Muscle mass, quality, and strength; physical function and activity; and metabolic status in cachectic patients with head and neck cancer

Background & aims: Cancer cachexia is commonly associated with poor prognosis in patients with head and neck cancer (HNC). However, its pathophysiology and treatment are not well established. The current study aimed to assess the muscle mass/quality/strength, physical function and activity, resting energy expenditure (REE), and respiratory quotient (RQ) in cachectic patients with HNC. Methods: This prospective cross-sectional study analyzed 64 patients with HNC. Body composition was measured via direct segmental multifrequency bioelectrical impedance analysis, and muscle quality was assessed using echo intensity on ultrasonography images. Muscle strength was investigated utilizing handgrip strength and isometric knee extension force (IKEF). Physical function was evaluated using the 10-mwalking speed test and the five times sit-to-stand (5-STS) test. Physical activity was examined using a wearable triaxial accelerometer. REE and RQ were measured via indirect calorimetry. These parameters were compared between the cachectic and noncachectic groups. Results: In total, 23 (36%) patients were diagnosed with cachexia. The cachectic group had a significantly lower muscle mass than the noncachectic group. Nevertheless, there was no significant difference in terms of fat between the two groups. The cachectic group had a higher quadriceps echo intensity and a lower handgrip strength and IKEF than the noncachectic group. Moreover, they had a significantly slower normal and maximum walking speed and 5 STS speed. The number of steps, total activity time, and time of activity (<3 Mets) did not significantly differ between the two groups. The cachectic group had a shorter time of activity (≥3 Mets) than the noncachectic group. Furthermore, the cachectic group had a significantly higher REE/body weight and REE/fat free mass and a significantly lower RQ than the noncachectic group. Conclusions: The cachectic group had a lower muscle mass/quality/strength and physical function and activity and a higher REE than the noncachectic group. Thus, REE and physical activity should be evaluated to determine energy requirements. The RQ was lower in the cachectic group than that in the noncachectic group, indicating changes in energy substrate. Further studies must be conducted to examine effective nutritional and exercise interventions for patients with cancer cachexia

Prediction equations for appendicular skeletal muscle mass

Objective: Muscle mass is typically assessed by abdominal computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry. However, these tests are not routinely performed in patients with head and neck cancer (HNC), making sarcopenia assessment difficult. This study aimed to develop and validate equations for predicting appendicular skeletal muscle (ASM) from data obtained in daily medical practice, with bioelectrical impedance analysis (BIA)-measured ASM (BIA-ASM) as a reference. Research Methods & Procedures: This cross-sectional study included 103 male patients with HNC and randomly divided them into development and validation groups. The prediction equations for BIA-ASM were developed by multiple regression analysis and validated by Bland–Altman analyses. The estimated skeletal muscle mass index (eSMI) was also statistically evaluated to discriminate the cutoff value for BIA-measured SMI according to Asian Working Groups for Sarcopenia. Results: Two practical equations, which include 24-hour urinary creatinine excretion volume (24hUCrV), handgrip strength (HGS), body weight (BW), and body height (BHt), were developed: ASM (kg) = −39.46 + (3.557 × 24hUCrV[g]) + (0.08872 × HGS[kg]) + (0.1263 × BW[kg]) + (0.2661 × BHt[cm]) if available for 24hUCrV (adjusted R2 = 0.8905), and ASM (kg) = −42.60 + (0.1643 × HGS[kg]) + (0.1589 × BW[kg]) + (0.2807 × BHt[cm]) if not (adjusted R2 = 0.8589). ASM estimated by these two equations showed a significantly strong correlation with BIA-ASM (R > 0.900). Bland–Altman analyses showed a good agreement, and eSMI accuracy was high (>80%) in both equations. Conclusions: These two equations are a valid option for estimating ASM and diagnosing sarcopenia in patients with HNC in all facilities without special equipment

Association of phase angle with muscle function and prognosis

Objective: We aimed to investigate the correlation of phase angle (PhA) with other parameters (e.g., muscle mass/quality/strength and physical function), assess the prognostic relevance of pre-chemoradiotherapy (CRT) PhA, and suggest a reference value of PhA in Asian patients with head and neck cancer (HNC). Research Methods & Procedures: Ninety-six patients with HNC who underwent CRT were divided into two groups, maintained-PhA group and low-PhA group, according to the PhA 25th percentile values by sex. Pretreatment PhA was measured using direct segmental multi-frequency bioelectrical impedance analysis, and muscle quality was assessed using echo intensity in ultrasound images. Correlation of PhA with other parameters was investigated, and between-group differences with respect to adverse events, treatment interruption, and 3-year survival were assessed. Results: PhA showed a positive correlation with isometric knee extension force (R = 0.710), handgrip strength (R = 0.649), skeletal muscle mass index (R = 0.620), and maximum gait speed (R = 0.543) (P < 0.001). PhA showed a negative correlation with echo intensity (R = −0.439) and five times sit-to-stand test (R = −0.505) (P < 0.01). The low-PhA group had a higher incidence of severe anemia (52% in low-PhA vs. 17% in maintained-PhA), aspiration (17% vs. 1%), radiotherapy interruption (17% vs. 3%), and poor 3-year survival (47% vs. 81%) than the maintained-PhA group (P < 0.05). Conclusion: PhA was correlated with muscle mass/quality/strength, and physical function. Low PhA was associated with severe adverse events, treatment interruption, and shorter survival. These findings suggested that 4.6° for men and 4.0° for women may be useful as prognostic reference values in Asian patients with HNC