While it was initially characterised by a loss of muscle mass, sarcopenia has been defined by several international panels as a decline in muscle function, with a focus on muscle strength and physical performance. Despite the existence of algorithms and research into screening tools for its diagnosis, sarcopenia has not yet been appropriately recognised by the World Health Organisation’s latest version of the ICD (ICD-11), which is used by most countries. Definitions of sarcopenia are growing more precise, yet this does not translate into improved patient care and outcomes. This article aims to summarise the knowledge gaps surrounding sarcopenia’s definition, diagnosis, and treatment in current clinical practice. It also highlights the next steps in achieving worldwide sarcopenia recognition.
Sarcopenia is characterised by progressive and generalised skeletal muscle loss, both in terms of mass and function. Its main risk factors include ageing, gender, sedentary lifestyles and malnutrition. The latter is also frequently diagnosed alongside head- and- neck squamous cell carcinomas (HNSCC), with up to 46%-49% of patients being malnourished upon diagnosis. Although sarcopenia has been identified as a prognostic factor for HNSCC, only a small number of studies investigate the association between sarcopenia and survival in HNSCC. This study aimed to assess the association between pre-therapeutic sarcopenia and survival, as well as its impact on tolerance of chemoradiotherapy for the treatment of HNSCC. The outcomes measured in this study were overall survival (OS), disease-free survival (DFS), and treatment tolerance.
Clinical Frailty Scale and Frailty Index in Predicting Long-Term Survival for the Critically Ill: a review
Frailty is a state of vulnerability, recognised clinically, where patients experience an ageing-associated decline in their physical and cognitive abilities. There are two main scales for measuring frailty. The Clinical Frailty Scale (CFS) is often used for intensive care unit patients. The Diseases-10 Modified Frailty Index (mFI) is also used; it is derived from the understanding of 11 comorbidities. However, it was unknown how the two compare. In this study of 7,001 patients, it was found that a greater proportion of patients were categorised as frail using the CFS, and this scale also predicted better those who would survive past the 6-month mark versus those who would die. This indicates that the two scales are not equivalent, and the mFI should not be used for frailty. This review by A. Subramaniam et al. aimed to highlight the differences between the two scales, the Clinical Frailty Scale and the Diseases-10 Modified Frailty Index, to determine which is a better predictor of frailty.
Globally, there are over 1.5 million new cases of gastric and oesophageal cancer annually. These cases (especially advanced cases) are often associated with cancer cachexia, a multifactorial syndrome that leads to progressive wasting which cannot be fully reverse through nutritional interventions. It is also responsible for around 20% of cancer deaths. Yet, the understanding of cancer cachexia is often neglected in treatment. This presents an issue as cytotoxic drug doses are most commonly calculated based on body surface area, not taking into account decreasing mass. Furthermore, understanding cancer cachexia would allow for the improvement of therapeutic options, which are currently little researched, including exercise- and nutrition-based interventions, as well as targeted treatments such as anti-IL1 α and anti-GDF-15. Even for patients with incurable cancers, the management of cachexia wasting can improve quality of life. This review by Brown LR et al. aimed to highlight the necessity of understanding the progression of cancer cachexia in association with diseases such as gastric and oesophageal cancer, as well as the possible future research directions associated with aiding in these conditions.
Cancer cachexia is a multifactorial syndrome that leads to progressive wasting which cannot be fully reverse through nutritional interventions. There is currently no clear method for the management of cachexia, but exercise seems to hold promising potential. Exercise may provide anti-inflammatory and anti-oxidative effects, which may prove important in aiding with cachexia due to its correlation with inflammation and oxidative stress. Furthermore, exercise improves muscle strength and function, which can improve quality of life for those with cancer cachexia. However, there is very scarce evidence for this, and even some evidence contradicting the benefit of exercise due to the risk of over-extending the patients. This review by Murphy BT et al. aimed to shine light on both sides of the complex discussion surrounding the benefits of exercise in aiding with cancer cachexia.
Introducing the Journal of Cachexia, Sarcopenia and Muscle (JCSM), a peer-reviewed publication focusing on body composition, muscle loss, and their implications in chronic diseases.