Page 17 - Diagnosis and clinical consequences of cachexia in patients with advanced cancer Susanne Blauwhoff-Buskermolen

women <11.4 kg/m2) (2). Authors advised to use a direct measure of muscularity 1 in the presence of uid retention, a large tumor mass, or overweight/obesity (2).
Unknown is whether the choice for type of muscle measurements affects the
detection of low muscle mass and cachexia.
Consequences of cancer cachexia
We have known for a long time,that weight loss in cancer is associated with shorter survival, reduced response to anticancer treatment, increased adverse events from treatment and poorer quality of life (36-38). Muscle wasting is regarded the most important contributor to the adverse effects of weight loss in patients with cancer (2). Patients with advanced cancer and low muscle mass experience more toxicity of chemotherapy (39-42), more complications of surgery and longer length of hospital stay (43-46), have lower quality of life scores (12) and shorter survival (47-49) compared to patients with normal muscle mass. Furthermore, anorexia has been associated with negative outcomes such as decreased quality of life, diminished social, emotional and physical functioning (50;51). Anorexia also affects clinical outcomes by contributing to muscle wasting via reduced food intake (52- 54).
Reversing muscle loss in patients with cancer is dif cult, because cachexia is mainly caused by tumor activity and released cytokines. Nevertheless, newer studies suggest the possibility of muscle anabolism in patients (55;56).The best chance for successful interventions is during active anticancer treatment, when the tumor and its metabolic effects are being targeted. Longitudinal studies on changes in muscle mass during treatment for advanced cancer are scarce. Most studies measured muscle mass at one time point, for example before star t of treatment (12;39-49;57), or over time, but not during active anticancer treatment (58;59).
Furthermore, studies on consequences of muscle wasting were mostly performed in relatively young patients with cancer, as in trials on anticancer treatment, patients above 70 years were often excluded, or older patients were underrepresented based on strict exclusion criteria regarding comorbidities (60).As older patients may present with comorbidity and age-related muscle loss simultaneously, associations between muscle measures and clinically relevant outcomes may be different.Thus, it is unknown whether muscle wasting is associated with treatment toxicity and survival in older patients with advanced cancer.
General introduction
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