Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer

Abstract

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.

Resistance but not elastic tubes training improves bioimpedance vector patterns and body composition in older women: A randomized trial

“…An increase in adiposity, especially if localized in the abdominal area, is associated with established risk factors for a variety of chronic diseases (Santanasto et al, 2017), while a reduction in intracellular fluid contributes to the accumulation of cellular senescence induced by destructive stimuli from inside and outside the cell (Li et al, 2021). Lastly, the loss of muscle mass is a contributing factor to the loss of muscle strength, and the decline of both are key features in the diagnosis of sarcopenia (Bellieni et al, 2021;Cruz-Jentoft et al, 2019).…”

Octogenarians’ Breast Cancer Is Associated with an Unfavorable Tumor Immune Microenvironment and Worse Disease-Free Survival

“…Often performance status and comorbidities rather than cancer biology dictate the management strategy in elderly patients [72]. About half of early-stage breast cancer patients over 70 years old were reported to have sarcopenia [73]. Further, data on the effect and toxicity of newer drugs are often limited for elderly patients since patients over 70 years old are typically excluded from clinical trials [74].…”

Plasma Aromatase Activity Index, Gonadotropins and Estrone Are Associated with Frailty Syndrome in Post-Menopausal Women with Breast Cancer

“…However, when more stringent criteria that incorporate muscle function (such as EWGSOP 2) were used, only a limited proportion of patients (26%) could still be defined as "sarcopenic". Indeed, severely sarcopenic patients were almost always classified as frail on the results of comprehensive geriatric assessment [23]. Both sarcopenia and frailty are affected by hormonal changes and tumor and cancer treatment [23][24][25].…”

“…Indeed, severely sarcopenic patients were almost always classified as frail on the results of comprehensive geriatric assessment [23]. Both sarcopenia and frailty are affected by hormonal changes and tumor and cancer treatment [23][24][25].…”