Abstract
Background
Advances in breast cancer research are making treatment options increasingly effective and reducing mortality. Body composition is an example of a prognostic tool that can help personalize breast cancer treatments and further increase their effectiveness. In this study, we examine the association of several body composition measures with comorbidities, physical function, and quality of life.
Methods
This study is a cross-sectional analysis of 99 women with early breast cancer scheduled for chemotherapy. Univariate regression models were used to identify significant associations of body composition metrics with patient demographics, clinical characteristics, measures of physical function, and patient-reported outcomes (PRO)s. Multivariable modeling was used to evaluate associations adjusted for age.
Results
Median age was 58 (range 24–83), 27% were non-white, and, 47% were obese (≥ 30 kg/m2). Increasing age was associated with lower Skeletal Muscle Density (SMD) (p = 0.0001), lower Skeletal Muscle Gauge (SMG) (p = 0.0005), and higher Visceral Adipose Tissue (VAT) (p < 0.0001). In patients with a prolonged Timed Up and Go tests (> 14 s), mean VAT was 57.87 higher (p = 0.004), SMD 5.70 lower (p = 0.04), and SMG 325.4 lower (p = 0.02). For each point of higher performance on the Short Physical Performance Battery (SPPB), VAT decreased 12.24 (p = 0.002) and SMD rose 1.22 (p = 0.02). In multivariable analysis adjusting for age, the association of TUG > 14 with higher VAT remained significant (p = 0.02).
Conclusions
Suboptimal body composition prior to treatment is associated poor physical function and may be an indicator of clinical importance.
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References
Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30
Torre LA, Siegel RL, Ward EM et al (2016) Global cancer incidence and mortality rates and trends–an update. Cancer Epidemiol Biomarkers Prev 25:16–27
SEER (2019) Cancer stat facts: female breast cancer
Veronesi U, Marubini E, Del Vecchio M et al (1995) Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 87:19–27
Gobbini E, Ezzalfani M, Dieras V et al (2018) Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur J Cancer 96:17–24
Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127:990S–991S
Williams GR, Rier HN, McDonald A et al (2019) Sarcopenia and aging in cancer. J Geriatr Oncol 10:374–377
Aleixo GFP, Williams GR, Nyrop KA et al (2019) Muscle composition and outcomes in patients with breast cancer: meta-analysis and systematic review. Breast Cancer Res Treat 177:569–579
Del Fabbro E, Parsons H, Warneke CL et al (2012) The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist 17:1240–1245
Feliciano ECLV, Chen W, Prado C, Shachar SS, Alexeeff S, Caan BJ (2019) Adiposity, muscle mass and delays and dose reduction on adjuvant taxane based chemotherapy for breast cancer. In: AACR2019 abstract:3284
Cespedes Feliciano EM, Chen WY, Bradshaw PT et al (2019) Adipose tissue distribution and cardiovascular disease risk among breast cancer survivors. J Clin Oncol 37:2528
Shachar SS, Deal AM, Weinberg M et al (2017) Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane-based chemotherapy. Clin Cancer Res 23:658–665
Caan BJ, Cespedes Feliciano EM, Prado CM et al (2018) Association of muscle and adiposity measured by computed tomography with survival in patients with nonmetastatic breast cancer. JAMA Oncol 4:798–804
Shachar SS, Deal AM, Weinberg M et al (2017) Body composition as a predictor of toxicity in patients receiving anthracycline and taxane based chemotherapy for early stage breast cancer. Clin Cancer Res 23:3537–3543
Vincent G, Velkoff V (2010) Timed up and go, the next four decades, the older population of the United States: 2010 to 2050. US Census Bureau, pp 25–1138
Pavasini R, Guralnik J, Brown JC et al (2016) Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med 14:215
Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579
Webster K, Cella D, Yost K (2003) The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 1:79
Stewart AL, Kamberg CJ (1992) Physical functioning measures. In: Stewart AL, Ware JE Jr (eds) Measuring functioning and well-being: the medical outcomes survey. Duke University Press, Durham and London
Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434
Williams GR, Deal AM, Muss HB et al (2017) Skeletal muscle measures and physical function in older adults with cancer: sarcopenia or myopenia? Oncotarget 8:33658–33665
Deluche E, Leobon S, Desport JC et al (2018) Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer 26:861–868
Weinberg MS, Shachar SS, Muss HB et al (2018) Beyond sarcopenia: Characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population. Breast J 24:278–284
Aleixo GFP, Shachar SS, Nyrop KA et al (2020) Myosteatosis and prognosis in cancer: systematic review and meta-analysis. Crit Rev Oncol Hematol 145:102839
Shachar SS, Williams GR, Muss HB et al (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58–67
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31
Soubeyran P, Fonck M, Blanc-Bisson C et al (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30:1829–1834
Ahima RS (2009) Connecting obesity, aging and diabetes. Nat Med 15:996–997
Lackey DE, Olefsky JM (2016) Regulation of metabolism by the innate immune system. Nat Rev Endocrinol 12:15–28
Hong CC, Ambrosone CB, Goodwin PJ (2015) Comorbidities and their management: potential impact on breast cancer outcomes. Adv Exp Med Biol 862:155–175
Nyrop KA, Deal AM, Lee JT et al (2017) Weight changes in postmenopausal breast cancer survivors over 2 years of endocrine therapy: a retrospective chart review. Breast Cancer Res Treat 162:375–388
Xiao J, Caan BJ, Weltzien E et al (2018) Associations of pre-existing co-morbidities with skeletal muscle mass and radiodensity in patients with non-metastatic colorectal cancer. J Cachexia Sarcopenia Muscle 9:654–663
Charette N, Vandeputte C, Ameye L et al (2019) Prognostic value of adipose tissue and muscle mass in advanced colorectal cancer: a post hoc analysis of two non-randomized phase II trials. BMC Cancer 19:134
Aleixo GFP, Choi SK, Tan AJ et al (2019) Is "geriatric" assessment just for older patients? Oncologist 24:1–4
Strulov Shachar S, Williams GR (2017) The obesity paradox in cancer-moving beyond BMI. Cancer Epidemiol Biomarkers Prev 26:13–16
Shachar SS, Deal AM, Weinberg M et al (2017) Body composition as a predictor of toxicity in patients receiving anthracycline and taxane-based chemotherapy for early-stage breast cancer. Clin Cancer Res 23:3537–3543
Engelke K, Museyko O, Wang L et al (2018) Quantitative analysis of skeletal muscle by computed tomography imaging-State of the art. J Orthop Translat 15:91–103
Chan TC, Luk JK, Chu LW et al (2015) Association between body mass index and cause-specific mortality as well as hospitalization in frail Chinese older adults. Geriatr Gerontol Int 15:72–79
Acknowledgements
We greatly appreciate the active support of oncology clinicians and their research staff at multiple sites and, most importantly, the breast cancer patients participating in our study. We thank Tucker Brenizer, Shanah R. Kirk, and Amy Garrett for their commitment to study implementation best practices.
Funding
This study was supported by the Breast Cancer Research Foundation (New York, NY), UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund (Chapel Hill, NC), and Kay Yow Fund (Raleigh, NC).
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Authors Gabriel FP Aleixo, Allison M Deal, Kirsten A. Nyrop, Hyman B Muss, Emily M Damone, Grant R. Williams, Hyeon Yu, and Shlomit S Shachar declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This article does not contain any animals performed by any of the authors. Informed consent was obtained from all individuals participants in this study and approved by the IRB of the University of North Carolina at Chapel Hill.
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Aleixo, G.F.P., Deal, A.M., Nyrop, K.A. et al. Association of body composition with function in women with early breast cancer. Breast Cancer Res Treat 181, 411–421 (2020). https://doi.org/10.1007/s10549-020-05624-3
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DOI: https://doi.org/10.1007/s10549-020-05624-3