Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study

Villaseñor, Adriana; Ballard‐Barbash, Rachel; Baumgartner, Kathy B.; Baumgartner, Richard N.; Bernstein, Leslie; McTiernan, Anne; Neuhouser, Marian L.

doi:10.1007/s11764-012-0234-x

Cited by 242 publications

(207 citation statements)

References 54 publications

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“…19,23,37,46 The relationship between increased muscle mass and disease-free survival has even been observed in oncological patients who have not undergone any cancer surgery. 13,16,24,38,44,50,55 This is a notable observation, as current methodologies for predicting oncological outcomes rely solely on histological grade of the malignancy and its TNM Classification of Malignant Tumors (TNM). Identifying more accurate and specific markers of survival would enable oncologists to discern which patients are appropriate candidates for a particular treatment, be it chemotherapy, radiation, surgery, or palliation.…”

mentioning

confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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OBJECTIVE Predicting the survival rate for patients with cancer is currently performed using the TNM Classification of Malignant Tumors (TNM). Identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. This is especially relevant for patients with spinal metastases, who all have identical TNM staging and whose surgical decision-making is potentially complex. Analytical morphometrics quantifies patient frailty by measuring lean muscle mass and can predict risk for postoperative morbidity after lumbar spine surgery. This study evaluates whether morphometrics can be predictive of survival in patients with spinal metastases. METHODS Utilizing a retrospective registry of patients with spinal metastases who had undergone stereotactic body radiation therapy, the authors identified patients with primary lung cancer. Morphometric measurements were taken of the psoas muscle using CT of the lumbar spine. Additional morphometrics were taken of the L-4 vertebral body. Patients were stratified into tertiles based on psoas muscle area. The primary outcome measure was overall survival, which was measured from the date of the patient's CT scan to date of death. RESULTS A total of 168 patients were identified, with 54% male and 54% having multiple-level metastases. The median survival for all patients was 185.5 days (95% confidence interval [CI] 146–228 days). Survival was not associated with age, sex, or the number of levels of metastasis. Patients in the smallest tertile for the left psoas area had significantly shorter survival compared with a combination of the other two tertiles: 139 days versus 222 days, respectively, hazard ratio (HR) 1.47, 95% CI 1.06–2.04, p = 0.007. Total psoas tertiles were not predictive of mortality, but patients whose total psoas size was below the median size had significantly shorter survival compared with those greater than the median size: 146 days versus 253.5 days, respectively, HR 1.43, 95% CI 1.05–1.94, p = 0.025. To try to differentiate small body habitus from frailty, the ratio of psoas muscle area to vertebral body area was calculated. Total psoas size became predictive of mortality when normalized to vertebral body ratio, with patients in the lowest tertile having significantly shorter survival (p = 0.017). Left psoas to vertebral body ratio was also predictive of mortality in patients within the lowest tertile (p = 0.021). Right psoas size was not predictive of mortality in any calculations. CONCLUSIONS In patients with lung cancer metastases to the spine, morphometric analysis of psoas muscle and vertebral body size can be used to identify patients who are at risk for shorter survival. This information should be used to select patients who are appropriate candidates for surgery and for the tailoring of oncological treatment regimens.

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mentioning

confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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“…In a prospective study of BC survivors (HEAL study) a remarkable prevalence of sarcopenia (about 16%), independently of body fat mass, resulted to be a predictor of poor survival. In fact, in this study sarcopenic women had a threefold increased chance of dying from any cause and twofold increased chance of dying from BC related causes, compared to non sarcopenic women (22). In BC patients we do not simply have to face the consequences of bone loss related morbidity and mortality, but we have to keep in mind that even muscle mass damage can have the same impact (22).…”

Section: -Diagnostic Densitometric T-score Values (Femoral Neck and Lmentioning

confidence: 70%

“…In fact, in this study sarcopenic women had a threefold increased chance of dying from any cause and twofold increased chance of dying from BC related causes, compared to non sarcopenic women (22). In BC patients we do not simply have to face the consequences of bone loss related morbidity and mortality, but we have to keep in mind that even muscle mass damage can have the same impact (22). Also, weakening in muscular strength may result in increased incidence of falls.…”

Section: -Diagnostic Densitometric T-score Values (Femoral Neck and Lmentioning

confidence: 72%

Quality of life in breast cancer: a secret passage through skeletal muscle and bone health

Persichetti¹

2014

RIO

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Breast cancer is the most common female cancer diagnosed worldwide. In Italy it represents about 30% of all cancer type in women and 17% of deaths due to malignancies. Neo or adjuvant therapy, which includes external beam radiation, chemotherapy and hormonal therapy (tamoxifen ± LH-RH analogues, aromatase inhibitors) allow early breast cancer patients to reach 10 years survival rate of about 80-85%. The improved prognosis of this subgroup of patients arise new challenges because cancer itself, treatments and age related changes can affect greatly patients' quality of life. Bone loss and osteoporosis are common disorders in patients affected with breast cancer because many systemic therapies for breast cancer interfere with skeletal homeostasis, either through their effects on gonadal steroid hormone production or by inhibiting peripheral aromatization of androgens into estrogens, and cause an increased risk of morbidity and mortality related to skeletal events such as vertebral and spine fractures. Also, age related modifications in body fat and lean mass, with progressive and generalized loss of skeletal muscle mass and strength, characterizing a condition known as sarcopenia, can exacerbate the risk of frailty and adverse outcomes. According to current evidence, a complete clinical evaluation of the breast cancer long survivors is imperative in order to prevent and treat in an early stage any comorbidity (osteoporosis, sarcopenia, metabolic syndrome). This can be achieved only with a multidisciplinary approach, where oncologist, endocrinologist and nutritionist work together to maximize bone and muscle health to enhance the quality of life and to reduce mortality and skeletal events related morbidity.

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“…While diet change to reduce calories and fat has been shown to be highly effi cacious in inducing relatively long-term weight loss , it does so at the expense of muscle loss (Mason et al 2013a , b ). This is a signifi cant issue for cancer survivors, who have a high prevalence of sarcopenia, among both obese and non-obese survivors, and sarcopenia has been associated with poorer prognosis (Villasenor et al 2012 ). In non-cancer populations, exercise aids with weight loss maintenance (Miller et al 2013 ), and somewhat with weight loss effi cacy (FosterSchubert et al 2012 ).…”

Section: Possible Adverse Effects Of Purposeful Weight Loss In Cancermentioning

confidence: 99%

Risk Reduction from Weight Management and Physical Activity Interventions

Irwin

Fabian

McTiernan

2015

Improving Outcomes for Breast Cancer Survivors

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Obesity and low levels of physical activity are associated with a higher risk of breast cancer recurrence and mortality. Currently, over 65% of breast cancer survivors are overweight or obese, and fewer than 30% engage in recommended levels of physical activity. The reason for low adherence to lifestyle guidelines is likely multifactorial. Given the continuing trend of increased obesity and physical inactivity in the United States, worldwide and in breast cancer survivors, more research showing the direct effect of weight loss and/or exercise on breast cancer recurrence and mortality is needed. Many exercise interventions have examined the impact of increasing exercise on changes in quality of life, with most studies showing a favorable effect of exercise on quality of life. Smaller Phase II randomized trials using biomarkers as surrogate endpoints is likely appropriate to answer questions regarding mechanisms of action, exercise type, volume, and intensity, yet a definitive trial of weight loss and exercise on disease-free survival is critical for moving the field forward. Research is also necessary on how to disseminate lifestyle interventions into the clinic and community that lead to clinically meaningful weight losses of at least 5% that are maintained over time, and favorable sustained changes in physical activity levels. Changes in referrals, access, and reimbursement of lifestyle programs may lead to favorable changes in the prevalence of obesity and physical activity in breast cancer survivors and in turn rates of breast cancer recurrence and mortality.

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Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study

Cited by 242 publications

References 54 publications

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Quality of life in breast cancer: a secret passage through skeletal muscle and bone health

Risk Reduction from Weight Management and Physical Activity Interventions

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