The association between geriatric assessment, muscle measures, and treatment-related toxicity in older adults with cancer: An Israeli prospective study

Shlomit S. Shachar*, Gil Bar-Sela, Avivit Peer, Mor Tal Moskovitz, Avital Bareket-Samish, Jessica Epstein, Mira Wollner, Itamar Shafran, Amit Boukal, Grant R. Williams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: We investigated the associations among frailty, as determined via the comprehensive geriatric assessment (CGA), muscle measures (i.e., sarcopenia), and treatment-related toxicity in older adults with cancer in Israel. Materials and methods: This prospective cohort study enrolled patients ≥65 years with newly-diagnosed stage IV lung, breast, or genitourinary cancer. Patients were enrolled and completed CGA before their first line of systemic therapy (chemotherapy, biologic therapy, immunologic therapy, or a combination thereof). CGA was used to classify patients as robust, pre-frail, or frail, and routine pre-treatment computed tomography (CT) images were used to quantify skeletal muscle index (SMI) and skeletal muscle density (SMD) at L3 cross-section. Two sarcopenia definitions were used: i. for women SMI <41 cm2/m2 regardless of body mass index (BMI), and for men SMI <43 cm2/m2 for those with BMI of <25 and < 53 cm2/m2 for those with BMI ≥25; and ii. SMI <38 cm2/m2 for women and < 41 cm2/m2 for men, regardless of BMI. The associations between frailty and muscle measures with the occurrence of at least one adverse event (AE) grade ≥ 2 were examined using the chi-square test, and logistic regression to determine odds ratio (OR) and 95% confidence interval (CI). Results: In total, 51 patients were included in the analysis. The median (interquartile range) age was 72 (68–76) years, 30 (59%) were male, and 26 (51%) had lung cancer. CGA data were available for 48 patients: fifteen (31%), thirteen (27%), and twenty (42%) were defined as robust, pre-frail, and frail, respectively. Overall, 33 (65%) were sarcopenic by the first aforementioned definition, and sixteen (31%) by the second. No statistically significant associations were identified between frailty and having at least one AE grade ≥ 2, or between frailty and sarcopenia. Statistically significant associations were found between having sarcopenia (the second definition) and having at least one AE grade ≥ 2 (P = 0.0217). The corresponding odds ratio (95% CI) was 4.2 (1.2–15.0), P = 0.026. Discussion: Our findings suggests that sarcopenia is significantly associated with treatment-related toxicity. Further studies with larger sample sizes are warranted.

Original languageEnglish
Pages (from-to)1203-1207
Number of pages5
JournalJournal of Geriatric Oncology
Volume13
Issue number8
DOIs
StatePublished - Nov 2022

Funding

FundersFunder number
Abraham Rotstein Foundations
Israel Cancer Association

    Keywords

    • Aging
    • Cancer
    • Geriatric assessment
    • Geriatric oncology
    • Israel
    • Sarcopenia
    • Skeletal muscle index
    • Toxicity

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