Loss of muscle mass in the end of life in patients with advanced cancer

Wallengren, Ola; Iresjö, Britt‐Marie; Lundholm, Kent; Bosæus, Ingvar

doi:10.1007/s00520-014-2332-y

Cited by 64 publications

(65 citation statements)

References 42 publications

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“…Wallengren and co-workers found a higher loss of muscle mass in men with advanced tumor stages than in women. Furthermore, this loss was associated with age, tumor type and concomitant inflammatory conditions [19]. In addition, a decrease of phase angle was seen in our patients that reached significance in male patients.…”

Section: Discussionmentioning

confidence: 54%

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Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial

et al. 2016

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PurposePatients with biliopancreatic tumors frequently suffer from weight loss and cachexia. The in-hospital work-up to differentiate between benign and malignant biliopancreatic lesions requires repeated pre-interventional fasting periods that can aggravate this problem. We conducted a randomized intervention study to test whether routine in-hospital peripheral intravenous nutrition on fasting days (1000 ml/24 h, 700 kcal) has a beneficial effect on body weight and body composition.Material and Methods168 patients were screened and 100 enrolled in the trial, all undergoing in-hospital work-up for biliopancreatic mass lesions and randomized to either intravenous nutrition or control. Primary endpoint was weight loss at time of hospital discharge; secondary endpoints were parameters determined by bioelectric impedance analysis and quality of life recorded by the EORTC questionnaire.ResultsWithin three months prior to hospital admission patients had a median self-reported loss of 4.0 kg (25*th: -10.0 kg and 75*th* percentile: 0.0kg) of body weight. On a multivariate analysis nutritional intervention increased body weight by 1.7 kg (95% CI: 0.204; 3.210, p = 0.027), particularly in patients with malignant lesions (2.7 kg (95% CI: 0.71; 4.76, p < 0.01).ConclusionsIn a hospital setting, patients with suspected biliopancreatic mass lesions stabilized their body weight when receiving parenteral nutrition in fasting periods even when no total parenteral nutrition was required. Analysis showed that this effect was greatest in patients with malignant tumors. Further studies will be necessary to see whether patient outcome is affected as well.Trial RegistrationClinicalTrials.gov NCT02670265

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Section: Discussionmentioning

confidence: 54%

“…The patients often suffer from absence of appetite, abdominal pain, diarrhea, anorexia, back pain, fatigue, jaundice, diabetes, maldigestion and systemic inflammation [13,18]. The same holds true for biliary tract cancer [19]. Furthermore, there are changes in metabolism by an increased protein catabolism and energy expenditure [20].…”

Section: Introductionmentioning

confidence: 99%

Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial

et al. 2016

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“…A previous study also described disagreement between different muscle measures in patients with cancer,25 whereby low muscle mass according to MUAMC was prevalent in 15% of patients and according to DEXA in 67% of the same patients. Another study showed that prevalence of low muscle mass ranged between 52 and 86% in elderly patients, dependent of type of muscle measurement and chosen cut‐off value 26.…”

Section: Discussionmentioning

confidence: 94%

The influence of different muscle mass measurements on the diagnosis of cancer cachexia

Blauwhoff‐Buskermolen

Langius

Becker

et al. 2017

J cachexia sarcopenia muscle

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BackgroundProgressive loss of muscle mass is a major characteristic of cancer cachexia. Consensus definitions for cachexia provide different options to measure muscle mass. This study describes the effect of different methods to determine muscle mass on the diagnosis of cancer cachexia. In addition, the association of cachexia with other features of cachexia, quality of life, and survival was explored.MethodsPrior to chemotherapy, cachexia was assessed by weight loss, body mass index, and muscle mass measurements, the latter by mid‐upper arm muscle area (MUAMA), computed tomography (CT) scans, and bio‐electrical impedance analysis (BIA). In addition, appetite, inflammation, muscle strength, fatigue, quality of life, and survival were measured, and associations with cachexia were explored.ResultsIncluded were 241 patients with advanced cancer of the lung (36%), colon/rectum (31%), prostate (18%), or breast (15%). Mean age was 64 ± 10 years; 54% was male. Prevalence of low muscle mass was as follows: 13% with MUAMA, 59% with CT, and 93% with BIA. In turn, the prevalence of cachexia was 37, 43, and 48%, whereby weight loss >5% was the most prominent component of being defined cachectic. Irrespective of type of muscle measurement, patients with cachexia presented more often with anorexia, inflammation, low muscle strength, and fatigue and had lower quality of life. Patients with cachexia had worse overall survival compared with patients without cachexia: HRs 2.00 (1.42–2.83) with MUAMA, 1.64 (1.15–2.34) with CT, and 1.50 (1.05–2.14) with BIA.ConclusionsAlthough the prevalence of low muscle mass in patients with cancer depended largely on the type of muscle measurement, this had little influence on the diagnosis of cancer cachexia (as the majority of patients was already defined cachectic based on weight loss). New studies are warranted to further elucidate the additional role of muscle measurements in the diagnosis of cachexia and the association with clinical outcomes.

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“…This age-group, already at higher risk to be deficient in muscle due to age-related decline, is then at high risk to lose additional muscle due as their cancer progresses and they receive anti-cancer therapy. Advanced cancer patients lose up to 1.5 kg of lean mass per year (84). Studies have also demonstrated that muscle mass directly correlates with survival in cancer patients (85,86).…”

Section: Potential Clinical Uses Of Sarmsmentioning

confidence: 99%

Development of selective androgen receptor modulators (SARMs)

Narayanan

Coss

Dalton

2018

Molecular and Cellular Endocrinology

193

139

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The Androgen Receptor (AR), a member of the steroid hormone receptor family, plays important roles in the physiology and pathology of diverse tissues. AR ligands, which include circulating testosterone and locally synthesized dihydrotestosterone, bind to and activate the AR to elicit their effects. Ubiquitous expression of the AR, metabolism and cross reactivity with other receptors limit broad therapeutic utilization of steroidal androgens. However, the discovery of selective androgen receptor modulators (SARMs) and other tissue-selective nuclear hormone receptor modulators that activate their cognate receptors in a tissue-selective manner provides an opportunity to promote the beneficial effects of androgens and other hormones in target tissues with greatly reduced unwanted side-effects. In the last two decades, significant resources have been dedicated to the discovery and biological characterization of SARMs in an effort to harness the untapped potential of the AR. SARMs have been proposed as treatments of choice for various diseases, including muscle-wasting, breast cancer, and osteoporosis. This review provides insight into the evolution of SARMs from proof-of-concept agents to the cusp of therapeutic use in less than two decades, while covering contemporary views of their mechanisms of action and therapeutic benefits.

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Loss of muscle mass in the end of life in patients with advanced cancer

Abstract: Muscle loss in advanced cancer is related to age, sex, tumor type, and inflammation. The mechanism(s) behind the apparent sexual dimorphism warrants further study.

Cited by 64 publications

References 42 publications

Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial

Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial

The influence of different muscle mass measurements on the diagnosis of cancer cachexia

Development of selective androgen receptor modulators (SARMs)

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