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Willbanks A, Seals M, Karmali R, Roy I. Harnessing the Systemic Biology of Functional Decline and Cachexia to Inform more Holistic Therapies for Incurable Cancers. Cancers (Basel) 2024; 16:360. [PMID: 38254849 PMCID: PMC10814065 DOI: 10.3390/cancers16020360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Options for treatment of incurable cancer remain scarce and are largely focused on limited therapeutic mechanisms. A new approach specific to advanced cancers is needed to identify new and effective treatments. Morbidity in advanced cancer is driven by functional decline and a number of systemic conditions, including cachexia and fatigue. This review will focus on these clinical concepts, describe our current understanding of their underlying biology, and then propose how future therapeutic strategies, including pharmaceuticals, exercise, and rehabilitation, could target these mechanisms as an alternative route to addressing incurable cancer.
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Affiliation(s)
| | - Mina Seals
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Reem Karmali
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
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2
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Evangelou I, Vamvakari K, Kalafati IP, Kipouros M, Kasti AN, Kosti RI, Bonoti F, Androutsos O. Depression and Anxiety Mediate the Associations between Nutritional Status, Functional Capacity, and Quality of Life in Patients with Cancer. Nutr Cancer 2023; 75:1783-1794. [PMID: 37497944 DOI: 10.1080/01635581.2023.2237688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
Cancer patients are at risk of malnutrition, which influences their functional status, mental health (MH), and quality of life (QoL). This study aimed to examine the associations between nutritional status, functional capacity, and aspects of QoL in cancer patients, as well as the potential mediating role of depression and anxiety in these associations. Patients with various types of cancer (n = 152) were recruited from the Attikon University Hospital, Greece. Validated questionnaires were used to assess nutritional status (PG-SGA), QoL (SF-36 and EQ-5D-3L), functional capacity (ECOG), depression, and anxiety (HADS and BEDS). Handgrip strength (HGS) was also measured. Poor nutritional status was inversely associated with functional capacity, QoL, depression, and anxiety, after adjusting for confounding factors (all P ≤ 0.05). Mediation analysis indicated a significant indirect effect of nutritional status on various parameters of functional capacity and QoL through depression and anxiety, after adjusting for age and sex. Mediated proportion ranged from 26.3-34% to 23.1-82.8% for functional capacity and QoL, respectively. A significant proportion of the effect of nutritional status on QoL and functional capacity can be partly attributed to psychological effects, highlighting the significance of integrating all aforementioned aspects in the nutritional intervention for cancer patients.
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Affiliation(s)
- Iliana Evangelou
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Konstantina Vamvakari
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Ioanna Panagiota Kalafati
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Kallithea, Greece
| | - Michail Kipouros
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Arezina N. Kasti
- Department of Nutrition and Dietetics, Attikon University General Hospital, Athens, Greece
| | - Rena I Kosti
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Fotini Bonoti
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Odysseas Androutsos
- Department of Nutrition-Dietetics, Lab of Clinical Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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Martin A, Freyssenet D. Phenotypic features of cancer cachexia-related loss of skeletal muscle mass and function: lessons from human and animal studies. J Cachexia Sarcopenia Muscle 2021; 12:252-273. [PMID: 33783983 PMCID: PMC8061402 DOI: 10.1002/jcsm.12678] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Cancer cachexia is a complex multi-organ catabolic syndrome that reduces mobility, increases fatigue, decreases the efficiency of therapeutic strategies, diminishes the quality of life, and increases the mortality of cancer patients. This review provides an exhaustive and comprehensive analysis of cancer cachexia-related phenotypic changes in skeletal muscle at both the cellular and subcellular levels in human cancer patients, as well as in animal models of cancer cachexia. Cancer cachexia is characterized by a major decrease in skeletal muscle mass in human and animals that depends on the severity of the disease/model and the localization of the tumour. It affects both type 1 and type 2 muscle fibres, even if some animal studies suggest that type 2 muscle fibres would be more prone to atrophy. Animal studies indicate an impairment in mitochondrial oxidative metabolism resulting from a decrease in mitochondrial content, an alteration in mitochondria morphology, and a reduction in mitochondrial metabolic fluxes. Immuno-histological analyses in human and animal models also suggest that a faulty mechanism of skeletal muscle repair would contribute to muscle mass loss. An increase in collagen deposit, an accumulation of fat depot outside and inside the muscle fibre, and a disrupted contractile machinery structure are also phenotypic features that have been consistently reported in cachectic skeletal muscle. Muscle function is also profoundly altered during cancer cachexia with a strong reduction in skeletal muscle force. Even though the loss of skeletal muscle mass largely contributes to the loss of muscle function, other factors such as muscle-nerve interaction and calcium handling are probably involved in the decrease in muscle force. Longitudinal analyses of skeletal muscle mass by imaging technics and skeletal muscle force in cancer patients, but also in animal models of cancer cachexia, are necessary to determine the respective kinetics and functional involvements of these factors. Our analysis also emphasizes that measuring skeletal muscle force through standardized tests could provide a simple and robust mean to early diagnose cachexia in cancer patients. That would be of great benefit to cancer patient's quality of life and health care systems.
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Affiliation(s)
- Agnès Martin
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
| | - Damien Freyssenet
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
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5
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Meaningful measures in cancer cachexia: implications for practice and research. Curr Opin Support Palliat Care 2020; 13:323-327. [PMID: 31599817 DOI: 10.1097/spc.0000000000000472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cancer cachexia is a complex inflammatory syndrome, which presents with a variety of discrete symptoms and signs. This creates a challenge for both clinicians and researchers in recognizing and assessing the syndrome. This review explores the evidence for various measures used in the assessment of cachexia. RECENT FINDINGS Objectively, cachexia may be assessed using CT-derived measures of skeletal muscle [skeletal muscle index (SMI) and skeletal muscle density (SMD)]. Evidence suggests that SMD may be of equal or greater value than SMI in assessing cachexia. Inflammatory markers are also used, and include interleukin(IL)-1α; IL-1β; IL-6 and Interferon Gamma (IFNγ). Other robust measures include performance status and the modified Glasgow prognostic score (mGPS). These measures, however, are more commonly used in academia. By comparison, clinical assessment is limited to individual measures of patient function, such as hand grip strength (HGS), calf circumference, gait speed, and the 'timed up and go test' (TUG). These have each been linked with components of cachexia but are less well evidenced. Evidence also exists for patient-reported quality-of-life measures, based upon the EORTC- QLQ-C30 questionnaire, in assessing cachexia. SUMMARY Further assessment is required to compare clinical measures of cachexia and determine their utility.
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Bland KA, Zopf EM, Harrison M, Ely M, Cormie P, Liu E, Dowd A, Martin P. Prognostic Markers of Overall Survival in Cancer Patients Attending a Cachexia Support Service: An Evaluation of Clinically Assessed Physical Function, Malnutrition and Inflammatory Status. Nutr Cancer 2020; 73:1400-1410. [PMID: 32757683 DOI: 10.1080/01635581.2020.1800765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer cachexia is a muscle-wasting syndrome that results in physical function impairments and decreased survival. While body weight and muscle mass loss predict survival, the prognostic significance of physical function in this population is unclear. Thus, we evaluated the association between physical function, and other routine measures, and overall survival (OS) in cancer patients attending a cachexia support service. METHODS Physical function was clinically-assessed using the 30 s sit-to-stand test and handgrip strength. Six-month weight loss, the Patient-Generated Subjective Global Assessment (PG-SGA) total score, C-reactive protein (CRP), albumin, and quality of life were also evaluated. RESULTS Records from 203 patients (age: 68.6 ± 11.6 years) were included. Handgrip strength did not predict OS. Sit-to-stand repetitions predicted OS in the single variable, but not the multivariable analysis. Multivariable results suggested higher PG-SGA total scores (HR: 1.04, 95% CI: 1.01-1.07), six-month weight loss (HR: 1.02, 95% CI: 1.004-1.04), and elevated CRP (HR: 1.004, 95% CI: 1.0004-1.01) predicted shorter OS. Higher albumin predicted longer OS (HR: 0.93, 95% CI: 0.90-0.97). CONCLUSION Six-month weight loss, the PG-SGA total score, CRP, and albumin independently predicted survival, while physical function did not. Functional impairments remain a hallmark of cancer cachexia and the benefit of their routine assessment warrants further exploration, especially in relation to patient quality of life.
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Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Meg Harrison
- Palliative Care, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Matthew Ely
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Anna Dowd
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Peter Martin
- Palliative Care, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
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Zhou Z, Gu Y, Zhang Q, Liu L, Wu H, Meng G, Bao X, Zhang S, Sun S, Wang X, Zhou M, Jia Q, Song K, Zhao Y, Niu K. Association between tooth loss and handgrip strength in a general adult population. PLoS One 2020; 15:e0236010. [PMID: 32649678 PMCID: PMC7351208 DOI: 10.1371/journal.pone.0236010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/26/2020] [Indexed: 12/25/2022] Open
Abstract
Tooth loss is a prevailing condition in China due to the high prevalence of oral diseases. Since previous studies explored the association between tooth loss and handgrip strength showed incongruous results, the aim of this study was to investigate the association between tooth loss and handgrip strength in Tianjin, China. Cross-sectional data in the present study used baseline data of Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study during 2013–2016. Eligible adults (n = 26275) were classified into four groups depending on the number of missing teeth (excluding third molars): 0, 1–2, 3–5 and ≥6. Handgrip strength was measured using a handheld type dynamometer. Analysis of covariance was used to examine the relationships between tooth loss and handgrip strength and handgrip strength per body weight according to gender. After adjustment for potential confounders, the relationships existed between increasing categories of tooth loss and handgrip strength, as well as handgrip strength per weight. The data of stratified analysis showed that there was a trending association between decreased handgrip strength and fewer retained teeth both in males and females less than 60 years of age (P for trend <0.01); whereas no significant association 60 years of age or older. Moreover, loss of more than 3 teeth was significantly associated with reduced muscle strength (P <0.01). Tooth loss is independently associated with handgrip strength in Chinese adults less than 60 years of age.
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Affiliation(s)
- Ziqi Zhou
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xue Bao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Wang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Zhou
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
- * E-mail: , (KN); (YZ)
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- * E-mail: , (KN); (YZ)
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Stene GB, Balstad TR, Leer ASM, Bye A, Kaasa S, Fallon M, Laird B, Maddocks M, Solheim TS. Deterioration in Muscle Mass and Physical Function Differs According to Weight Loss History in Cancer Cachexia. Cancers (Basel) 2019; 11:cancers11121925. [PMID: 31816924 PMCID: PMC6966581 DOI: 10.3390/cancers11121925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline. Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III–IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks. Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (−5.3 cm2, p = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (−2.8 cm2, p = 0.146), but demonstrated a statistically significant decline in PF; KPS (−3.8 points, p = 0.030), self-PF (−8.8 points, p = 0.027), and HGS (−2.7 kg, p = 0.026). Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further.
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Affiliation(s)
- Guro Birgitte Stene
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-48226799
| | - Trude Rakel Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
| | - Anne Silja M. Leer
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 0167 Oslo, Norway;
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, 0167 Oslo, Norway
| | - Stein Kaasa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0167 Oslo, Norway
| | - Marie Fallon
- Edinburgh Cancer Research Centre, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK;
| | - Barry Laird
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
- St Columba’s Hospice, Boswall Road, Edinburgh EH4 2XR, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London SE5 9PJ, UK;
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU—Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.R.B.); (S.K.); (B.L.); (T.S.S.)
- Cancer Clinic, Trondheim University Hospital, 7491 Trondheim, Norway
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Montalvo RN, Counts BR, Carson JA. Understanding sex differences in the regulation of cancer-induced muscle wasting. Curr Opin Support Palliat Care 2018; 12:394-403. [PMID: 30102621 PMCID: PMC6239206 DOI: 10.1097/spc.0000000000000380] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We highlight evidence for sexual dimorphism in preclinical and clinical studies investigating the cause and treatment of cancer cachexia. RECENT FINDINGS Cancer cachexia is unintended bodyweight loss occurring with cancer, and skeletal muscle wasting is a critical predictor of negative outcomes in the cancer patient. Skeletal muscle exhibits sexual dimorphism in fiber type, function, and regeneration capacity. Sex differences have been implicated in skeletal muscle metabolism, mitochondrial function, immune response to injury, and myogenic stem cell regulation. All of these processes have the potential to be involved in cancer-induced muscle wasting. Unfortunately, the vast majority of published studies examining cancer cachexia in preclinical models or cancer patients either have not accounted for sex in their design or have exclusively studied males. Preclinical studies have established that ovarian function and estradiol can affect skeletal muscle function, metabolism and mass; ovarian function has also been implicated in the sensitivity of circulating inflammatory cytokines and the progression of cachexia. SUMMARY Females and males have unique characteristics that effect skeletal muscle's microenvironment and intrinsic signaling. These differences provide a strong rationale for distinct causes for cancer cachexia development and treatment in males and females.
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Affiliation(s)
- Ryan N Montalvo
- Department of Exercise Science, University of South Carolina, Public Health Research Center, Columbia, USA
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