Association between skeletal muscle mass and quality of life in adults with cancer: a systematic review and meta‐analysis

Abstract

Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health‐related quality of life (HRQOL) is less established. This systematic review and meta‐analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta‐analysis to investigate cross‐sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies (n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [n = 985 from seven studies, standardized mean difference −0.27, 95% confidence interval (CI) −0.40 to −0.14, P < 0.0001], and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardized mean difference −0.40, 95% CI −0.74 to −0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P > 0.05). Five studies examined the cross‐sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non‐linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.

Effect of Sarcopenia on Survival and Health-Related Quality of Life in Patients with Hepatocellular Carcinoma after Hepatectomy

“…First, this was a prospective study that utilized a comprehensive set of indicators for patient evaluation. Most recent investigations examining sarcopenia in cancer have used a retrospective study design [ 4 , 5 ]. In these studies, the indicators of sarcopenia were single, failing to comprehensively evaluate sarcopenia and ultimately affecting the quality of the evidence.…”

“…Sarcopenia, which is characterized by a progressive and generalized loss of muscle mass and muscle function [ 1 ], affects more than 50 million people worldwide, and the number of affected individuals is expected to exceed 200 million in the next 40 years [ 2 ]. Sarcopenia has been shown to be associated with nutritional health and to result in severely reduced health-related quality of life (HRQOL) [ 1 , 3 , 4 ]. A growing body of research has revealed that preoperative sarcopenia is associated with worse survival in patients with cancer [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…According to the updated consensus guidelines of the European Working Group on Sarcopenia in Older People (EWGSOP2), a comprehensive evaluation of muscle mass and muscle strength should be used to assess sarcopenia [ 13 ]. Therefore, prospective and refined cohort studies with comprehensive sarcopenia assessments are urgently needed to assess the relationship between preoperative sarcopenia and postoperative HRQOL in patients with cancer [ 4 ].…”

Perceptions of Older Adults with Hematological Cancer on Diet and Exercise Behavior and Its Role in Navigating Daily Tasks

“…Reduced physical function is often reported by hematological cancer patients and is associated with poor overall quality of life. A recent systematic review and meta-analysis showed that low muscle mass was associated with poorer physical functioning domain and global health-related quality of life (HRQOL) scores, as well as a longitudinal association between changes in skeletal muscle and several HRQOL domains in adults with cancer [ 8 ]. Loss of muscle mass and strength in those with hematological cancer seem to be attributed to the interplay among the cytotoxic effects of chemotherapy [ 9 , 10 ], the treatment’s side-effects and the disease itself [ 11 , 12 , 13 ], resulting in reduced oral intake and low energy.…”

Doxorubicin-Induced Skeletal Muscle Atrophy is Mediated by Mitochondrial Permeability Transition

“…Skeletal muscle is essential to life and plays an essential role in movement, eating, and breathing. Conditions associated with muscle atrophy, therefore, have far-reaching implications for not only quality of life [1], but if severe can also impact mortality [2]. In this respect, cancer and its treatment can adversely affect skeletal muscle, causing atrophy, impaired contractility and mitochondrial dysfunction [3][4][5][6][7][8].…”