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Loss of muscle mass in the end of life in patients with advanced cancer

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Abstract

Purpose

Muscle mass depletion is associated with adverse outcomes in cancer patients. There is limited information on the impact of age, sex, tumor type, and inflammation on muscle loss in the end of life of cancer patients.

Methods

Muscle depletion and loss of muscle in the last 2 years of life was estimated in 471 cancer patients from 779 dual-energy X-ray absorptiometry scans. A linear mixed model was used to estimate the impact of age, sex, tumor type, and inflammation.

Results

Patients above median age (>71 years) had less muscle mass (−1.1 ± 0.3 kg, P < 0.001). Prevalence of muscle depletion was higher in men than women (59 vs. 28 %, P < 0.001). Men lost muscle mass over time (mean, 1.4 ± 0.3 kg/year, P < 0.001) contrary to women (0.3 ± 0.4 kg/year, P = 0.5). Patients with pancreatic cancer had less muscle mass than patients with biliary tract and colorectal cancers (P < 0.02). There were no differences in muscle loss over time in patients grouped by median age or tumor type. The prevalence of elevated C-reactive protein was 61 to 70 % during the study. Patients with C-reactive protein >10 mg/L had less muscle mass (0.6 ± 0.2 kg, P < 0.001) and lost muscle mass at an accelerated pace during the disease trajectory (0.7 ± 0.3 kg/year, P = 0.03).

Conclusions

Muscle loss in advanced cancer is related to age, sex, tumor type, and inflammation. The mechanism(s) behind the apparent sexual dimorphism warrants further study.

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Abbreviations

ALST:

Appendicular lean soft tissue

ALSTI:

Appendicular lean soft tissue index

BMI:

Body mass index

CRP:

C-reactive protein

FMI:

Fat mass index

EORTC:

European Organization for Research and Treatment of Cancer Scale

KPS:

Karnofsky Performance Score

QoL:

Quality of life

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Acknowledgments

This study is supported by the Swedish Cancer Society (2014) and the Swedish state under the ALF agreement.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Dietistmotagningen, Per Dubbsgatan 14, 413 45, Gothenburg, Sweden

    Ola Wallengren & Ingvar Bosaeus

  2. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Bruna Stråket 20, 413 45, Gothenburg, Sweden

    Britt-Marie Iresjö & Kent Lundholm

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  1. Ola Wallengren
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  2. Britt-Marie Iresjö
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  3. Kent Lundholm
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  4. Ingvar Bosaeus
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Correspondence to Ola Wallengren.

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Wallengren, O., Iresjö, BM., Lundholm, K. et al. Loss of muscle mass in the end of life in patients with advanced cancer. Support Care Cancer 23, 79–86 (2015). https://doi.org/10.1007/s00520-014-2332-y

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