The value of physical performance measurements alongside assessment of sarcopenia in predicting receipt and completion of planned treatment in non-small cell lung cancer: an observational exploratory study
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The presence of muscle mass depletion is associated with poor outcomes and survival in cancer. Alongside muscle mass, assessment of muscle strength or physical performance is essential for the diagnosis of sarcopenia. Non-small cell lung cancer (NSCLC) is a prevalent form of cancer with high mortality, and Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) is commonly used to assess patients’ suitability for treatment. However, a significant proportion of patients with good PS are unable to complete multidisciplinary team (MDT)-planned treatment. Little is known about the ability of objective measurements of physical performance in predicting patients’ ability to complete MDT-planned treatment and outcomes in NSCLC.
We sought to establish whether physical performance, utilising the short physical performance battery (SPPB), alongside muscle mass measurements, was able to predict receipt and completion of MDT-planned treatment, with a focus on chemotherapy in NSCLC.
Materials and methods
Participants with NSCLC treated through a single lung cancer MDT and ECOG PS 0–2 were recruited and the following assessed: body composition [bioelectrical impedance (BIA) and whole body dual-energy X-ray absorptiometry (DXA) in a subset], physical performance (SPPB), PS and nutritional status. We recorded receipt and completion of chemotherapy, as well as any adverse effects, hospitalisations, and treatment delays.
We included a total of 62 participants with NSCLC, and in 26 of these, the MDT-planned treatment was chemotherapy. Participants with earlier stage disease and weight loss of <10% were more likely to complete MDT-planned treatment (p < 0.001 and p < 0.05). Patients with a higher total SPPB score were more likely to complete more cycles of chemotherapy as well as the full course. Quicker gait speeds and sit-to-stand times were associated with completion of three or more cycles of chemotherapy (all p < 0.05). For every unit increase in SPPB score, there was a 28.2% decrease in adverse events, hospitalisations and delays of chemotherapy (incidence rate ratio 0.718, p = 0.001), whilst ECOG PS showed no correlation with these outcomes.
Assessing physical performance by SPPB is quick and simple to do in clinical settings and may give better indication of likely chemotherapy treatment course completion than muscle mass alone and ECOG PS. In turn, this may identify specific targets for early functional intervention and impact on MDT decision-making and prudent use of resources.
KeywordsSarcopenia Non-small cell lung cancer Short physical performance battery
This study received a grant from the lung cancer charity Stepping Stones, Velindre Cancer Centre. Jemima Collins is funded via the Clinical Research Fellowship scheme from the Cardiff and Vale University Health Board.
JCo, HED and AB devised the study concept and design. JCo, HED, DP, WDE, RP, JL and AB contributed to the study protocol. JCo and DF statistically analysed the data. JCo, SN and AB wrote the manuscript, with contributions from all other authors. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
- 19.European Society for Medical Oncology (ESMO) (2017) Perfomance Scales: Karnofsky and ECOG scores. Available from: http://oncologypro.esmo.org/Guidelines-Practice/Practice-Tools/Performance-Scales
- 31.Lauretani, F., et al., Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985), 2003. 95(5): p. 1851–1860Google Scholar
- 32.National Cancer Institute (2009) Common Toxicity Criteria for Adverse Events (CTCAE) v4.03, N.C.I.C.T.E.P. (CTEP), EditorGoogle Scholar
- 36.Non-Small Cell Lung Cancer Collaborative Group (2010) Chemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer. Cochrane Database Syst Rev 5:CD007309Google Scholar
- 38.Paz-Ares L et al (2012) Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 13(3):247–255CrossRefGoogle Scholar
- 46.Cushen SJ et al. (2014) Body composition by computed tomography as a predictor of toxicity in patients with renal cell carcinoma treated with Sunitinib. Am J Clin OncolGoogle Scholar