Accelerated losses in differing sarcopenia measures existed both prior to and after cancer diagnosis in older adults, according to a recent study published in JAMA Network Open.
More, these findings may present opportunities to improve outcomes via targeted interventions moving forward.
“This study affords a rare glimpse of sarcopenia indices both before and after cancer diagnosis compared with a population without cancer,” wrote the researchers. “Accelerated loses in gait speed prior to cancer diagnosis and accelerated loses in (appendicular lean mass) after cancer diagnosis suggest that a cancer diagnosis does affect age-related losses in some sarcopenia indices.”
Of the total sample, 515 patients developed cancer within the first 7 years of the study. Of those developments, the most common cancers were prostate (n = 117; 23.2%), colorectal (n = 63; 12.5%), lung (n = 61; 12.1%), and breast (n = 61; 12.1%) cancer, with 165 (32%) patients diagnosed with metastatic disease.
When compared with the control group, the patients who developed cancer saw a steeper decline in gait speed, but not appendicular lean mass or hand grip strength prior to diagnosis. After cancer diagnosis, these patients saw a decline in appendicular lean mass, but not hand grip strength or gait speed. The declines in appendicular lean mass for this cohort were most severe in patients with metastases.
Overall, slow gait speed was associated with a 44% increase in mortality (HR, 1.44; 95% CI, 1.05 to 1.98; P= .02) and a 70% increase in disability (HR, 1.70; 95% CI, 1.08 to 2.68; P= .02). Low appendicular lean mass or hand grip strength was not associated with an increase in mortality or disability.
A total of 3,075 older adult patients were included in the study, with a mean age of 74.1 years recruited from a random sample. The patients were examined for 17 years from January 1997 until December 2013.
“Accelerated losses in differing sarcopenia indices were found among older adults before and after cancer diagnosis compared with a comparison group without cancer,” wrote the researchers. “Decline in gait speed was observed prior to cancer diagnosis, and accelerated decline in ALM was seen after cancer diagnosis, particularly in those with metastatic disease.”
For the limitations, the researchers note that the older participants recruited from the Health, Aging, and Body Composition study were only from 2 United States cities, Pittsburgh and Memphis. More, the researchers were unable to examine the association of specific treatments with trajectories of specific sarcopenia indices because no information regarding cancer treatment was obtained from the cohort. Lastly, given that sarcopenia’s development is multifactorial, the researchers were unable to account for all potential events that may have contributed to the decline
Moving forward, the researchers suggest future studies examine the causes of muscle loss and decline in gait speed for this population with the intent of informing appropriately targeted interventions.
“Further work is needed to provide a deeper understanding of the effect of cancer and specific cancer treatments on the decline in sarcopenia indices in cancer survivors to inform effective interventions to combat sarcopenia in this growing population,” wrote the researchers.
Williams GR, Chen Y, Kenzik KM, et al. Assessment of Sarcopenia Measures, Survival, and Disability in Older Adults Before and After Diagnosis With Cancer. JAMA Network Open. doi:10.1001/jamanetworkopen.2020.4783.