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Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance

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Abstract

Purpose

Preoperative chemo(radio)therapy for oesophageal cancer (OC) may have an attritional impact on body composition and functional status, impacting postoperative outcome. Physical decline with skeletal muscle loss has not been previously characterised in OC and may be amenable to physical rehabilitation. This study characterises skeletal muscle mass and physical performance from diagnosis to post-neoadjuvant therapy in patients undergoing preoperative chemo(radio)therapy for OC.

Methods

Measures of body composition (axial computerised tomography), muscle strength (handgrip), functional capacity (walking distance), anthropometry (weight, height and waist circumference), physical activity, quality-of-life and nutritional status were captured prospectively. Sarcopenia status was defined as pre-sarcopenic (low muscle mass only), sarcopenic (low muscle mass and low muscle strength or function) or severely sarcopenic (low muscle mass and low muscle strength and low muscle function).

Results

Twenty-eight participants were studied at both time points (mean age 62.86 ± 8.18 years, n = 23 male). Lean body mass reduced by 4.9 (95% confidence interval 3.2 to 6.7) kg and mean grip strength reduced by 4.3 (2.5 to 6.1) kg from pre- to post-neoadjuvant therapy. Quality-of-life scores capturing gastrointestinal symptoms improved. Measures of anthropometry, walking distance, physical activity and nutritional status did not change. There was an increase in sarcopenic status from diagnosis (pre-sarcopenic n = 2) to post-treatment (pre-sarcopenic n = 5, severely sarcopenic n = 1).

Conclusions

Despite maintenance of body weight, functional capacity and activity habits, participants experience declines in muscle mass and strength. Interventions involving exercise and/or nutritional support to build muscle mass and strength during preoperative therapy, even in patients who are functioning normally, are warranted.

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Acknowledgements

This project was funded through a grant awarded by the Health Research Board, Ireland (POR HRA-POR-2014-535). We would like to acknowledge the assistance and support of the Wellcome Trust/HRB Clinical Research Facility at St James’ Hospital in providing a dedicated environment for the conduct of high quality clinical research activities. We also wish to thank the study participants for kindly agreeing to take time to participate.

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Authors and Affiliations

  1. School of Medicine, Trinity College Dublin, Dublin, Ireland

    Emer M. Guinan

  2. School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland

    S. L. Doyle

  3. Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland

    A. E. Bennett, L. O’Neill, J. Gannon & J. Hussey

  4. Department of Surgery, St. James’ Hospital, Dublin, Ireland

    J. A. Elliott & J. V. Reynolds

  5. Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, Dublin, Ireland

    J. O’Sullivan & J. V. Reynolds

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  1. Emer M. Guinan
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  4. L. O’Neill
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Correspondence to Emer M. Guinan.

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Ethical approval was obtained from the SJH–Tallaght Hospital Joint Research Ethics Committee. Informed written consent was obtained prior to study commencement.

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The authors declare that they have no conflict of interest.

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Guinan, E.M., Doyle, S.L., Bennett, A.E. et al. Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance. Support Care Cancer 26, 1569–1576 (2018). https://doi.org/10.1007/s00520-017-3993-0

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