Short communicationPrevalence of sarcopenia in older patients with colorectal cancer
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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