Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer

Abstract

Rationale: It has been shown that early nutrition intervention improves nutrition status (NS) and treatment tolerance in patients with esophageal cancer. However, it remains unknown whether pretreatment parameters of NS are associated with treatment modifications (TMs) during neoadjuvant chemoradiation (CR) in patients who are intensively nutritionally supervised during treatment. Methods:All outpatients with esophageal cancer who were scheduled for CR in the VU medical center from 2006–2015 were included. NS was assessed by body mass index (BMI), weight loss in the past 6 months (WL), fat mass index (FMI) and fat-free mass index (FFMI), handgrip strength (HGS), and energy/protein intake. Logistic regression analyses, adjusted for age, sex, previous tumor, tumor stage, and physical status, were applied. TMs were defined as delay, dose reduction or discontinuation of chemotherapy and/or radiotherapy, hospitalization, or mortality (yes/no). Results: In total, 162 patients were included (73% male; mean age 65 ± 9 years). Mean BMI was 25.1 ± 4.5 kg/m2, and WL was 4.8 ± 5.1 kg. HGS and FFMI were below the 10th percentile of reference values in 21 and 37 patients, respectively. Thirty-five (22%) patients experienced at least 1 TM during CR; unplanned hospitalization (n = 18, 11%) was the most prevalent. After adjustments for confounders, only HGS was statistically significantly associated with TMs (odds ratio, 0.93; 95% confidence interval, 0.88–1.00). Conclusion: In this group of intensively supervised patients with esophageal cancer, pretreatment parameters of NS had little influence on TMs during CR. Only a lower HGS was associated with TMs.

Associations of Pretreatment Physical Status Parameters with Tolerance of Concurrent Chemoradiation and Survival in Patients with Non-small Cell Lung Cancer

“…Although significance disappeared in multivariable analyses, low handgrip strength also seemed to be associated with poorer tolerance of cCHRT. This is in line with previous studies which have shown an association between low handgrip strength before treatment and an increased risk of poor treatment tolerance in patients with oesophageal and colorectal cancer [36][37][38]. Results of the current study and previous studies therefore suggest that BMI < 18.5 kg/m 2 , poor WHO performance status and low handgrip strength before treatment might have an added value in identifying patients at high risk of poor tolerance of cCHRT.…”

Nutritional Intervention Contributes to the Improvement of Symptoms Related to Quality of Life in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Randomized Clinical Trial

“…Although the main outcome of the study was not to evaluate the effects of the intervention on nutritional status and body composition, this finding corroborates the positive results of the nutritional intervention on role function evaluated as an aspect of QoL. A previous study showed that the strength of the upper limbs in women diagnosed with breast cancer is reduced [ 36 ] and this highlights the importance of measuring the HGS in this public, which can correlate with the loss of muscle mass [ 37 ] as well as being associated with musculoskeletal symptoms [ 38 , 39 ], reduced physical function [ 38 , 40 ], increased occurrence of adverse events [ 39 ] and/or complications during treatment [ 41 ], therapy change [ 42 ] and higher mortality [ 43 , 44 ] for various types of cancer. The relationship between the preservation of muscle strength and QoL is indisputable, demonstrating another benefit of adequate nutrition as a positive agent for maintaining nutritional status and, consequently, physical function.…”

Oesophageal cancer: The effect of early nutrition support on clinical outcomes

“…Techniques including the use of handgrip strength (HGS) have been shown to be a functional measure of muscle mass [8] and may be a simple, cost-effective measurement to complete in an outpatient setting [9]. Low handgrip strength is associated with increased mortality in a mixed cohort of cancer diagnoses [10,11], treatment modification (such as delay in chemo/radiotherapy >1 week, dose reduction, hospital admission or discontinuation of treatment) during chemoradiotherapy in oesophageal cancer [12] and as a predictor of postoperative complications in adults following oesophagectomy [13e15].…”