Severe sarcopenia might be associated with a decline of physical independence in older patients undergoing chemotherapeutic treatment

Hánah N. Rier, Agnes Jager, Marieke C. Meinardi, Joost van Rosmalen, Marc C. J. M. Kock, Peter E. Westerweel, Marija Trajkovic, Stefan Sleijfer, Mark-David Levin

Assessing physical reserve in older cancer patients before treatment decision-making remains challenging. The maintenance of physical independence during therapy is sometimes just as important for these patients as oncological outcomes. Recently, sarcopenia has been recognized as a possible important prognostic factor for outcome in cancer patients. We investigated the association between different levels of sarcopenia and the decline of physical independence during chemotherapy in older cancer patients (≥ 65 years). Sarcopenia was divided into presarcopenia, sarcopenia, and severe sarcopenia according to an international consensus and was related to physical independence determined by measuring instrumental activities of daily living (IADL), using binary logistic regression models. CT-based muscle mass is necessary to diagnose sarcopenia and was related to five functional tests, in order to investigate whether these easy-to-perform tests could replace the more invasive CT-based muscle measurement. A total of 131 patients were included (median age 72 years). The prevalence of presarcopenia, sarcopenia, and severe sarcopenia was 47.7, 18.5, and 7.7%, respectively. Compared to no sarcopenia, only severe sarcopenia seemed associated with a decline of physical independence after chemotherapy (OR 5.95, 95% CI 0.76-46.48). Muscle mass was only significantly associated with muscle strength, but not with tests measuring physical function. The level of sarcopenia might be a useful tool in addition to routine oncological assessment to identify older cancer patients with increased risk of physical decline after chemotherapy.