for the WC definition. Conclusion: There is large variation in the prevalence of SO across different obesity definitions, with low-to-moderate agreement between them. Our results corroborate recent evidence that WC, and thus central obesity, is best associated with poorer muscle function in SO. Thus, WC should be further explored in defining obesity for accurate and early characterization of SO among older adults in Asian populations.

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Testosterone and Adipokines are Determinants of Physical Performance, Strength, and Aerobic Fitness in Frail, Obese, Older Adults

International Journal of Endocrinology ◽

10.1155/2014/507395 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Lina E. Aguirre ◽

Irum Zeb Jan ◽

Kenneth Fowler ◽

Debra L. Waters ◽

Dennis T. Villareal ◽

...

Keyword(s):

Older Adults ◽

Physical Performance ◽

Knee Flexion ◽

Performance Testing ◽

High Sensitivity ◽

Knee Extension ◽

Peak Oxygen Consumption ◽

Physical Strength ◽

Insulin Growth Factor ◽

Hs Crp

In this study, we evaluated the independent and combined effects of baseline circulating gonadal, anabolic hormones and adipokines on physical function in 107 frail, obese (BMI ≥ 30 kg/m2), and older (≥65 yr) subjects. Our results showed significant positive correlations between circulating testosterone and insulin growth factor-1 (IGF-1) with knee flexion, knee extension, one-repetition maximum (1-RM), and peak oxygen consumption (VO2peak), while no correlation was observed with estradiol. Among the adipokines, high sensitivity C-reactive protein (Hs-CRP) and leptin negatively correlated with the modified physical performance testing (PPT), knee flexion, knee extension, 1-RM, and VO2peak. Interleukin-6 ( Il-6) negatively correlated with knee flexion and VO2peak and soluble tumor necrosis factors receptor-1 (sTNFr1) correlated with PPT, 1-RM, and VO2peak. Adiponectin correlated negatively with 1-RM. Multiple regression analysis revealed that, for PPT, sTNFr1 was the only independent predictor. Independent predictors included adiponectin, leptin, and testosterone for knee flexion; leptin and testosterone for knee extension; adiponectin, leptin, and testosterone for 1-RM; and IGF-1, IL-6, leptin, and testosterone for VO2peak. In conclusion, in frail obese older adults, circulating levels of testosterone, adiponectin, and leptin appear to be important predictors of physical strength and fitness, while inflammation appears to be a major determinant of physical frailty.

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