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Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study

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Abstract

Purpose

This study aimed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer (stages I–IIIA).

Methods

A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospective Health, Eating, Activity, and Lifestyle Study were included in this study. Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception, on average, 12 months after diagnosis. Sarcopenia was defined as two standard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared (<5.45 kg/m2). Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries. Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality.

Results

Median follow-up was 9.2 years; 75 women were classified as sarcopenic, and among 92 deaths, 46 were attributed to breast cancer. In multivariable models that included age, race-ethnicity/study site, treatment type, comorbidities, waist circumference, and total body fat percentage, sarcopenia was independently associated with overall mortality (hazard ratio (HR) = 2.86; 95 % CI, 1.67–4.89). Sarcopenic women had increased risk of breast-cancer-specific mortality, although the association was not statistically significant (HR = 1.95, 95 % CI, 0.87–4.35).

Conclusion

Sarcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality. The development of effective interventions to maintain and/or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study.

Implications for Cancer Survivors

Such interventions may help breast cancer patients live longer.

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References

  1. Chen X, et al. Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat. 2010;122(3):823–33.

    Article  PubMed  Google Scholar 

  2. Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev. 2006;7(4):333–40.

    Article  PubMed  CAS  Google Scholar 

  3. Prado CM, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15(8):2920–6.

    Article  PubMed  CAS  Google Scholar 

  4. Prado CM, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.

    Article  PubMed  Google Scholar 

  5. Tan BH, et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15(22):6973–9.

    Article  PubMed  CAS  Google Scholar 

  6. Gallagher D. Weight loss in older women: influences on body composition. Am J Clin Nutr. 2006;84(5):957–8.

    PubMed  CAS  Google Scholar 

  7. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990S–1.

    PubMed  CAS  Google Scholar 

  8. Baumgartner R, et al. Epidemiology of sarcopenia among elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.

    Article  PubMed  CAS  Google Scholar 

  9. Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci. 2000;904:437–48.

    Article  PubMed  CAS  Google Scholar 

  10. Morley JE, et al. Sarcopenia. J Lab Clin Med. 2001;137(4):231–43.

    Article  PubMed  CAS  Google Scholar 

  11. Marcell TJ. Sarcopenia: causes, consequences, and preventions. J Gerontol A Biol Sci Med Sci. 2003;58(10):M911–6.

    Article  PubMed  Google Scholar 

  12. Courneya KS, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiol Biomarkers Prev. 2007;16(12):2572–8.

    Article  PubMed  Google Scholar 

  13. Courneya KS, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J clinic oncol: off j Amer Soc Clinic Oncol. 2007;25(28):4396–404.

    Article  Google Scholar 

  14. Janssen I. The epidemiology of sarcopenia. Clin Geriatr Med. 2011;27(3):355–63.

    Article  PubMed  Google Scholar 

  15. Fielding RA, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–56.

    Article  PubMed  Google Scholar 

  16. Irwin ML, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23(4):774–82.

    Article  PubMed  Google Scholar 

  17. Prado CM, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin canc res: official j Amer Assoc Canc Res. 2007;13(11):3264–8.

    Article  CAS  Google Scholar 

  18. WHO, Obesity: preventing and managing the global epidemic, World Health Organization: Geneva, Switzerland; 2000.

  19. Stenholm S, et al. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008;11(6):693–700.

    Article  PubMed  Google Scholar 

  20. Baumgartner RN, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res. 2004;12(12):1995–2004.

    Article  PubMed  Google Scholar 

  21. Davison KK, et al. Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. J Am Geriatr Soc. 2002;50(11):1802–9.

    Article  PubMed  Google Scholar 

  22. Zamboni M, et al. Sarcopenic obesity: a new category of obesity in the elderly. Nutr, metab, cardiovasc dis: NMCD. 2008;18(5):388–95.

    Article  CAS  Google Scholar 

  23. McTiernan A, et al. Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol. 2003;21(10):1961–6.

    Article  PubMed  CAS  Google Scholar 

  24. Baumgartner KB, et al. Association of body composition and weight history with breast cancer prognostic markers: divergent pattern for Hispanic and non-Hispanic White women. Am J Epidemiol. 2004;160(11):1087–97.

    Article  PubMed  CAS  Google Scholar 

  25. Link J, et al. International Classification of Diseases coding changes lead to profound declines in reported idiopathic pulmonary arterial hypertension mortality and hospitalizations: implications for database studies. Chest. 2011;139(3):497–504.

    Article  PubMed  Google Scholar 

  26. Kiebzak GM, et al. Measurement precision of body composition variables using the lunar DPX-L densitometer. J Clin Densitom. 2000;3(1):35–41.

    Article  PubMed  CAS  Google Scholar 

  27. WHO, International Statistical Classification of Diseases and Related Health Problems (10th revision), World Health Organization: Geneva; 1992.

  28. Cruz-Jentoft AJ, et al. Sarcopenia: European consensus on definition and diagnosis. Age and ageing. 2010;39(4):412–23.

    Article  PubMed  Google Scholar 

  29. Rolland Y, et al. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc. 2003;51(8):1120–4.

    Article  PubMed  Google Scholar 

  30. Delmonico MJ, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc. 2007;55(5):769–74.

    Article  PubMed  Google Scholar 

  31. Therneau TM, Grambsch PM. Modeling survival data: extending the Cox model. Statistics for biology and health. New York: Springer; 2000, p. 350.

  32. Kleinbaum DG, Klein M. Evaluating the proportional hazards assumption, in Survival analysis a self-learning text. New York: Springer; 2005. p. 131–71.

    Google Scholar 

  33. Harrell Jr FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.

    Article  PubMed  Google Scholar 

  34. Charlson M, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.

    Article  PubMed  CAS  Google Scholar 

  35. Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol. 2002;20(15):3302–16.

    Article  PubMed  Google Scholar 

  36. Li CI, et al. Epidemiologic and molecular risk factors for contralateral breast cancer among young women. Br J Cancer. 2003;89(3):513–8.

    Article  PubMed  CAS  Google Scholar 

  37. Li CI, Moe RE, Daling JR. Risk of mortality by histologic type of breast cancer among women aged 50 to 79 years. Arch Intern Med. 2003;163(18):2149–53.

    Article  PubMed  Google Scholar 

  38. Phipps AI, Li CI. Breast cancer biology and clinical characteristics. In: Li CI, editor. Breast cancer epidemiology. New York: Springer; 2010. p. 21–46.

    Chapter  Google Scholar 

  39. Gurney HP, et al. Factors affecting epirubicin pharmacokinetics and toxicity: evidence against using body-surface area for dose calculation. J Clin Oncol. 1998;16(7):2299–304.

    PubMed  CAS  Google Scholar 

  40. Cosolo WC, et al. Lean body mass, body surface area and epirubicin kinetics. Anticancer Drugs. 1994;5(3):293–7.

    Article  PubMed  CAS  Google Scholar 

  41. Morgan DJ, Bray KM. Lean body mass as a predictor of drug dosage. Implications for drug therapy. Clin Pharmacokinet. 1994;26(4):292–307.

    Article  PubMed  CAS  Google Scholar 

  42. Visser M, et al. Validity of fan-beam dual-energy X-ray absorptiometry for measuring fat-free mass and leg muscle mass. Health, aging, and body composition study—Dual-Energy X-ray Absorptiometry and Body Composition Working Group. J Appl Physiol. 1999;87(4):1513–20.

    PubMed  CAS  Google Scholar 

  43. Rock CL, Demark-Wahnefried W. Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr. 2002;132(11 Suppl):3504S–7.

    PubMed  CAS  Google Scholar 

  44. George SM, et al. Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Canc causes & contr: CCC. 2011;22(4):589–98.

    Article  Google Scholar 

  45. Chen X, et al. Exercise after diagnosis of breast cancer in association with survival. Canc Prev Res (Phila). 2011;4(9):1409–18.

    Article  Google Scholar 

  46. Cederholm TE, et al. Toward a definition of sarcopenia. Clin Geriatr Med. 2011;27(3):341.

    Article  PubMed  Google Scholar 

  47. Newman AB, et al. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc. 2003;51(11):1602–9.

    Article  PubMed  Google Scholar 

  48. Honda H, et al. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr. 2007;86(3):633–8.

    PubMed  CAS  Google Scholar 

  49. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002;50(5):889–96.

    Article  PubMed  Google Scholar 

  50. Project TIH. A haplotype map of the human genome. Nature. 2005;437:1299–320.

    Article  Google Scholar 

  51. Howie BN, et al. Efficient selection of tagging single-nucleotide polymorphisms in multiple populations. Hum Genet. 2006;120(1):58–68.

    Article  PubMed  Google Scholar 

  52. Wang ZM, et al. Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. J Appl Physiol. 1996;80(3):824–31.

    PubMed  CAS  Google Scholar 

  53. Cruz-Jentoft AJ, et al. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010;13(1):1–7.

    Article  PubMed  Google Scholar 

  54. Messier V, et al. Menopause and sarcopenia: a potential role for sex hormones. Maturitas. 2011;68(4):331–6.

    Article  PubMed  CAS  Google Scholar 

  55. Beyer I, Mets T, Bautmans I. Chronic low-grade inflammation and age-related sarcopenia. Curr Opin Clin Nutr Metab Care. 2012;15(1):12–22.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Anita Ambs and Todd Gibson for their continued assistance and support, as well as the HEAL participants for their ongoing dedication to this study. This study was supported through National Cancer Institute contracts NO1-CN-75036-20, NO1-CN-05228, NO1-PC-67010, U54-CA116847, and training grant R25-CA094880. A portion of this work was conducted through the Clinical Research Center at the University of Washington and support by the National Institutes of Health grant MO1-RR-0037 and University of New Mexico grant, NCRR MO1-RR-0997.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-B402, Seattle, WA, 98109-1024, USA

    Adriana Villaseñor & Marian L. Neuhouser

  2. School of Public Health, Department of Epidemiology, University of Washington, Seattle, WA, USA

    Adriana Villaseñor, Anne McTiernan & Marian L. Neuhouser

  3. Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Rachel Ballard-Barbash

  4. Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA

    Kathy Baumgartner & Richard Baumgartner

  5. Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA

    Leslie Bernstein

  6. Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Anne McTiernan

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  1. Adriana Villaseñor
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Correspondence to Adriana Villaseñor.

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Villaseñor, A., Ballard-Barbash, R., Baumgartner, K. et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv 6, 398–406 (2012). https://doi.org/10.1007/s11764-012-0234-x

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  • DOI: https://doi.org/10.1007/s11764-012-0234-x

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