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      Muscle mass as a target to reduce fatigue in patients with advanced cancer


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          Cancer‐related fatigue (CRF) reduces quality of life and the activity level of patients with cancer. Cancer related fatigue can be reduced by exercise interventions that may concurrently increase muscle mass. We hypothesized that low muscle mass is directly related to higher CRF.


          A total of 233 patients with advanced cancer starting palliative chemotherapy for lung, colorectal, breast, or prostate cancer were studied. The skeletal muscle index (SMI) was calculated as the patient's muscle mass on level L3 or T4 of a computed tomography scan, adjusted for height. Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy‐fatigue questionnaire (cut‐off for fatigue <34). Multiple linear regression analyses were conducted to study the association between SMI and CRF adjusting for relevant confounders.


          In this group of patients with advanced cancer, the median fatigue score was 36 (interquartile range 26–44). A higher SMI on level L3 was significantly associated with less CRF for men (B 0.447, P 0.004) but not for women (B − 0.401, P 0.090). No association between SMI on level T4 and the Functional Assessment of Chronic Illness Therapy‐fatigue score was found ( n = 82).


          The association between SMI and CRF may lead to the suggestion that male patients may be able to reduce fatigue by exercise interventions aiming at an increased muscle mass. In women with advanced cancer, CRF is more influenced by other causes, because it is not significantly related to muscle mass. To further reduce CRF in both men and women with cancer, multifactorial assessments need to be performed in order to develop effective treatment strategies.

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          Most cited references19

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          The assessment of fatigue: a practical guide for clinicians and researchers.

          Fatigue is a common feature of physical and neurological disease as well as psychiatric disorders, often reported amongst patients' most severe and distressing symptoms. A large number of scales have been developed attempting to measure the nature, severity and impact of fatigue in a range of clinical populations. The aim of the present review is to guide the clinician and researcher in choosing a scale to suit their needs. Database searches of Medline, PsycINFO and EMBASE were undertaken to find published scales. Details of 30 scales are reported. These vary greatly in how widely they have been used and how well they have been evaluated. The present review describes the scales and their properties and provides illustrations of their use in published studies. Recommendations are made for the selection of a scale and for the development and validation of new and existing scales.
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            Loss of Muscle Mass During Chemotherapy Is Predictive for Poor Survival of Patients With Metastatic Colorectal Cancer.

            Low muscle mass is present in approximately 40% of patients with metastatic colorectal cancer (mCRC) and may be associated with poor outcome. We studied change in skeletal muscle during palliative chemotherapy in patients with mCRC and its association with treatment modifications and overall survival.
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              Impact of resistance training in cancer survivors: a meta-analysis.

              Current evidence suggests many health benefits from physical activity during and after cancer treatment. However, the optimal exercise program for cancer survivors has not yet been established. The purpose of this meta-analysis was to summarize evidence for the efficacy of resistance training (RT) interventions to improve muscle strength and body composition among adult cancer survivors. We also investigate potential dose-response relationships between intensity, duration, and frequency of RT and assessed outcomes. A systematic literature review of the Clinical Trial Register, Cochrane Trial Register, MEDLINE, and EMBASE literature databases was undertaken. Studies were included if they were randomized controlled trials (RCT) comparing RT with an exercise or nonexercise control group in cancer survivors during and after treatment. Thirteen articles from 11 RCT met our inclusion criteria. We performed a random-effects meta-analysis to determine weighted mean differences (WMD) with 95% confidence intervals using the Cochrane Review Manager 5.0.25. A random-effects metaregression model was performed to examine dose-response relationships between RT variables and assessed outcomes. Quantitative evidence shows a large effect of RT on lower-limb and upper-limb muscle strength (WMD: +14.57 kg, P = 0.0005 and +6.90 kg, P < 0.00001, respectively) and moderate effects on lean body mass and percentage of body fat (WMD: +1.07 kg, P < 0.0001 and -2.08%, P = 0.003, respectively). A small positive effect of RT was noted on Functional Assessment of Cancer Therapy-Fatigue (P = 0.05). Upper-limb muscle strength and percentage of body fat improved to a greater extent when RT interventions were of low to moderate intensity (≤ 75% one-repetition maximum, P = 0.042). RT was shown to be associated with clinically important positive effects on muscular function and body composition in patients during treatment or in long-term follow-up.

                Author and article information

                J Cachexia Sarcopenia Muscle
                J Cachexia Sarcopenia Muscle
                Journal of Cachexia, Sarcopenia and Muscle
                John Wiley and Sons Inc. (Hoboken )
                21 June 2017
                August 2017
                : 8
                : 4 ( doiID: 10.1002/jcsm.v8.4 )
                : 623-629
                [ 1 ] Department of Medical Oncology VU University Medical Center/Cancer Center Amsterdam de Boelelaan 1117 1081 HV Amsterdam The Netherlands
                [ 2 ] Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center de Boelelaan 1117 1081 HV Amsterdam The Netherlands
                [ 3 ] Department of Internal Medicine Rijnstate Hospital Wagnerlaan 55 6815 AD Arnhem The Netherlands
                [ 4 ] Department of Pulmonary Diseases VU University Medical Center de Boelelaan 1117 1081 HV Amsterdam The Netherlands
                [ 5 ] Department of Epidemiology and Biostatistics VU University Medical Center, Amsterdam Public Health Research Institute de Boelelaan 1117 1081 HV Amsterdam The Netherlands
                [ 6 ] Exercise Medicine Research Institute Edith Cowan University 270 Joondalup Dr Joondalup WA 6027 Australia
                Author notes
                [*] [* ]Correspondence to: Henk M.W. Verheul, Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Fax: +31(0)20‐4444355, Tel: +31(0)20‐4444300, Email: h.verheul@ 123456vumc.nl
                JCSM12199 JCSM-D-16-00124
                © 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                : 31 May 2016
                : 11 December 2016
                : 07 February 2017
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 2842
                Original Article
                Original Articles
                Custom metadata
                August 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.7 mode:remove_FC converted:23.08.2017

                fatigue, muscle, neoplasms, cancer, exercise


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