The additional benefit of computed tomography in cancer patients: impacts of sarcopenia and cachexia on quality of life during chemotherapy

Medeiros, Galtieri Otávio Cunha de; Rocha, Ilanna Marques Gomes da; Marcadenti, Aline; Bezerra, Ricardo Andrade; Barbalho, Erica Roberta; Sousa Júnior, Carlos Alves de; Fayh, Ana Paula Trussardi

doi:10.1590/0100-3984.2024.0012

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Original Article • Radiol Bras 57 • 2024 • https://doi.org/10.1590/0100-3984.2024.0012 copy

The additional benefit of computed tomography in cancer patients: impacts of sarcopenia and cachexia on quality of life during chemotherapy

O benefício adicional da tomografia computadorizada no paciente oncológico: impactos da sarcopenia e caquexia na qualidade de vida durante a quimioterapia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study evaluates the effects of sarcopenia and cachexia on the quality of life (QoL) of patients with gastrointestinal cancer during their initial cycle of chemotherapy, emphasizing the significance of computed tomography (CT) in assessing muscle mass.

Materials and Methods:

In this prospective study, we evaluated 60 adult patients with gastrointestinal cancer who started chemotherapy between January and December of 2017. Sarcopenia was diagnosed on the basis of CT findings, and QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.

Results:

The mean age was 60.9 years, and 33 (55.0%) of the patients were men. Of the 60 patients, 33 (55.0%) had cachexia and 14 (23.3%) had sarcopenia. Chemotherapy significantly reduced QoL, particularly in the physical, role functioning, and social domains, with no differences between the cachexia and sarcopenia groups.

Conclusion:

Among patients with gastrointestinal cancer submitted to chemotherapy, the chemotherapy-induced decline in QoL does not seem to differ significantly between those with cachexia or sarcopenia, as classified by CT-measured muscle mass, and those without. However, CT-based muscle mass evaluation remains crucial for guiding customized intervention strategies. Integrating this evaluation in radiological reports can provide valuable insights for planning specific care, thus improving patient QoL during treatment.

Keywords:
Gastrointestinal neoplasms; Cachexia; Sarcopenia; Drug therapy; Antineoplastic agents/adverse effects; Quality of life

Characteristic	(N = 60)
Age (years), mean ± SD	60.9 ± 14.0
≤ 60 years, n (%)	27 (45.0)
> 60 years, n (%)	33 (55.0)
Sex, n (%)
Female	27 (45.0)
Male	33 (55.0)
Ethnicity, n (%)
White	18 (30.0)
Non-White	42 (70.0)
Tumor site, n (%)
Esophagus	6 (10.0)
Stomach	14 (23.3)
Colon/rectum	36 (60.0)
Other gastrointestinal	4 (6.7)
Clinical TNM stage, n (%)
II	8 (13.3)
III	24 (40.0)
IV	28 (46.7)
Treatment modalities, n (%)
Chemotherapy	12 (20.0)
Chemotherapy + radiotherapy	21 (35.0)
Chemotherapy + surgery	20 (33.3)
Chemotherapy + radiotherapy + surgery	7 (11.7)
Chemotherapy protocol, n (%)
5FU + leucovorin	36 (46.7)
FOLFOX	12 (15.6)
Paclitaxel + carboplatin	11 (14.3)
Other	4 (5.2)
Height (m), mean ± SD	1.60 ± 0.09
Weight (kg), mean ± SD	61.5 ± 14.9
BMI (kg/m²), mean ± SD	24.5 ± 5.7
Underweight, n (%)	6 (10.0)
Normal weight, n (%)	26 (43.3)
Overweight, n (%)	19 (31.7)
Obese, n (%)	9 (15.0)
SMI (cm²/m²), mean ± SD
Men	53.5 ± 10.1
Women	46.4 ± 8.4
Muscle attenuation (HU), mean ± SD	37.8 ± 9.1
Low muscle attenuation, n (%)	30 (50.0)
Sarcopenia, n (%)	14 (23.3)
PG-SGA, n (%)
Nourished	25 (41.7)
Malnourished	35 (58.3)
ECOG performance status, n (%)
0–1	47 (78.3)
2	13 (21.7)
EORTC QLQ-C30 scores, mean ± SD
Global health	73.3 ± 18.4
Physical functioning	80.0 ± 14.9
Role functioning	72.0 ± 22.3
Emotional functioning	85.7 ± 16.5
Cognitive functioning	88.3 ± 14.1
Social functioning	77.5 ± 20.3

EORTC QLQ-C30 scores	With cachexia (n = 31)				Without cachexia (n = 27)
EORTC QLQ-C30 scores	Pre-chemo*	Post-chemo*	95% CI	P^†	Pre-chemo*	Post-chemo*	95% CI	P^†
Global health	66.67	66.67		0.001	66.67	66.67
Log global health	1.85 ± 0.09	1.76 ± 0.15	0.046 to 0.133		1.85 ± 0.09	1.79 ± 0.12	0.019 to 0.089	0.040
Physical functioning	80.00	73.33		0.039	86.67	73.33
Log physical functioning	1.87 ± 0.12	1.80 ± 0.22	0.003 to 0.135		1.89 ± 0.11	1.85 ± 0.14	-0.028 to 0.109	0.235
Role functioning	66.67	50.00		0.038	83.33	66.70
Log role functioning	1.77 ± 0.21	1.67 ± 0.26	0.005 to 0.187		1.85 ± 0.17	1.80 ± 0.19	-0.046 to 0.145	0.296
Emotional functioning	83.33	75.00		0.101	83.33	83.33
Log emotional functioning	1.90 ± 0.11	1.83 ± 0.24	-0.013 to 0.148		1.88 ± 0.09	1.88 ± 0.14	-0.068 to 0.061	0.911
Cognitive functioning	83.33	83.33		0.388	100. 00	83.33
Log cognitive functioning	1.90 ± 0.13	1.83 ± 0.24	-0.035 to 0.088		1.92 ± 0.14	1.89 ± 0.16	-0.025 to 0.057	0.435
Social functioning	66.67	50.00		0.006	83.33	66.67
Log social functioning	1.83 ± 0.15	1.69 ± 0.24	0.043 to 0.231		1.90 ± 0.13	1.76 ± 0.21	0.068 to 0.211	0.001

EORTC QLQ-C30 scores	With cachexia (n = 31)				Without cachexia (n = 27)
EORTC QLQ-C30 scores	Pre-chemo*	Post-chemo*	95% CI	P^†	Pre-chemo*	Post-chemo*	95% CI	P^†
Global health	83.3	66.67			66.67	66.67
Log global health	1.86 ± 0.13	1.81 ± 1.13	0.004 to 0.106	0.036	1.85 ± 0.08	1.77 ± 0.14	0.045 to 0.113	0.001
Physical functioning	86.67	73.33			83.33	73.33
Log physical functioning	1.90 ± 0.11	1.84 ± 0.16	-0.034 to 0.153	0.197	1.88 ± 0.12	1.82 ± 0.20	0.000 to 0.110	0.050
Role functioning	66.67	50.00			66.67	66.67
Log role functioning	1.75 ± 0.24	1.67 ± 0.26	-0.073 to 0.223	0.296	1.82 ± 0.18	1.75 ± 0.23	0.001 to 0.148	0.047
Emotional functioning	83.33	83.33			83.33	75.00
Log emotional functioning	1.85 ± 0.13	1.83 ± 0.23	-0.081 to 0.130	0.630	1.90 ± 0.09	1.86 ± 0.19	-0.023 to 0.101	0.218
Cognitive functioning	75.00	66.66			100	83.33
Log cognitive functioning	1.86 ± 0.13	1.83 ± 0.18	-0.046 to 0.121	0.355	1.92 ± 0.13	1.90 ± 0.15	-0.026 to 0.060	0.436
Social functioning	75.00	50.00			66.67	50.00
Log social functioning	1.91 ± 0.10	1.74 ± 0.26	0.000 to 0.340	0.050	1.85 ± 0.15	1.72 ± 0.22	0.030 to 0.067	0.001

Parameter	Post-chemotherapy decline in QoL
	< 10%	10–20%	> 20%
	n (%)	n (%)	n (%)
Global health	19 (31.7)	16 (26.7)	25 (41.6)
Physical functioning	18 (30.0)	18 (30.0)	24 (40.0)
Role functioning	13 (21.7)	9 (15.2)	38 (63.1)
Emotional functioning	19 (31.7)	12 (20.0)	29 (48.3)
Cognitive functioning	34 (56.7)	4 (6.7)	22 (36.6)
Social functioning	12 (20.0)	8 (13.3)	40 (66.7)

Group	n (%)	Global health covariation		Adjusted delta Mean ± SD	P
Group	n (%)	Pre-chemo Mean ± SD	Post-chemo Mean ± SD	Adjusted delta Mean ± SD	P
With cachexia	33 (55.0)	71.97 ± 15.28	56.56 ± 25.49	-15.39 ± 3.52	0.61
Without cachexia	27 (45.0)	71.30 ± 15.56	58.64 ± 25.79	-12.68 ± 3.90
With sarcopenia	14 (23.3)	73.21 ± 20.46	60.71 ± 27.82	-12.58 ± 5.04	0.74
Without sarcopenia	46 (76.7)	71.20 ± 13.57	56.52 ± 24.90	-14.65 ± 2.98

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[1] Correspondence: Galtieri Otávio Cunha de Medeiros. Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte. Avenida Nilo Peçanha, 620, Petrópolis. Natal, RN, Brazil, 59012-300. Email: galtieri_otavio@yahoo.com.br.