Skeletal muscle and childhood cancer: Where are we now and where we go from here

Abstract

Skeletal muscle (muscle) is essential for physical health and for metabolic integrity, with sarcopenia (progressive muscle mass loss and weakness), a precursor of aging and chronic disease. Loss of lean mass and muscle quality (force generation per unit of muscle) in the general population are associated with fatigue, weakness, and slowed walking speed, eventually interfering with the ability to maintain physical independence, and impacting participation in social roles and quality of life. Muscle mass and strength impairments are also documented during childhood cancer treatment, which often persist into adult survivorship, and contribute to an aging phenotype in this vulnerable population.Although several treatment exposures appear to confer increased risk for loss of mass and strength that persists after therapy, the pathophysiology responsible for poor muscle quantity and quality is not well understood in the childhood cancer survivor population. This is partly due to limited access to both pediatric and adult survivor muscle tissue samples, and to difficulties surrounding noninvasive investigative approaches for muscle assessment. Because muscle accounts for just under half of the body's mass and is essential for movement, metabolism, and metabolic health, understanding mechanisms of injury responsible for both initial and persistent dysfunction is important and will provide a foundation for intervention. The purpose of this review is to provide an overview of the available evidence describing associations between childhood cancer, its treatment, and muscle outcomes, identifying gaps in current knowledge. K E Y W O R D Schildhood cancer, muscle fitness, muscle health, muscle mass, muscle outcomes, muscle quality, skeletal muscle INTRODUCTIONIncreased survival rates for childhood cancer are a direct reflection of major therapeutic and diagnostic advancesThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Role of Nutrition in Pediatric Patients with Cancer

“…Muscle health and function are impaired in both pediatric cancer patients and survivors [ 34 ]. The musculoskeletal effects such as loss of mass and strength that can be seen in cancer patients are due to CHT and RT used at a crucial period of physiological development.…”

“…The musculoskeletal effects such as loss of mass and strength that can be seen in cancer patients are due to CHT and RT used at a crucial period of physiological development. Hand-held dynamometry (HHD) is a cost- and time-efficient method that can provide a basic quantifiable measure of strength [ 34 ].…”

The impact of sarcopenia and sarcopenic obesity on survival in children with Ewing sarcoma and osteosarcoma

“…Impaired muscle quality and function are seen not only in those who succumb to cancer, but also in survivors. It is thought to be one of the reasons for the early onset of chronic conditions in cancer survivors [ 4 ].…”

Sarcopenia in long‐term survivors of cancer in childhood and adolescence: A cross‐sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle–bone unit

“…Sarcopenia, defined as a systemic reduction in skeletal muscle mass (SMM), accompanied by a diminution of skeletal muscle function, 1–3 has been studied extensively in older adults for more than 20 years; its consequent impact on function, frailty, and overall quality of life are well established 4–6 . More recently it has been recognized in children, notably as a component of malnutrition, 7 and associated with chronic disease 5,8,9 . Particular attention has been devoted to quantitative sarcopenia in children with cancer (especially acute lymphoblastic leukemia [ALL]) before, during, and after therapy 9,10 .…”