A longitudinal study of muscle strength and function in patients
with cancer cachexia
Robert van Deursen
Received: 29 September 2017 /Accepted: 27 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Patients with cancer frequently experience an involuntary loss of weight (in particular loss of muscle mass), defined as
cachexia, with profound implications for independence and quality of life. The rate at which such patients’ physical performance
declines has not been well established. The aim of this study was to determine the change in muscle strength and function over
8 weeks in patients with already established cancer cachexia, to help inform the design and duration of physical activity
interventions applicable to this patient group.
Methods Patients with thoracic and gastrointestinal cancer and with unintentional weight loss of > 5% in 6 months or BMI < 20
plus 2% weight loss were included. Physical and functional assessments (baseline, 4 weeks, 8 weeks) included isometric
quadriceps and hamstring strength, handgrip, standing balance, 10-m walk time and timed up and go.
Results Fifty patients (32 male), mean ± SD age 65 ± 10 years and BMI 24.9 ± 4.3 kg/m
, were recruited. Thoracic cancer
patients had lower muscle strength and function (p < 0.05). Despite notable attrition, in patients who completed all assessments
(8 thoracic and 12 gastrointestinal), there was little change in performance over 8 weeks (p > 0.05). Baseline variables did not
differentiate between completers and non-completers (p >0.05).
Conclusions More than a third of patients with established cancer cachexia in our study were stable over 8 weeks, suggesting a
subgroup who may benefit from targeted interventions of reasonable duration. Better understanding the physical performance param-
eters which characterise and differentiate these patients has important clinical implications for cancer multidisciplinary team practice.
Patients with cancer frequently experience cachexia, defined
as weight loss greater than 5%, or > 2% in individuals with a
low body mass index (BMI < 20 kg/m
) in the last 6 months
. This is associated with a decline in function, daily activ-
ities and quality of life (QoL) . However, there is very little
reproducible data available on the rate and size of decline in
muscle strength in cancer site-specific patients with
established cachexia . Greater understanding of the pro-
gression of the disease will inform the targeted intervention
to optimise function and wellbeing.
The mechanism of loss of muscle and physical function in
cancer cachexia is multifactorial, including metabolic alter-
ations, reduced nutritional stores and intake, and reduced activity
. Consequently, there is a need for multimodal therapy to
optimise patient outcomes . As part of this approach, struc-
tured physical activity has potential to attenuate the process of
muscle wasting in cachexia. In the advanced stages of chronic
thoracic disease, exercise interventions are an effective means of
improving muscle strength andQoL, and there is evi-
dence that programmed exercise is associated with improved
outcomes in cancer patients undergoing active treatment .
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00520-018-4297-8) contains supplementary
material, which is available to authorized users.
* Nichola Gale
School of Healthcare Sciences, College of Biomedical and Life
Sciences, Heath Park, Cardiff University, Cardiff CF14 4XN, UK
Cardiff School of Sport, Cardiff Metropolitan University,
Cardiff CF23 6XD, UK
Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
Marie Curie Research Centre (MCPCRC), School of Medicine,
Heath Park, Cardiff University, Cardiff CF14 4XN, UK
Supportive Care in Cancer