Identification of Sarcopenia Risk in Oncology Outpatients using the SARC-F Method

Abstract

Introduction: Sarcopenia is a common syndrome of highly catabolic diseases like cancer. Maintaining adequate body composition is fundamental for oncology patients' best prognosis. Existing tools to help in early identification of sarcopenia are limited and impractical in outpatient care. The SARC-F questionnaire, validated by Malmstrom et al, in order to screen the risk of sarcopenia can help on the early diagnosis and intervention. The objective of this study was to evaluate the sarcopenia risk in oncology outpatients by SARC-F tool, and to analyze its relationship with the Body Mass Index (BMI) and treatment toxicity. Method: A prospective study was carried out to 52 elderly oncology outpatients of a tertiary hospital clinic in São Paulo, Brazil. The patients' risk of sarcopenia was assessed by SARC-F questionnaire, through direct interview, at the time of radiotherapy or chemotherapy. The demographic data collected were sex, age, diagnosis, weight, presence of toxicity and BMI, (classified according to SABE PAHO, 2003). Toxicity classification was performed according to the Common Toxicity Criteria of the National Cancer Institute. Results: In the study, most patients were males (n=32, 61.53%), mean age was 72 years-old (± 8.4), weight showed mean of 72.9 kg (± 12.9) and BMI of 25, 65 kg/m² (±3, 85), classifying as eutrophic 55.7% (n=29), 19.2% underweight (n=10) and 25% overweight (n=13). Of the patients, 34 were undergoing to chemotherapy (65.38%) and 18 to radiotherapy (34.19%). The most frequent neoplasms were: prostate (n=8, 15, 38%), breast (n = 7, 13, 46%), lung (n=7, 13, 46% 62%) and others (n=25; 48.08%). Toxicity was presented in 55.76% of patients (n=29), being the most common inappetence (n=9; 31.03%); nausea (n=5; 17.24%) and diarrhea (n=5; 17.24%). Among the patients who presented a risk for sarcopenia (n=6; 11.53%), according to SARC-F, the majority were female (n=4; 66.6%) aged 80 to 90 years-old (n=3; 50.0%). Of patients at sarcopenia risk, 33.3% were underweight, 50.0% were eutrophic and 16.6% were overweight according to the BMI classification. Regarding toxicity, 66.6% (n=4) of the sarcopenia risk patients presented toxicity, 50.0% with inappetence (n=2) and 50.0% with nausea or diarrhea (n=2). Conclusion: There was a risk of sarcopenia in 11.53% of the patients (n=6), but it was not related to BMI. As for toxicity, the tool revealed a positive relation regarding sensitivity but without statistical relevance. SARC-F is a quick and simple screening method for sarcopenia, which can be applied by any healthcare professional. However, further studies are needed for application in clinical oncology area.