Perioperative care in cancer patients is being reconsidered with our understanding of the association of sarcopenia and post-operative complications risks. Generally, there exists very little literature regarding the perioperative care of sarcopenic cancer patients. It has, however, been found that sarcopenic patients had significantly higher complication rates than that of non-sarcopenic patients. Future research needs to continue to understand the reasons behind this. Perioperative cancer also needs to be understood within various degrees of sarcopenia, through stratifying the population by muscle depletion and reduced function levels. Although nutritional support alone cannot counteract these issues that sarcopenic patients face, this approach can aid in decreasing progressive muscle mass loss, potentially lowering the risk of post-operative complications. This review by Bozzetti F aimed to understand the relationship between sarcopenia, muscle mass loss, and nutritional interventions.
Colorectal cancer is the second leading cause of cancer death in the world. However, incidence rates and mortality can both be significantly reduced through adhering to healthy lifestyle recommendations. In this study, 82 people were included, where their nutritional profile was evaluated to assess their risk of colorectal cancer. This is because obesity is one of the biggest risk factors for colorectal cancer, and when associated with sarcopenia, there are usually worse health outcomes. This study has therefore highlighted the need for understanding muscle composition in obese individuals when screening for cancer, as this may affect outcomes. Furthermore, this study underscores the necessity to aim for health lifestyles through weight control and physical exercise, to decrease incidence and mortality of diseases such as colorectal cancer. This review by Santos M et al. aimed to evaluate nutritional profiles for those screening for colorectal cancer, to aid a better understanding of the risk factors behind this cancer.
Fraily development is largely determined by low levels of nutrients, increased expression of inflammatory biomarkers, and age-related oxidative stress (OS). These frailty-related dysfunctions may lead to impairments in muscle structure and function, causing the onset of a muscle-catabolic state. As such, they may contribute to the development of sarcopenia, which is both a cause and a consequence of frailty. Measuring biomarker patterns such as dietary, OS, inflammatory, and muscle-related biomarkers (e.g., 3-methylhistidine (3MH)) has been touted as a means to understand the complex mechanisms behind frailty. Despite this, data on multi-biomarker patterns remains scarce. The aim of this study was to measure a variety of circulating biomarkers in an attempt to characterise their patterns. The existence of an association between these patterns and frailty status in non-frail and frail in-hospital patients was then assessed.
Total knee arthroplasty (TKA) is the main procedure used to treat end-stage osteoarthritis. Although it is a highly successful treatment associated with 10-year survival in over 90% of cases, approximately 25% of patients experience unsatisfactory functional outcomes. Poor recovery rates after TKA have been linked to sarcopenia, a condition up to 44% of patients undergoing TKA suffer from. Mitochondrial dysfunction is one of sarcopenia’s major drivers. Despite this, mitochondrial function’s role in recovery post-TKA remains unknown. The aim of this study was to investigate the link between mitochondrial function at baseline and recovery after TKA. To do so, activity after TKA was monitored using a wrist mounted tracker. From this data, the relationship between activity and traditional outcome measures (e.g. grip strength) associated with recovery was clarified.
In this study, 102 Japanese patients with gastrointestinal or non-small cell lung cancer with cancer cachexia were used to test anamorelin. Anamorelin is a selective ghrelin receptor agonist and is taken orally. This drug is generally known to increase appetite and was hypothesised to help with improving cancer cachexia as well as increasing the patients’ low body mass index. It was found that improvements in their body weight were durable for up to 24 weeks, and overall, the patients reported a better appetite and overall well-being. The drug was also generally well tolerated, with around 37% of patients experiencing adverse side effects. Most commonly, these included symptoms such as glycosylated haemoglobin increase, peripheral oedema and constipation. This review by Naito T et al. aimed to understand the benefits of anamorelin in cancer cachexia patients with improving their low body mass index.
Resilience is characterised by the ability to bounce back after exposure to a stressor or a form of adversity. It is frequently separated into physical and psychological components, with the former being defined as the ability to recover following age-related losses or disease. A decline in resilience is both a marker and a risk factor for accelerated ageing and frailty, respectively. The aim of this editorial was to showcase the importance of resilience in the recovery of frail patients. It also exposes the mechanisms behind resilience, as well as the gaps in its clinical assessment.
The Hospital Frailty Risk Score (HFRS) was developed to detect frail individuals based on data extracted from hospital databases. An association between the HFRS, 30-day mortality, 30-day emergency hospital readmission, and long length of stay (LOS) was originally validated in populations of elderly patients admitted to hospital via the emergency department. Data regarding the HFRS’ predictive ability in the context of direct admissions and post-discharge outcomes is thus lacking. The aim of this study was to investigate the associations between the HFRS and 30-day mortality, 30-day hospital readmission, and long LOS by analysing in- and out-patient healthcare in France.
For hepatocellular carcinoma, the most common type of liver cancer, liver transplantations are considered the best treatment, as they present with a 60-80% survival rate for 5 years. Suitability for a transplant is assessed by factors such as the patient’s tumour presentation and their responses to treatments, with the Milan Criteria representing the total criteria with all additional prognostic factors. Yet, general health is rarely included into this judgement. General health, especially low muscle pass (e.g, sarcopenia) may affect survival rates for liver transplantations; this has, however, rarely been addressed. This study discovered that a higher pre-operative muscle mass contributed to an increased rate of long-term survival post-liver transplantation. This review by Beumer B et al. aimed to determine whether adding in the consideration of muscle mass, and working beyond the Milan Criteria, may benefit our understanding of the outcomes of liver transplantations.
Weight loss is clearly related to cancer, yet there is very little data concerning when and at what stage weight loss should be considered a sign of a need to diagnose cancer. In this study of 43,302 patients, it was found that there was a linear increase in the chance of being diagnosed with cancer compared to the amount of weight lost. This finding was independent of any co-factors, such as age, sex, original weight or co-morbidities. Therefore, it is clear that the percentage of weight lost must be focused on, rather than a guideline with an arbitrary cut-off point for a cancer diagnosis. It could be possible to trigger an alert for patients who lose certain percentages of weight over specified periods of time. This review by Nicholson B et al aimed to understand the diagnostic value of weight loss in relationship to cancer.
Cancer is often associated with cachexia, a wasting syndrome which is multifactorial and cannot be resolved with simple nutritional aid. It causes loss of muscle mass and is the cause of death for almost a third of cancer patients. However, cachexia is very complex. This muscle-wasting disorder has many underlying mechanisms, whether cancer-induced or chemotherapy induced. Heighted protein catabolism and reduced anabolism, as well as disrupted energy metabolism, are associated with cachexia, but the mechanisms underlying these changes are not fully known. Inflammation and oxidative stress are believed to be important within the mechanisms. This review by Huot J et al. aimed to evaluate the mechanisms underlying cancer cachexia, particularly discussing the role of oxidative stress.
Experience of renal cachexia in end-stage renal disease and the interrelated experience of their carers: a review
Renal cachexia often occurs in end-stage renal disease, yet there are few guidelines for clinicians in how to treat and manage this condition. To ensure a patient-centric approach, understanding the experiences of patients with renal cachexia, as well as their carers, will help to implement the most beneficial guidelines possible. This study focuses on assessing quality of life outcomes, including psychological and social factors, in an attempt to raise awareness about the impact of cancer cachexia. This information aims to inform the management of renal cachexia, as well as general holistic care within the field of nephrology. This review by Blair C et al. aimed to synthesize the lived experiences of renal cachexia in patients suffering with end-stage renal disease, as well as that of their carers.
Frailty is characterised by increased vulnerability to acute stressors associated with an age-related decline in function across multiple physiological systems. Since it is an age-dependent clinical syndrome, countries with ageing populations, like the United Kingdom (UK), are predicted to become increasingly exposed to worsening frailty-associated patient outcomes and burdened healthcare systems. This article aimed to emphasise the importance of frailty-related education for healthcare professionals in the UK.
Recent studies have identified energy dysregulation as one of the principle drivers of frailty. Exercise, the most effective tool to combat frailty, is associated with energy metabolism upregulation and reduction of inflammation. It has been hypothesised this therapeutic effect is linked to the production of myokines by skeletal muscle in response to acute and chronic exercise. Evidence has concluded that myokines play a crucial role in upholding energy metabolism and combating inflammation. However, despite this, only a limited number of studies have examined the changes in myokine concentrations with exercise in older adults. This review aims to summarise evidence supporting an association between energy metabolism and frailty. It also assesses the role of myokines, released during exercise, in combating frailty.
Cancer cachexia is a wasting disorder, where nutritional interventions cannot fully aid in restoring weight in patients. It severely impacts quality of life and survival rates of patients. In this study, a 58-question questionnaire was completed by clinicians to understand the knowledge and practice gaps within the treatment of cancer cachexia. Some issues raised included the lack of a standardised definition of cancer cachexia for diagnosis, with 43% of respondents stating that low levels of attention are given to providing such a diagnosis. Furthermore, it was reported that screening for cachexia was not completed routinely, among other practice gaps. This review by Baracos VE et al. aimed to highlight the gaps in understanding of cancer cachexia that clinicians face worldwide.
For patients with advanced-stage cancer, weight loss and lower body mass index has been associated with shorter rates of survival. On the other hand, obesity has been associated with longer survival. Weight loss or cachexia could therefore be used as a prognostic tool, although it has not yet been studied much in clinical trials. It is predicted to be due to the fact that decreased muscle mass is a predictor of shortened survival, as well as lowered nutrient stores and activity level. However, further research is required into understanding weight loss in relation to cancer survival rates, especially in the context of therapies such as chemotherapy, as it is not fully known how this interacts with body mass. This review by Oswalt C et al. aimed to explore the relationship between body mass index, weight loss and survival rates in advanced lung cancer.
Frailty is characterised by increased vulnerability to acute stressors. As it is common in adults with heart failure (HF), frailty has been used as a predictor of mortality and morbidity for HF patients. Frailty Phenotype, the most commonly used frailty instrument in HF, is used for the physical examination of frailty. While physical frailty instruments are commonly used in clinical practice, a proportion of studies have expressed issues with such tools. As HF may have detrimental effects on physical function, the use of physical instruments may lead to an under- or over-estimation of frailty. This study aims to compare the predictive ability of three physical frailty instruments (the Frailty Phenotype, the St Vincent’s Frailty instrument and the SHARE-FI); and three multi-domain instruments (the FRAIL scale, the Deficit Accumulation Index, and St Vincent’s Frailty plus cognition 7 and mood) in adults with HF.