Prevalence of sarcopenia in older patients with colorectal cancer

doi:10.1016/j.jgo.2015.08.005

Journal of Geriatric Oncology

Volume 6, Issue 6, November 2015, Pages 442-445

https://doi.org/10.1016/j.jgo.2015.08.005 Get rights and content

Abstract

Objective

Sarcopenia is the age-related loss of muscle mass, strength, and function. It is a common finding in older patients and is associated with decreased life expectancy and potentially higher susceptibility to chemotherapy toxicity. This study describes the prevalence of sarcopenia in older adults with early stage colorectal cancer.

Materials and Methods

Patients ≥ 70 years old who underwent surgical resection for stage I–III colorectal cancer between 2008 and 2013 were identified from the medical record. Sarcopenia was assessed by measuring the total muscle area on computerized tomography (CT) images obtained prior to surgery. Total muscle area was measured at the level of L3 and normalized using each patient’s height to produce a skeletal muscle index (SMI). Sarcopenia was defined using sex- and body mass index (BMI)–specific threshold values of SMI.

Results

Eighty-seven patients were included, with a median age of 77 years (70–96). Twenty-five men (60% of 42) and 25 women (56% of 45) had sarcopenia. Sarcopenic patients had significantly lower BMI (p = 0.03) compared to non-sarcopenic patients. There was a positive correlation between BMI and SMI for both men (r = 0.44) and women (r = 0.16).

Conclusion

Sarcopenia is highly prevalent among older patients with early stage colorectal cancer. BMI alone is a poor indicator of lean body mass and improved methods of screening for sarcopenia are necessary. CT scans are a viable option for identifying sarcopenic patients in whom timely interventions may improve survival, quality of life, and functional outcomes.

Introduction

Sarcopenia is the age-related loss of muscle mass. The prevalence of sarcopenia in community dwelling adults ranges from 13% to 24% in those under age 70 to more than 50% in persons over the age of 70.¹ In the elderly, sarcopenia may lead to frailty and is predictive of impairments in instrumental and basic activities of daily living (IADL, ADL), falls, and death.[2], [3] As both cancer and sarcopenia are associated with advancing age, it is important to assess whether an elderly patient with cancer is sarcopenic as this is related to reduced survival, poor response to chemotherapy, and increased chemotherapy toxicity.⁴

The study presented here pertains to older patients with a colorectal cancer diagnosis. Of the estimated 143,460 new patients with colorectal cancer in 2012, about half were age 70 or older.⁵ Patients with early stage (stage I–III) colorectal cancer are offered surgical resection with or without adjuvant chemotherapy, depending on the depth of invasion and involvement of lymph nodes. In patients with non-metastatic colorectal cancer, sarcopenia has been linked to postoperative infection and delayed recovery.⁶ Despite the prevalence and negative outcomes of sarcopenia, there is little data on its frequency in older patients with early stage colorectal cancer.

The purpose of this study is to define the prevalence of sarcopenia in older adults with early stage colorectal cancer. The specific focus is patients age 70 and older because they are at especially high risk for poor outcomes due to diminished physiologic reserves. The study uses computed tomography (CT)—a procedure used in routine management of colorectal cancer—to measure lean body mass in patients age 70 and older.

Section snippets

Design

This study is a cross-sectional analysis of CT data collected routinely in the diagnosis and treatment of patients with colorectal cancer. This study was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill.

Study Participants

Eligible patients were treated at the North Carolina Cancer Hospital between 2008 and 2013, and met the following criteria: (1) ≥ 70 years of age at the time of stage I–III colorectal cancer diagnosis, (2) underwent surgical resection of their cancer

Sample

Of patients diagnosed with non-metastatic colorectal cancer (N = 1,029), 218 were 70 years or older at time of diagnosis. Of the patients age 70 or older (N = 218), 214 had adenocarcinoma or mixed endocrine carcinoma and 197 met the surgery criteria (17 patients undergoing transanal excision for stage 1 disease were excluded). One hundred had an abdominal CT scan within 42 days prior to surgery; however, only 87 were technically adequate for SMI assessment.

The sample was distributed roughly evenly

Discussion

In this study, we demonstrate that sarcopenia is prevalent among older persons with an early stage colorectal cancer diagnosis. To identify sarcopenic patients, we used information that is typically found in the medical record of patients with colorectal cancer: cancer stage, BMI, and CT imaging. CT scans are routinely ordered as standard of care for colorectal cancer, but are typically not used beyond the scope of assessing metastases, tumor location, size, and stage. We make further use of

Funding

The research reported was supported by NIA 5-T35-AG038047-04 - UNC-CH Summer Research in Aging for Medical Students. This funding source had no involvement in study design, collection of data, data interpretation, or writing of this report.

Disclosures and Conflict of Interest Statements

The authors have no conflicts of interest to disclose.

Author Contributions

Study concept: HB Muss, HK Sanoff, JR Broughman

Study design: HB Muss, HK Sanoff, JR Broughman

Data acquisition: BB Gordon, H Yu, SM Alston

Quality control of data and algorithms: AM Deal, SM Alston

Data analysis and interpretation: BB Gordon, H Yu

Statistical analysis: AM Deal, JR Broughman

Manuscript preparation: JR Broughman, GR Williams

Manuscript editing: KA Nyrop, GR Williams, HK Sanoff, HB Muss

Manuscript review: KA Nyrop, SM Alstron, GR Williams, HB Muss

Acknowledgements

Portions of this study were presented in poster form at the American Geriatric Society Symposium in Orlando, FL on May 15, 2014.

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Short communicationPrevalence of sarcopenia in older patients with colorectal cancer

Abstract

Objective

Materials and Methods

Results

Conclusion

Introduction

Section snippets

Design

Study Participants

Sample

Discussion

Funding

Disclosures and Conflict of Interest Statements

Author Contributions

Acknowledgements

J Am Coll Surg

An overview of sarcopenia: facts and numbers on prevalence and clinical impact

J Cachex Sarcopenia Muscle

Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study

Age Ageing

The relationship between sarcopenia,undernutrition, physical mobility and basic activities of daily living in a group of elderly women of Mexico City

Nutr Hosp [Internet]

Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy

Support Care Cancer

Short communication
Prevalence of sarcopenia in older patients with colorectal cancer