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Open AccessArticle

Deterioration in Muscle Mass and Physical Function Differs According to Weight Loss History in Cancer Cachexia

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Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
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Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 0167 Oslo, Norway
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Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, 0167 Oslo, Norway
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European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0167 Oslo, Norway
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Edinburgh Cancer Research Centre, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK
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Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
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St Columba’s Hospice, Boswall Road, Edinburgh EH4 2XR, UK
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Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London SE5 9PJ, UK
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(12), 1925; https://doi.org/10.3390/cancers11121925
Received: 27 September 2019 / Revised: 20 November 2019 / Accepted: 22 November 2019 / Published: 3 December 2019
(This article belongs to the Special Issue Cancer Cachexia)
Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline. Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III–IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks. Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (−5.3 cm2, p = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (−2.8 cm2, p = 0.146), but demonstrated a statistically significant decline in PF; KPS (−3.8 points, p = 0.030), self-PF (−8.8 points, p = 0.027), and HGS (−2.7 kg, p = 0.026). Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further. View Full-Text
Keywords: cachexia; weight loss; muscle mass; grip strength; physical performance; cancer; endpoints cachexia; weight loss; muscle mass; grip strength; physical performance; cancer; endpoints
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MDPI and ACS Style

Stene, G.B.; Balstad, T.R.; Leer, A.S.M.; Bye, A.; Kaasa, S.; Fallon, M.; Laird, B.; Maddocks, M.; Solheim, T.S. Deterioration in Muscle Mass and Physical Function Differs According to Weight Loss History in Cancer Cachexia. Cancers 2019, 11, 1925.

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