Unveiling sarcopenia prevalence in post-cancer patients: Integrating functional and morphological assessments for accurate diagnosis.

OBJECTIVES

Sarcopenia is a muscle disease characterized by the progressive loss of muscle mass, strength, and function. Despite evolving definitions, validated diagnostic tools for younger individuals, especially those with cancer or chronic diseases, remain lacking. Oncological treatments can lead to severe muscle deconditioning. Many patients face limited follow-up and remain physically diminished in post-cancer period. We aimed to determine the prevalence of sarcopenia in post-cancer patients and to highlight its occurrence even in younger individuals and long after completion of oncological treatments.

METHODS

We performed prospective and standardized muscle assessment through: physical activity questionnaires (International Physical Activity Questionnaire [IPAQ] and Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls [SARC-F]); functional tests (grip strength, 6-minute walk, and 30-second chair stand tests); and appendicular lean mass (ALM) index measurement by dual-energy X-ray absorptiometry (DXA; ALM/height2 in kg/m2).

RESULTS

Ninety-eight patients (68 females) were included (age (mean±SD) 53.8±11.0 years and body mass index (BMI) 27.8±6.4kg/m2). Fifty-five had solid tumors (41 metastatic) with a post-treatment duration of 20.3±21.75 months. SARC-F score was 1.5±1.6. Grip strength and ALM index were 27.3±11.7kg and 6.4±1.4kg/m2 respectively. Considering cancer as a sarcopenia at risk status, we used European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and identified 27 (27.6%) patients with sarcopenia. Patients with sarcopenia were younger (50.2±11.6 vs 55.2±12.0 years; P=0.07), more frequently in remission and long after treatment, and had lower BMI (23.3±3.2 vs 29.5±6.5kg/m2; P<0.0001) compared to patients without sarcopenia. When using SARC-F for screening, only 5 patients were detected, underlining its poor sensitivity in this setting.

CONCLUSION

Sarcopenia is highly prevalent in post-cancer patients including younger individuals and those in long-term remission. The 2019 EWGSOP2 criteria, combining ALM and functional tests, effectively identified sarcopenia but screening with SARC-F may not be suitable in the post-cancer population.