Novel Adaption of the SARC-F Score to Classify Pediatric Hemato-Oncology Patients with Functional Sarcopenia

Abstract

Sarcopenia in pediatric hemato-oncology patients is undesirable because of the consequences it may have for treatment continuation and outcome, physical abilities and participation in daily life. An easy-to-use screening tool for sarcopenia will facilitate the identification of children at risk who need interventions to prevent serious physical deterioration. In the elderly, the use of the SARC-F score as a case-finding tool for sarcopenia is recommended. The aim of this cross-sectional study was to investigate the accuracy of the pediatric SARC-F (PED-SARC-F) for identifying sarcopenia in pediatric hemato-oncology patients, including the determination of a cut-off point for clinical use. Patients 3–20 years of age, under active treatment or within 12 months after treatment cessation were eligible. Patients had a physiotherapy assessment including a PED-SARC-F (0–10) and measurements of muscle strength (handheld dynamometry), physical performance (various tests) and/or muscle mass (bio-impedance analysis), as part of the standard of care. Spearman’s correlation coefficient (rs) between the PED-SARC-F and physiotherapy outcomes were calculated. Structural sarcopenia was defined as low appendicular skeletal muscle mass (ASMM) in combination with low muscle strength and/or low physical performance. Functional sarcopenia indicated low muscle strength combined with low physical performance. Multiple logistic regression models were estimated to study the associations between the PED-SARC-F and structural/functional sarcopenia. To evaluate which cut-off point provides the most accurate classification, the area under the receiver operating characteristic curve (AUCs), sensitivity and specificity per point were calculated. In total, 215 assessments were included, 62% were performed in boys and the median age was 12.9 years (interquartile range: 8.5–15.8). The PED-SARC-F scores correlated moderately with the measurements of muscle strength (rs = −0.37 to −0.47, p < 0.001) and physical performance (rs = −0.45 to −0.66, p < 0.001), and weakly with ASMM (rs = −0.27, p < 0.001). The PED-SARC-F had an AUC of 0.90 (95% confidence interval (CI) = 0.84–0.95) for functional sarcopenia and 0.79 (95% CI = 0.68–0.90) for structural sarcopenia. A cut-off point of ≥5 had the highest specificity of 96% and a sensitivity of 74%. In conclusion, we adapted the SARC-F to a pediatric version, confirmed its excellent diagnostic accuracy for identifying functional sarcopenia and defined a clinically useful cut-off point in pediatric hemato-oncology patients.

Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

“…These screening measures often incorporate measure(s) of function, rather than a discrete measure of low muscle mass. An example is the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC‐F) six‐item questionnaire 63 or its derivatives (e.g., SARC‐F–calf 64 [SARC‐F plus calf circumference] and the paediatric SARC‐F [PED‐SARC‐F] 65 ). SARC‐F‐calf has shown good predictive potential 64 for low muscle mass in other cancer cohorts; however, further studies in HCT and within discrete populations (<60 years, ethnicity and BMI) are needed.…”

Challenges and physiological implications of sarcopenia in children and youth in health and disease

“…Sarcopenic obesity has also been described in a variety of pediatric populations including bone marrow transplant recipients, children with nonalcoholic fatty liver disease and/or autoimmune liver diseases [9 ▪ ,10,11]. Within the healthy pediatric population, less is known about the potential for sarcopenia (± obesity).…”