The association between changes in muscle mass and quality of life in patients with metastatic colorectal cancer

Abstract

Background Skeletal muscle mass (SMM) loss is common in metastatic colorectal cancer (mCRC) patients and associated with poor clinical outcomes, including increased treatment‐related toxicities and reduced survival. Muscle loss may contribute to reduced health‐related quality of life (HRQoL), including fatigue. Our aim was to study associations between changes in SMM and concomitant changes in patient‐reported HRQoL. Methods This was a secondary analysis of mCRC patients in the CAIRO3 randomized clinical trial who were—after initial treatment—randomized between maintenance treatment with capecitabine plus bevacizumab (CAP‐B) and observation until first disease progression (PD1). Included patients had computed tomography images for SMM quantification, together with HRQoL assessments available at randomization and PD1. Changes in SMM (categorized as >2% loss, stable, and >2% gain) and HRQoL were computed between randomization and PD1. Changes in HRQoL score >10 points were considered clinically relevant. Associations between SMM and HRQoL changes were studied by multiple linear regression models. We also investigated whether associations differed by treatment arm for global health and the 13 other HRQoL subscales. Results Of 221 patients included (mean age 63.5 ± 8.4 years), 24% lost, 27% remained stable, and 49% gained SMM. At randomization, mean global health status was 73.5 ± 15.9 in the CAP‐B arm and 75.1 ± 17.5 in the observation arm ( P = 0.48). A stable or gain in SMM was significantly associated with a clinically relevant improvement in global health status (9.9 and 14.7 points, respectively), compared with patients who lost SMM. From the subscales that did not show significant differences between the two treatment arms, we found significant and clinically relevant associations for stable or gain in SMM with improved role functioning (12.0 and 17.9, respectively) and with less fatigue (−10.0 and −15.0, respectively) and pain (−16.3 for SMM gain). From the subscales that did show significantly different associations with SMM between the two treatment arms, we only found significant results in the observation arm. Here, associations were found for stable or gain in SMM with clinically relevant improved physical (12.4 for SMM gain), cognitive (10.7 and 9.7, respectively), and social functioning (15.5 and 15.6, respectively) as well as reduced appetite loss (−28.5 and −30.7, respectively). Conclusions In mCRC, SMM preservation during CAP‐B and observation treatment is associated with significant and clinically relevant improvements in global health status and multiple functional and symptom scales. Studies are warranted to investigate whether interventions targeting SMM lead to improved HRQoL, fewer symptoms, and better functioning.

Association between skeletal muscle mass and quality of life in adults with cancer: a systematic review and meta‐analysis

“…A total of 14 studies met the criteria for inclusion. 27,28,[39][40][41][42][43][44][45][46][47][48][49][50]…”

“…Ten studies categorized a total of 1375 participants according to baseline skeletal muscle mass using a range of cut points, presented in Table 2. In nine studies, 28,[40][41][42]44,[46][47][48][49] widely used cut points based on association with mortality in cancer patients, 1,3 or consensus guidelines for diagnosis of cancer cachexia, 61 were used to dichotomize participants as having either low muscle mass or not. The study by Huang et al 45 used a percentage change in SMI pre-surgery to post-surgery (≥10% vs. <10%) to dichotomize low and normal muscle mass, as this extent of muscle loss was deemed clinically relevant.…”

“…Six studies assessed the relationship between skeletal muscle mass and quality of life using continuous linear associations of correlation or linear regression. 27,39,[41][42][43]50 There was heterogeneity in the assessment of the relationship and data reported; thus, these results were synthesized qualitatively.…”

Pancreatic Cancer Prognosis, Malnutrition Risk, and Quality of Life: A Cross-Sectional Study

“…Patients with lower handgrip strength and dynamopenia reported lower HQoL. Studies on other types of cancer, i.e., colorectal cancer, identified the maintenance of skeletal muscle mass and functionality as an important factor affecting QoL [24]. On the other hand, added to the low muscle mass, symptoms related to lower nutritional intake, i.e., nausea and vomiting and constipation, were found to affect the prognosis of the patients, as they result in either limited nutrient intake or a higher possibility of discontinuation of the treatments due to higher toxicity [25].…”

Agreement between upper and lower limb measures to identify older adults with low skeletal muscle strength, muscle mass and muscle quality

“…For example, the European Working Group on Sarcopenia in Older People (EWGSOP2) recommends assessing SMS, SMM, and SMQ to identify those who are at high risk for or have established sarcopenia [7]. In addition, low SMS, SMM, and SMQ are associated with a higher risk for several adverse health-related outcomes in older adults, such as reduced mobility [8], physical disability [8], frailty [9], falls [10], impaired health-related quality of life [11,12], allcause and cardiovascular mortality [13][14][15][16].…”