Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer.
Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer.
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DOI：
10.1634/theoncologist.2017-0255
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Fintelmann FJ
中科院分区：
文献类型：
--
作者：
Nipp RD;Fuchs G;El-Jawahri A;Mario J;Troschel FM;Greer JA;Gallagher ER;Jackson VA;Kambadakone A;Hong TS;Temel JS;Fintelmann FJ
癌症恶病质和肌肉减少症可能经常发生在晚期癌症患者中，并可能对治疗结果产生负面影响。本文强调了评估肌肉减少症的重要性，并描述了肌肉减少症与新诊断的不可治愈的癌症患者的生活质量之间的关系。晚期癌症患者经常出现肌肉萎缩（肌肉减少症），但对肌肉减少症的相关特征以及肌肉减少症与患者生活质量（QOL）和情绪之间的关系知之甚少。作为随机试验的一部分，我们在诊断为不可治愈的肺癌或胃肠道癌的8周内和随机化之前评估了患者的基线QOL（癌症治疗功能评估-一般[FACT-G]）和情绪（医院焦虑和抑郁量表[HADS]）。使用作为常规临床护理的一部分收集的计算机断层扫描，我们评估了第三腰椎水平的肌肉减少症，并验证了性别特异性临界值。我们使用逻辑回归来探讨与肌肉减少症相关的特征。为了检验肌肉减少症、生活质量和情绪之间的关系，我们使用了线性回归，调整了患者的年龄、性别、婚姻状况、教育程度和癌症类型。在237名参与者中（平均年龄= 64.41 ± 10.93岁），大多数为男性（54.0%）和已婚（70.5%），并患有肺癌（56.5%）。超过一半的人有肌肉减少症（55.3%）。年龄较大（比值比[OR] = 1.05，p = 0.002）和高中以上教育程度（OR = 1.95，p = 0.047）与患肌肉减少症的可能性较大相关，而女性（OR = 0.25，p <0.001）和较高的体重指数（OR = 0.79，p <0.001）与患肌肉减少症的可能性较低相关。肌肉减少症与更差的QOL（FACT-G：B =-4.26，p = 0.048）和更严重的抑郁症状（HADS-抑郁：B =-1.56，p = 0.005）相关。肌肉减少症在新诊断的无法治愈的癌症患者中非常普遍。肌肉减少症与更差的生活质量和抑郁症状的关联突出了在疾病过程中早期解决肌肉减少症问题的必要性。这项研究发现，使用作为常规临床护理的一部分获得的计算机断层扫描评估的肌肉减少症在新诊断的不可治愈的癌症患者中非常普遍。值得注意的是，肌肉减少症患者报告的生活质量更差，抑郁症状比那些没有肌肉减少症。这些发现强调了在不可治愈的癌症患者的疾病过程中早期解决肌肉损失的重要性。在未来，研究人员应该扩展这些发现，以制定评估和治疗肌肉减少症的策略，同时努力提高晚期癌症患者的生活质量和情绪结果。
Cancer cachexia and sarcopenia can occur frequently in patients with advanced cancer, and may negatively affect treatment outcomes. This article highlights the importance of assessing sarcopenia and describes the relationship between sarcopenia and patients' quality of life in patients with newly diagnosed, incurable cancer. Patients with advanced cancer often experience muscle wasting (sarcopenia), yet little is known about the characteristics associated with sarcopenia and the relationship between sarcopenia and patients’ quality of life (QOL) and mood. As part of a randomized trial, we assessed baseline QOL (Functional Assessment of Cancer Therapy‐General [FACT‐G]) and mood (Hospital Anxiety and Depression Scale [HADS]) in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer, and prior to randomization. Using computed tomography scans collected as part of routine clinical care, we assessed sarcopenia at the level of the third lumbar vertebra with validated sex‐specific cutoffs. We used logistic regression to explore characteristics associated with presence of sarcopenia. To examine associations between sarcopenia, QOL and mood, we used linear regression, adjusted for patients’ age, sex, marital status, education, and cancer type. Of 237 participants (mean age = 64.41 ± 10.93 years), the majority were male (54.0%) and married (70.5%) and had lung cancer (56.5%). Over half had sarcopenia (55.3%). Older age (odds ratio [OR] = 1.05, p = .002) and education beyond high school (OR = 1.95, p = .047) were associated with greater likelihood of having sarcopenia, while female sex (OR = 0.25, p < .001) and higher body mass index (OR = 0.79, p < .001) correlated with lower likelihood of sarcopenia. Sarcopenia was associated with worse QOL (FACT‐G: B = −4.26, p = .048) and greater depression symptoms (HADS‐depression: B = −1.56, p = .005). Sarcopenia was highly prevalent among patients with newly diagnosed, incurable cancer. The associations of sarcopenia with worse QOL and depression symptoms highlight the need to address the issue of sarcopenia early in the course of illness. This study found that sarcopenia, assessed using computed tomography scans acquired as part of routine clinical care, is highly prevalent in patients with newly diagnosed, incurable cancer. Notably, patients with sarcopenia reported worse quality of life and greater depression symptoms than those without sarcopenia. These findings highlight the importance of addressing muscle loss early in the course of illness among patients with incurable cancer. In the future, investigators should expand upon these findings to develop strategies for assessing and treating sarcopenia while striving to enhance the quality of life and mood outcomes of patients with advanced cancer.
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DOI：
10.1080/01635581.2014.894103
发表时间：
2014-05-19
影响因子：
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