Weight loss versus muscle loss: re-evaluating inclusion criteria for future cancer cachexia interventional trials

Roeland, Eric; Joseph, D.; Nelson, Sandahl H; Seibert, Tyler M.; Heavey, Sean; Revta, Carolyn; Gallivan, Andrea; Baracos, Vickie E.

doi:10.1007/s00520-016-3402-0

Cited by 36 publications

(42 citation statements)

References 19 publications

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“…Finally, even if accurate body weight data were available, it appears to be less sensitive for identifying cachexia than muscle loss in humans and likely in dogs. Of human patients with cancer that did not meet the inclusion criterion for cachexia of ≥5% weight loss, 41% had ≥5% muscle loss over the same period, suggesting that muscle loss is a more sensitive measure of cachexia …”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure

Ineson

Freeman

2019

Veterinary Internal Medicne

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Background Cardiac cachexia, loss of muscle mass associated with congestive heart failure (CHF), is associated with increased morbidity and shorter survival times in people, but an association between cardiac cachexia and survival has not been reported in dogs. Objectives To determine the prevalence of cachexia and its associations with clinical, laboratory, and survival data in dogs with CHF. Animals Two hundred sixty‐nine dogs with CHF. Methods Retrospective cohort study. Cachexia was defined by 1 of 2 definitions: (1) mild, moderate, or severe muscle loss or (2) weight loss of ≥5% in 12 months or less. Variables were compared between dogs with and without cachexia. Results One hundred thirty of 269 dogs (48.3%) had cardiac cachexia based on muscle loss, whereas 67 of 159 dogs (42.1%) with pre‐evaluation body weights had cachexia based on weight loss. Dogs with cachexia (based on muscle loss) were significantly older (P = .05), more likely to have a cardiac arrhythmia (P = .02), had higher chloride concentrations (P = .04), and had a lower body condition score (P < .001), hematocrit (P = .006), hemoglobin (P = .006), and albumin (P = .004) concentrations. On multivariable analysis, cachexia (P = .05), clinically important tachyarrhythmias (P < .001), azotemia (P < .001), and being under‐ or overweight (both P = .003) were associated with shorter survival times. Conclusions and Clinical Importance Cardiac cachexia in common in dogs with CHF and is associated with significantly shorter survival. This emphasizes the importance of preventing, diagnosing, and treating muscle loss in dogs with CHF.

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Section: Discussionmentioning

confidence: 99%

Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure

Ineson

Freeman

2019

Veterinary Internal Medicne

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“…Traditionally, weight loss has been used to identify patients with cancer who are at risk for malnutrition [ 4 , 5 ]. However, muscle loss occurs in patients who may not be losing weight; therefore, measures of specific body components are required [ 6 , 7 , 8 ]. Assessment of cancer related malnutrition aims to identify and measure metabolic derangements and muscle depletion.…”

Section: Introductionmentioning

confidence: 99%

Poor Vitamin Status is Associated with Skeletal Muscle Loss and Mucositis in Head and Neck Cancer Patients

et al. 2018

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Mucositis and muscle wasting are two common toxicity effects of cancer treatment in head and neck cancer (HNC). There is limited data evaluating cancer treatment toxicities in relation to vitamin status. This study aimed to assess changes in vitamin status during HNC treatment in relation to body composition, inflammation and mucositis. In this prospective cohort study, dietary intakes (3-day food record), plasma levels of vitamins and C-reactive protein (CRP) were assessed at baseline (at diagnosis) and post-treatment (after 6–8 weeks of radiation therapy with or without chemotherapy). Computed tomography images were used to quantify body composition. Mucositis information was collected from health records of patients. Twenty-eight HNC patients (age 60 ± 10 years) completed both study time points. Patients who developed mucositis had significantly lower dietary intake of vitamins and plasma 25-hydroxy vitamin D (25-OHD) and all-trans retinol levels (p < 0.02). Patients lost a considerable amount of muscle mass (3.4 kg) and fat mass (3.6 kg) over the course of treatment. There was a trend toward greater muscle loss in patients with 25-OHD < 50 nmol/L compared to patients with 25-OHD ≥ 50 nmol/L (p = 0.07). A significant negative correlation was found between plasma all-trans retinol and CRP level at the end of treatment (p = 0.03). Poor vitamin status could be a contributing factor in developing treatment-induced toxicities.

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“…The discrepancy between number of patients being underweight and the number being sarcopenic highlights the need for the use of other parameters than BMI to assess the nutritional encounters. Using Body Mass Index (BMI) or weightloss as criteria for study inclusion may not be accurate in patients with cancer, since fluid imbalance will affect these parameters [24]. As well, it may be considered if the screening tool NRS 2002, originally developed for the use in hospitalized patients, is sufficiently accurate to identify the patients before the severe decrease in muscle mass or the decline in mGPS.…”

Section: Discussionmentioning

confidence: 99%

Assessment of muscle mass with computerised tomography in patients with incurable gastrointestinal cancer. A prospective single centre study

Wilson¹,

Kjeldsen²,

Pfeiffer³

et al. 2019

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Body composition is often affected in patients with incurable cancer, but the prevalence of sarcopenia is unknown. Our aim was to evaluate sarcopenia as predictor of overall survival in a cohort of patients with incurable gastrointestinal cancer and furthermore to evaluate if this cohort had different characteristics than patients, from an identical cohort who accepted participation in a RCT. Design and methods In this single centre study, we prospectively included a cohort of patients with incurable gastrointestinal cancer nutritionally at risk (NRS 2002≥2). Patients were screened but refused participation in an RCT testing supplemental HPN. To assess sarcopenia, data on skeletal muscle mass (SMM) from the cross-sectional area of L3 were assessed using computerized tomography scan (CT scan). SMM evaluation was included if a CT scan was available within 60 days from the inclusion date. Differences in survival were tested according to sarcopenia and modified Glasgow Prognostic Score (mGPS). Survival was compared between the patients who refused to participate in the RCT and patients who actually did participate. Results Eligible for inclusion were 187 patients, and 165 had a CT scan available for analysis. Most prevalent diagnosis was pancreatic cancer (52%), median age was 70.5 (41.2-89.4), median BMI 22.3 (14.4-36.8) and 99% were receiving chemotherapy. Sarcopenia was present in 78% of the overall cohort, more women (88%) than men (70%) were sarcopenic at inclusion. There was a positive correlation between BMI and SMM, but SMM accounted for only 8% of the variance in BMI. Conclusions Prevalence of sarcopenia was high in this cohort of patient with incurable gastrointestinal cancer; SMM did positively correlate to BMI, but only accounted for minor variations. mGPS was in the multivariate cox regression model predictive of survival and sarcopenia did not add to this elevated risk.

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Weight loss versus muscle loss: re-evaluating inclusion criteria for future cancer cachexia interventional trials

Abstract: Defining cancer cachexia by WL over time may be limited as it does not capture skeletal muscle loss. Cross-sectional CT body composition analysis may improve early detection of muscle loss and patient participation in future cancer cachexia clinical trials.

Cited by 36 publications

References 19 publications

Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure

Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure

Poor Vitamin Status is Associated with Skeletal Muscle Loss and Mucositis in Head and Neck Cancer Patients

Assessment of muscle mass with computerised tomography in patients with incurable gastrointestinal cancer. A prospective single centre study

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