Supportive Care in Cancer

, Volume 26, Issue 6, pp 1781–1789 | Cite as

Severe sarcopenia might be associated with a decline of physical independence in older patients undergoing chemotherapeutic treatment

  • Hánah N. RierEmail author
  • Agnes Jager
  • Marieke C. Meinardi
  • Joost van Rosmalen
  • Marc C. J. M. Kock
  • Peter E. Westerweel
  • Marija Trajkovic
  • Stefan Sleijfer
  • Mark-David Levin
Original Article



Assessing physical reserve in older cancer patients before treatment decision-making remains challenging. The maintenance of physical independence during therapy is sometimes just as important for these patients as oncological outcomes. Recently, sarcopenia has been recognized as a possible important prognostic factor for outcome in cancer patients. We investigated the association between different levels of sarcopenia and the decline of physical independence during chemotherapy in older cancer patients (≥ 65 years).


Sarcopenia was divided into presarcopenia, sarcopenia, and severe sarcopenia according to an international consensus and was related to physical independence determined by measuring instrumental activities of daily living (IADL), using binary logistic regression models. CT-based muscle mass is necessary to diagnose sarcopenia and was related to five functional tests, in order to investigate whether these easy-to-perform tests could replace the more invasive CT-based muscle measurement.


A total of 131 patients were included (median age 72 years). The prevalence of presarcopenia, sarcopenia, and severe sarcopenia was 47.7, 18.5, and 7.7%, respectively. Compared to no sarcopenia, only severe sarcopenia seemed associated with a decline of physical independence after chemotherapy (OR 5.95, 95% CI 0.76–46.48). Muscle mass was only significantly associated with muscle strength, but not with tests measuring physical function.


The level of sarcopenia might be a useful tool in addition to routine oncological assessment to identify older cancer patients with increased risk of physical decline after chemotherapy.


Muscle mass Sarcopenia Elderly Physical performance Functional tests 



We thank Marianne Wingelaar and Patricia Matthieu-van Welie for their participation in the patient inclusion and conducting all geriatric assessments.

Role of the funding source

This study was funded by ORAS (Oncological Research Albert Schweitzer hospital). The foundation had no involvement in the conduct of the study.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Supplementary material

520_2017_4018_MOESM1_ESM.pdf (26 kb)
Appendix A (PDF 25 kb)


  1. 1.
    Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in new mexico. Am J Epidemiol 147(8):755–763. CrossRefPubMedGoogle Scholar
  2. 2.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, de Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12(4):249–256. CrossRefPubMedGoogle Scholar
  3. 3.
    Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, Tylavsky FA, Newman AB, for the Health, Aging and Body Composition Study (2007) Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 55(5):769–774. CrossRefPubMedGoogle Scholar
  4. 4.
    Arango-Lopera VE, Arroyo P, Gutierrez-Robledo LM, Perez-Zepeda MU, Cesari M (2013) Mortality as an adverse outcome of sarcopenia. J Nutr Health Aging 17(3):259–262. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58–67CrossRefGoogle Scholar
  6. 6.
    Huang DD, Wang SL, Zhuang CL, Zheng BS, JX L, Chen FF et al (2015) Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer. Color Dis 17(11):O256–O264. CrossRefGoogle Scholar
  7. 7.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People (2010) Sarcopenia: European consensus on definition and diagnosis: report of the european working group on sarcopenia in older people. Age Ageing 39(4):412–423. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Clark BC, Manini TM (2008) Sarcopenia =/= dynapenia. J Gerontol A Biol Sci Med Sci 63(8):829–834. CrossRefPubMedGoogle Scholar
  9. 9.
    Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB, on Behalf of the Health, Aging and Body Composition Study Investigators (2006) Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 61(1):72–77. CrossRefPubMedGoogle Scholar
  10. 10.
    Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB, for the Health ABC Study (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61(10):1059–1064. CrossRefPubMedGoogle Scholar
  11. 11.
    Hughes VA, Frontera WR, Wood M, Evans WJ, Dallal GE, Roubenoff R, Singh MAF (2001) Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health. J Gerontol A Biol Sci Med Sci 56(5):B209–B217. CrossRefPubMedGoogle Scholar
  12. 12.
    Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S, Aapro MS, Serraino D, Zagonel V (2002) Comprehensive geriatric assessment adds information to eastern cooperative oncology group performance status in elderly cancer patients: an italian group for geriatric oncology study. J Clin Oncol 20(2):494–502. CrossRefPubMedGoogle Scholar
  13. 13.
    Sonpavde G, Vogelzang NJ, Galsky MD, Raghavan VA, Daniel S (2012) Objective measures of physical functional capacity warrant exploration to complement or replace the subjective physician estimated performance status. Am J Clin Oncol 35(2):163–166. CrossRefPubMedGoogle Scholar
  14. 14.
    Lawton MP, Brody EM (1969 Autumn) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186. CrossRefPubMedGoogle Scholar
  15. 15.
  16. 16.
    Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 97(6):2333–2338. CrossRefGoogle Scholar
  17. 17.
    Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–1547. CrossRefPubMedGoogle Scholar
  18. 18.
    Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM, Kiel DP, Kritchevsky SB, Shardell MD, Dam TTL, Vassileva MT (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69(5):547–558. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–635. CrossRefPubMedGoogle Scholar
  20. 20.
    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94. CrossRefPubMedGoogle Scholar
  21. 21.
    Bohannon RW (1995) Sit-to-stand test for measuring performance of lower extremity muscles. Percept Mot Skills 80(1):163–166. CrossRefPubMedGoogle Scholar
  22. 22.
    De Backer IC, Schep G, Hoogeveen A, Vreugdenhil G, Kester AD, van Breda E (2007) Exercise testing and training in a cancer rehabilitation program: the advantage of the steep ramp test. Arch Phys Med Rehabil 88(5):610–616. CrossRefPubMedGoogle Scholar
  23. 23.
    Mathias S, Nayak US, Isaacs B (1986) Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 67(6):387–389PubMedGoogle Scholar
  24. 24.
    Barret M, Antoun S, Dalban C, Malka D, Mansourbakht T, Zaanan A, Latko E, Taieb J (2014) Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 66(4):583–589. CrossRefPubMedGoogle Scholar
  25. 25.
    Huang DD, Chen XX, Chen XY, Wang SL, Shen X, Chen XL, Yu Z, Zhuang CL (2016) Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study. J Cancer Res Clin Oncol 142(11):2347–2356. CrossRefPubMedGoogle Scholar
  26. 26.
    Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA (2002) Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr 76(2):473–481CrossRefGoogle Scholar
  27. 27.
    Anderson DE, D'Agostino JM, Bruno AG, Demissie S, Kiel DP, Bouxsein ML (2013) Variations of CT-based trunk muscle attenuation by age, sex, and specific muscle. J Gerontol A Biol Sci Med Sci 68(3):317–323. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Hánah N. Rier
    • 1
    • 2
    Email author
  • Agnes Jager
    • 2
  • Marieke C. Meinardi
    • 3
  • Joost van Rosmalen
    • 4
  • Marc C. J. M. Kock
    • 5
  • Peter E. Westerweel
    • 1
  • Marija Trajkovic
    • 1
  • Stefan Sleijfer
    • 2
  • Mark-David Levin
    • 1
  1. 1.Department of Internal MedicineAlbert Schweitzer HospitalDordrechtthe Netherlands
  2. 2.Department of Medical OncologyErasmus Medical Center Cancer InstituteRotterdamthe Netherlands
  3. 3.Department of Geriatric MedicineAlbert Schweitzer HospitalDordrechtthe Netherlands
  4. 4.Department of BiostatisticsErasmus MCRotterdamthe Netherlands
  5. 5.Department of RadiologyAlbert Schweitzer HospitalDordrechtthe Netherlands

Personalised recommendations