Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association With Frailty

Abstract

In head and neck cancer (HNC) there is a need for more personalized treatment based on risk assessment for treatment related adverse events (i.e. toxicities and complications), expected survival and quality of life. Sarcopenia, defined as a condition characterized by loss of skeletal muscle mass and function, can predict adverse outcomes in HNC patients. A review of the literature on the measurement of sarcopenia in head and neck cancer patients and its association with frailty was performed. Skeletal muscle mass (SMM) measurement only is often used to determine if sarcopenia is present or not. SMM is most often assessed by measuring skeletal muscle cross-sectional area on CT or MRI at the level of the third lumbar vertebra. As abdominal scans are not always available in HNC patients, measurement of SMM at the third cervical vertebra has been developed and is frequently used. Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. There is no international standard measure of frailty and there are multiple measures of frailty. Both sarcopenia and frailty can predict adverse outcomes and can be used to identify vulnerable patients, select treatment options, adjust treatments, improve patient counselling, improve preoperative nutritional status and anticipate early on complications, length of hospital stay and discharge. Depending on the definitions used for sarcopenia and frailty, there is more or less overlap between both conditions. However, it has yet to be determined if sarcopenia and frailty can be used interchangeably or that they have additional value and should be used in combination to optimize individualized treatment in HNC patients.

Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer

“…Sarcopenia, defined by low SMM, has been previously identified as an important factor influencing both survival and functional outcomes in a variety of oncologic contexts. 36 Traditional measurement of SMM is performed by dual-energy X-ray absorptiometry (DEXA), which requires special equipment, is costly, and involves additional exposure to ionizing radiation. As a result, many surrogates for sarcopenia have been developed that can be readily measured at an outpatient visit, including grip strength and gait speed.…”

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

“…Regarding muscle mass, multiple studies observed that sarcopenia is related to subsequent frailty and instability in the elderly population [35]. Measuring sarcopenia by using a CT scan or ultrasound has proved effective in practice [10][11][12][13][14][15][16]. Also, psoas muscle area and subcutaneous fat were analyzed and showed to be predictors for poor outcomes after TAVR [17][18][19][20].…”

“…This investigative approach extends beyond conventional cardiac risk assessment paradigms to encompass a broader spectrum, inclusive of noncardiac risk assessment considerations. The exploration of muscle mass and fat mass as objective markers of frailty introduces a comprehensive dimension to risk assessment protocols [10][11][12][13][14][15][16]. Traditionally, frailty assessments have predominantly revolved around physiological and functional domains.…”

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

“…Recognizing that frailty is a holistic concept, affected by both cardiac and noncardiac factors, allows for a more encompassing risk stratification strategy. This holistic approach aligns with the evolving understanding of frailty as a multifaceted entity and emphasizes the need for a comprehensive evaluation that transcends traditional boundaries [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”