title: Epidemiology of sarcopenia among the elderly in New Mexico. Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Objective evaluation of physical function in patients with advanced lung cancer: a preliminary report. Performance status assessment in cancer patients. An inter-observer variability study. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study Association of Nutrition Parameters Including Bioelectrical Impedance and Systemic Inflammatory Response With Quality of Life and Prognosis in Patients With Advanced Non-Small-Cell Lung Cancer: A Prospective Study Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study Nutritional status of patients undergoing lung cancer operations. Cysteine-rich protein reverses weight loss in lung cancer patients receiving chemotherapy or radiotherapy. Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Beneficial effects of adenosine triphosphate on nutritional status in advanced lung cancer patients: a randomized clinical trial. Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. A placebo-controlled, double-blind trial of infliximab for cancer-associated weight loss in elderly and/or poor performance non-small cell lung cancer patients (N01C9). Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy Effect of adenosine 5′-triphosphate infusions on the nutritional status and survival of preterminal cancer patients Growth hormone and insulin reverse net whole body and skeletal muscle protein catabolism in cancer patients. The effect of 6 months of androgen deprivation therapy on muscle and fat mass in older men with localized prostate cancer Why Do Some Lung Cancer Patients Receive No Anticancer Treatment?
abstract: Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article PURPOSE This prospect i ve study was design ed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test ( Simmonds Functional Assessment Tool [ SFA ] ) . PATIENTS AND METHODS One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment . Patients underwent assessment using the  Karnofsky , the Brief fatigue Inventory , The Functional Assessment of Cancer Therapy-Lung patients ( FACT-L ) and the  Edmonton Symptom Assessment Scale ( ESAS ) . These results were compared to the SFA tool . The SFA consists of six tasks : tying a belt , putting coins in a cup , reaching above head , st and ing up/sitting down , reaching forward and walking 50 feet . RESULTS Ninety-nine patients completed the study over 8 months : median Karnofsky performance status was 85 ( 70 to 100 ) , Edmonton Symptom Assessment Scale ( ESAS ) score ( 0 to 10 ) was generally low ( 0.5 to 2.8 ) . SFA scores were significantly different in patients compared to a control group . The correlation between the subscales of the SFA and the Karnofsky , the Brief Fatigue Inventory , The FACT-L and the ESAS was generally low to moderate ( r values : 0.22 to 0.38 ) . There was generally a moderate correlation between the different subjective scales ( r values : 0.3 to 0.62 ) . CONCLUSION Adherence to the SFA tool was excellent . The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions . These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer . Large trials of objective functional assessment are justified The ECOG Scale of Performance Status  ( PS ) is widely used to quantify the functional status of cancer patients , and is an important factor determining prognosis in a number of malignant conditions . The PS describes the status of symptoms and functions with respect to ambulatory status and need for care . PS 0 means normal activity , PS 1 means some symptoms , but still near fully ambulatory , PS 2 means less than 50 % , and PS 3 means more than 50 % of daytime in bed , while PS 4 means completely bedridden . An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients .  Total unanimity was observed in 40 cases , unanimity between two observers in 53 cases , and total disagreement in seven cases . Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement . Overall Kappa was 0.44 , ( 95 % confidence limits 0.38 - 0.51 ) . The Kappa for PS 0 was 0.55 ( 0.44 - 0.67 ) , while those for PS 1 , 2 , 3 and four were 0.48 ( 0.37 - 0.60 ) , 0.31 ( 0.19 - 0.42 ) , 0.43 ( 0.32 - 0.55 ) , and 0.33 ( 0.33 - 0.45 ) , respectively . If one observer allocated patients to PS 0 - 2 , then another r and omly selected observed placed the patients in the same category with a probability of 0.92 . For patients with PS 3 - 4 the probability that the same category would be chosen was 0.82 . Overall , the non-chance agreement between observers was only moderate , when all ECOG Performance Status groups were considered . However , agreement with regard to allocation of patients to PS 0 - 2 versus 3 - 4 was high . This is of interest because this cut-off is often used in clinical studies Purpose This study aim ed 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 prospect i ve 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 st and ard 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 ) . ConclusionS arcopenia 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 . Implication s for Cancer SurvivorsSuch interventions may help breast cancer patients live longer Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life ( QoL ) and survival of patients with nonsmall cell lung cancer ( NSCLC ) . Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status . The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life ( HRQL ) and survival in patients with advanced NSCLC . Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group ( ECOG ) 0–2 were included prospect ively in the study . We evaluated inflammatory parameters such as C-reactive protein , platelet/lymphocyte index , neutrophil/lymphocyte index , serum interleukin (IL)-6 , and tumor necrosis factor-α , and nutritional variables such as body mass index ( BMI ) and serum albumin levels . Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started  . HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Question naire (QLQ)-C30 and QLQ-LC13 instruments at baseline . Overall survival ( OS ) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models . One hundred nineteen patients were included .  Mean BMI was 24.8 ± 4.5 kg/m2 , average weight loss of patients was 8.4 % , and median phase angle was 5.8 ° . Malnutrition measured by subjective global assessment ( SGA ) , weight loss > 10 % , BMI > 20 was associated with lower HRQL scales . Patients with ECOG 2 , high content serum IL-6 , lower phase angle , and malnutrition parameters showed lower OS ; however , after multivariate analysis , only ECOG 2 [ Hazard ratio ( HR ) , 2.7 ; 95 % confidence interval ( 95 % CI ) , 1.5–4.7 ; P = 0.001 ] , phase angle ≤5.8 ° ( HR = 3.02 ; 95 % CI : 1.2–7.11 ; P = 0.011 ) , and SGA ( HR = 2.7 ; 95 % CI , 1.31–5.5 ; P = 0.005 ) were associated with poor survival . Patients were divided into low- , intermediate- , and high-risk groups according to regression coefficients ; OS at 1 yr was 78.4 , 53 , and 13.8 % , respectively . Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC . The results warrant prospect i ve trials to evaluate the impact of different nutritional interventions on HRQL and survival Background A frequent manifestation of advanced NSCLC is malnutrition , even though there are many studies which relate it with a poor survival , its relation with toxicity has not yet been consistently reported . The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC . Methods We prospect ively evaluated 100 stage IV NSCLC patients treated with paclitaxel ( 175 mg/m2 ) and cisplatin ( 80 mg/m2 ) . Malnutrition was assessed using SGA prior treatment . Neutrophil Lymphocyte Ratio ( NLR ) and the Platelet Lymphocyte Ratio ( PLR ) were used to determine the presence of systemic inflammatory response ( SIR ) and were related to the development of toxicity . Toxicity was grade d according to NCI CTCAE version 3.0 after two chemotherapy cycles . Results Median age was 58 ± 10 years , 51 % of patients were malnourished , 50 % had albumin ≤3.0 mg/mL. NLR ≥ 5 was associated with basal hypoalbuminemia ( mean ranks , 55.7 vs. 39 p = 0.006 ) , ECOG = 2 ( 47.2 vs. 55.4 p = 0.026 ) and PLR ≥ 150 were significantly related with a basal body mass index ≤20 ( 56.6 vs. 43.5 ; p = 0.02 ) and hypoalbuminemia ( 58.9 vs. 41.3 ; p = 0.02 ) . Main toxicities observed after 2 cycles of chemotherapy were alopecia ( 84 % ) , nausea ( 49 % ) , neuropathy ( 46 % ) , anemia ( 33 % ) , lymphopenia ( 31 % ) , and leukopenia ( 30 % ) . Patients malnourished and with hypoalbuminemia developed more chemotherapy-induced toxicity overall when compared with those without malnutrition ( 31 vs 22 ; p = 0.02 ) and normal albumin ( mean ranks , 62 vs 43 ; p = 0.002 ) , respectively . Hypoalbuminemia was associated with anemia ( 56 vs 47 ; p = 0.05 ) , fatigue ( 58 vs 46 ; p = 0.01 ) , and appetite loss ( 57.1 vs 46.7 ; p = 0.004 ) compared with normal albumin . PLR ≥ 150 was related with the development of toxicity grade III/IV ( 59.27 vs. 47.03 p = 0.008 ) and anemia ( 37.9 vs 53.8 p = 0.004 ) . ConclusionS IR parameters were associated with malnutrition , weight loss and hypoalbuminemia . Chemotherapy-induced toxicity in NSCLC patients treated with  paclitaxel and cisplatin  was associated with malnutrition and hypoalbuminemia . Early nutritional assessment and support might confer beneficial effects BACKGROUND Patients referred for lung cancer operations were reported to be nutritionally depleted . This may be relevant in determining patient outcome after surgical procedures . A study was undertaken to measure a range of nutritional variables including dietary intake of patients referred to a regional cardiothoracic center for curative lung cancer operations . METHODS Anthropometric measurements , grip strength , fat-free mass ( FFM ) , serum protein concentrations , lymphocyte count , creatinine-height index , subjective global assessment , and data on daily intakes of energy , protein , and vitamin C  were collected prospect ively . Anthropometric indices were also measured in a group of control patients with mild chronic obstructive pulmonary disease . RESULTS Sixty patients and 22 control patients were recruited .  Weight , skin-fold thickness , and grip strength were not significantly different between patients and control patients , and both groups were similar to the general population . However , 8 patients ( 13.3 % ) had a body mass index ( BMI ) less than 20 , and 14 patients ( 24.1 % ) had a fat-free mass index less than 15 . Serum albumin and transferrin concentrations and lymphocyte count were very rarely depressed but prealbumin and retinol-binding protein levels were below normal in 11.9 % and 8.3 % of patients , respectively . Thirty percent of patients reported low energy intake , 13 % reported a low protein intake , and 61.7 % had reduced vitamin  C  intake . CONCLUSIONS Severe nutritional depletion was uncommon in patients referred for operations for lung cancer and its frequency may have been overestimated in some previous reports . A low intake of vitamin C  was common in our patients but its clinical significance is unclear Oxidative stress plays a role in the tumor-cytotoxic effect of cancer chemotherapy and radiotherapy and also in certain adverse events . In view of these conflicting aspects , a double-blind trial over a 6-month period was performed to determine whether a cysteine-rich protein ( IMN1207 ) may have a positive or negative effect on the clinical outcome if compared with casein , a widely used protein supplement low in cysteine . Sixty-six patients with stage IIIB-IV non-small cell lung cancer were r and omly assigned to IMN1207 or casein . Included were patients with a previous involuntary weight loss of > or = 3 % , Karnofsky status > or = 70 , and an estimated survival of > 3 months . Thirty-five lung cancer patients remained on study at 6 weeks . Overall compliance was not different between treatment arms ( 42 - 44 % or 13 g/day ) . The patients treated with the cysteine-rich protein had a mean increase of 2.5 % body weight , whereas casein-treated patients lost 2.6 % ( p = 0.049 ) . Differences in secondary endpoints included an increase in survival , h and -grip force , and quality of life . Adverse events were mild or moderate . Further studies will have to show whether the positive clinical effects can be confirmed and related to specific parameters of oxidative stress in the host PURPOSE To evaluate the effect of megestrol acetate at a lower dose than previously investigated on the symptoms of cachexia in patients with advanced cancer . METHODS A total of 84 patients with advanced , solid tumours not responsive to hormone therapy were enrolled in this double-blind , crossover study . During phase 1 , patients were r and omly assigned to receive megestrol acetate ( 160 mg 3 times daily ) for 10 days or placebo . During phase 2 , after a 2-day washout period , patients received the alternate treatment for 10 days . Patients underwent daily assessment s of activity , nausea , appetite and well-being by means of a visual analogue scale ( VAS ) . In addition , nutritional status ( weight , tricep skinfold measure , arm muscle circumference ) , energy intake , fatigue ( Piper Fatigue Scale ) and quality of life ( Functional Living Index-Cancer [ FLIC ] ) were assessed . RESULTS Among the 53 evaluable patients  megestrol acetate result ed in a significant improvement in appetite ( p = 0.005 ) , activity ( p = 0.007 ) and well-being ( p = 0.03 ) . There was no significant change in the intensity of nausea , nutritional parameters , energy intake or FLIC scores . There was a significant improvement in 2 of the 3 factors measured by the Piper Fatigue Scale and in the overall fatigue score . Upon completion of the study , while still blind to the treatment condition , 30 patients indicated that they felt better overall after megestrol , 15 said they felt better after placebo , and 10 indicated no preference ( p = 0.001 ) . CONCLUSION Treatment with megestrol acetate results in rapid and significant improvement of symptoms in terminally ill patients at lower doses than previously reported . The effects are not secondary to nutritional changes . The FLIC quality -of-life question naire was unable to detect these changes PURPOSE In a r and omized clinical trial in patients with advanced non-small-cell lung cancer ( NSCLC ) , infusion with adenosine 5'-triphosphate ( ATP ) inhibited loss of body weight and quality of life . In the present article , the effects of ATP on body composition , energy intake , and energy expenditure as secondary outcome measures in the same patients are reported . PATIENTS AND METHODS Patients with NSCLC , stage IIIB or IV , were r and omized to receive either 10 intravenous , 30-hour ATP infusions every 2 to 4 weeks or no ATP .  Fat mass ( FM ) , fat-free mass ( FFM ) , and arm muscle area were assessed at 4-week intervals for 28 weeks . Food intake , body cell mass ( BCM ) , and resting energy expenditure ( REE ) were assessed at 8-week intervals for 16 weeks . Between-group differences were tested for statistical significance by repeated- measures analysis of covariance . RESULTS Fifty-eight patients were r and omized ( 28 ATP , 30 control ) . No change in body composition over the 28-week follow-up period was found in the ATP group , whereas , per 4 weeks , the control group lost 0.6 kg of FM ( P = .004 ) , 0.5 kg of FFM ( P = .02 ) , 1.8 % of arm muscle area ( P = .02 ) , and 0.6 % of BCM/kg body weight ( P = .054 ) and decreased 568 KJ/d in energy intake ( P = .0001 ) . Appetite also remained stable in the ATP group but decreased significantly in the control group ( P = .0004 ) . No significant differences in REE between the ATP and control groups were observed . CONCLUSION The inhibition of weight loss by ATP infusions in patients with advanced NSCLC is attributed to counteracting the loss of both metabolically active and inactive tissues . These effects are partly ascribed to maintenance of energy intake PURPOSE Eicosapentaenoic acid ( EPA ) has been proposed to have specific anticachectic effects . This trial compared EPA diethyl ester with placebo in cachectic cancer patients for effects on weight and lean body mass . PATIENTS AND METHODS Five hundred eighteen weight-losing patients with advanced gastrointestinal or lung cancer were studied in a multicenter , double-blind , placebo controlled trial . Patients were r and omly assigned to receive a novel preparation of pure EPA at a dose of 2 g or 4 g daily or placebo ( 2 g EPA , n = 175 ; 4 g EPA , n = 172 ; placebo , n = 171 ) . Patients were assessed at 4 weeks and 8 weeks . RESULTS The groups were well balanced at baseline . Mean weight loss at baseline was 18 % ( n = 518 ) . Over the 8-week treatment period , both intention-to-treat analysis and per protocol analysis revealed no statistically significant improvements in survival , weight , or other nutritional variables . There was , however , a trend in favor of EPA with analysis of the primary end point , weight , at 8 weeks showing a borderline , nonsignificant treatment effect ( P = .066 ) . Relative to placebo , mean weight increased by 1.2 kg with 2 g EPA ( 95 % CI , 0 kg to 2.3 kg ) and by 0.3 kg with 4 g EPA ( -0.9 kg to 1.5 kg ) . CONCLUSION The results indicate no statistically significant benefit from single agent EPA in the treatment of cancer cachexia . Future studies should concentrate on other agents or combination regimens PURPOSE This study tested whether infliximab , a chimeric IgG1kappa monoclonal antibody that blocks tumor necrosis factor ( TNF ) alpha , improves/stabilizes weight loss in elderly and /or poor performance status patients with metastatic non-small cell lung cancer ( NSCLC ) . METHODS This double-blind trial r and omly assigned patients to infliximab/docetaxel ( n=32 ) versus placebo/docetaxel ( n=29 ) . The primary endpoint was > or = 10 % weight gain . RESULTS Groups were balanced with respect to age , number of prior chemotherapy regimens , baseline weight loss , and performance status . No patient gained > or = 10 % baseline weight , and early evidence of the lack of efficacy prompted early trial closure . Appetite improvement was negligible in both arms . However , infliximab-/docetaxel-treated patients developed greater fatigue and worse global quality of life scores . Other outcomes , such as tumor response rate ( < 10 % in both groups ) and overall survival , were not statistically different between groups . There were no statistically significant differences in adverse events , although one death was attributed to infliximab . Genotyping for the TNF alpha -238 and -308 polymorphisms revealed no clinical significance of these genotypes , as relevant to the loss of weight or appetite . CONCLUSIONS This trial closed early because infliximab did not prevent or palliate cancer-associated weight loss .  Infliximab was associated with increased fatigue and inferior global quality of life Involuntary weight loss is a major contributor to mortality and morbidity in patients with advanced cancer .  Nutritional intervention with fish oil (FO)‐derived eicosapentaenoic acid ( EPA ) may prevent deterioration of body composition . This study compared intervention with FO with st and ard of care ( SOC ; no intervention ) with regard to weight , skeletal muscle , and adipose tissue in newly referred patients with nonsmall cell lung cancer from the time of initiation to completion of first‐line chemotherapy The aim of the study was to investigate the effect of intravenous infusions of adenosine 5′-triphosphate ( ATP ) on nutritional status and survival in preterminal cancer patients . Ninety-nine preterminal cancer patients ( estimated life expectancy 1–6 months ) with mixed tumor types were r and omly allocated to receive either intravenous ATP weekly ( 8–10 h/week , maximum 50 μg/kg/min ) for 8 weeks , or no ATP ( control group ) . Nutritional status parameters were assessed until 8 weeks , and analyzed by repeated- measures analysis of covariance . Cox proportional hazards models were fitted to assess the effect of ATP on short-term ( 0–8 weeks ) and long-term ( 0–6 months ) survival . Fifty-one patients were r and omized to ATP and 48 to the control group . Results showed a significant favorable effect of ATP  on triceps skin fold thickness [ between-group difference per 8 weeks 1.76 mm , 95 % confidence interval ( CI ) : 0.48–3.12 mm ; P = 0.009 ] and on short-term survival [ 0–8 weeks hazard ratio ( HR ) : 0.40 , 95 % CI : 0.17–0.95 ; P = 0.037 ] . In weight-stable patients and in lung cancer patients , long-term survival ( 0–6 months ) was also significantly better in ATP-treated patients ( weight-stable patients HR : 0.40 , 95 % CI : 0.19–0.83 ; P = 0.014 ; patients with lung cancer : HR : 0.35 , 95 % CI : 0.14–0.88 ; P = 0.025 ) . In conclusion , in this population of preterminal cancer patients  , ATP infusions , at the dose and schedule studied , had a favorable effect on triceps skin fold thickness and survival , especially in weight-stable patients and patients with lung cancer . Larger studies are warranted to confirm these findings and to further define the effect of ATP  on tumor growth and survival The authors examined the effect of recombinant-human growth hormone ( r-hGH ) and insulin ( INS ) administration on protein kinetics in cancer patients . Twenty-eight cancer patients either received r-hGH for 3 days ( GH group , n = 12 , weight loss = 6 + /- 2 % ) or were not treated ( control [ CTL ] group , n = 16 , weight loss = 11 + /- 2 % ) before metabolic study . Recombinant-human growth hormone dose was 0.1 mg/kg/day ( n = 6 ) or 0.2 mg/kg/day ( n = 6 ) . Patients then underwent measurement of baseline protein kinetics ( GH/B , CTL/B ) followed by a 2-hour euglycemic insulin infusion ( 1 mU/kg/minute ) and repeat kinetic measurements ( GH/INS , CTL/INS ) . Whole-body protein net balance ( mumol leucine/kg/minute ) was higher ( p less than 0.05 ) in GH/INS ( 0.20 + /- 0.06 ) than in CTL/INS ( 0.06 + /- 0.03 ) or GH/B ( -0.19 + /- 0.03 ) . Skeletal muscle protein net balance ( nmol phenylalanine/100 g/minute ) in GH/INS ( 25 + /- 6 ) and CTL/INS ( 19 + /- 5 ) was higher than CTL/B ( -18 + /- 3 ) . Recombinant-human growth hormone and insulin reduce whole-body and skeletal muscle protein loss in cancer patients . Simultaneous use of these agents during nutritional therapy may benefit the cancer patient Objective . To evaluate body composition changes , specifically skeletal muscle mass , in men receiving and rogen deprivation with luteinizing-hormone releasing hormone-agonist ( LHRH-A ) for prostate cancer ( PCa ) in comparison with healthy controls . Design . Retrospective analysis of body composition changes in men with prostate cancer receiving LHRH-A therapy from 2 clinical trials compared to men without prostate cancer serving as a placebo-control in another clinical trial . Setting . Clinical Research Center in Connecticut . Participants . Thirty men ( > 60 years ) receiving 6 months of LHRH-A therapy for PCa were compared to a healthy group of 25 men without PCa . Measurements . Appendicular skeletal muscle/height2 ( ASM/ht2 ) , lean and fat mass were assessed by dual energy x-ray absorptiometry . Total testosterone levels were assessed by enzyme immunoassay . Results . At baseline , 12/30 ( 40 % ) of the treatment group and 7/25 ( 28 % ) of the control group ( p = 0.11 ) met criteria for sarcopenia . There were no differences between control groups in ASM/ht2 or lean mass . The LHRH-A group had a higher percent body fat than the control group , 29.8 ± 6.3 versus 26.3 ± 4.6 ( p = 0.02 ) . ASM/ht2 and lean mass decreased in the LHRH-A group from 7.5 ± 0.9 kg to 7.3 ± 0.9 kg ( −2.3 % ± 0.03 ; p ⩽ 0.001 ) and 53.5 ± 5.4 kg to 52.3 ± 5.3 kg ( −2.1 % ± 0.03 ; p ⩽ 0.001 ) , respectively . There was no muscle loss in the control group . At 6 months , the LHRH-A group had increased percent body fat from 29.8 ± 6.4 to 32.2 ± 5.8 ( 9.5 % ± 0.13 ; p ⩽ 0.001 ) , whereas the control group had decreased in percent body fat from 26.6 ± 4.6 to 25.3 ± 5.0 ( −3.8 % ± 0.08 ; p = 0.02 ) . Conclusions . Men  undergoing LHRH-A treatment for PCa decreased appendicular skeletal muscle and lean tissue and increased body fat within 6 months of initiation of therapy . Lifestyle changes or medical interventions to minimize the effects of and rogen deprivation therapy for PCa deserve investigation Introduction : A significant proportion of lung cancer patients receive no anticancer treatment . This varies from 19 % in USA , 33 % in Australia , 37 % in Scotl and , and 50 % in Irel and . The aim of this study was to identify the reasons behind this . Methods : The Lung Cancer Multidisciplinary Meeting ( MDM ) in South-West Sydney prospect ively collects data on all patients presented . All new lung cancer patients presented between December 1 , 2005 , and December 31 , 2007 , were review ed . Patients were assigned optimal treatment based on evidence -based guidelines . Those patients in whom guidelines recommended no treatment ( GNT ) were compared with those whom the MDM recommended no treatment ( MNT ) and with those who actually received no treatment ( ANT ) . Results : There were 335 patients with a median age of 69 years . A total of 82 % had non-small cell lung cancer , 14 % had small cell lung cancer , and 4 % had no pathologic diagnosis . Eighty-five percent had locally advanced or metastatic disease .  GNT was recommended in 4 % ( n = 13 ) , MNT in 10 % ( n = 32 ) but ANT comprised 20 % ( n = 66 ) . The differences between GNT and MNT were mainly due to patient comorbidities and clinician decision , but the differences between MNT and ANT were due to patient preference and declining performance status . In multivariate analysis , older age , poorer Eastern Cooperative Oncology Group status , non-small cell lung cancer , and non-English language predicted for ANT . Conclusions : The proportion of patients with lung cancer receiving no treatment  is greater than that predicted by guidelines or recommended by the MDM but lower than that described in population -based studies suggesting that MDMs can improve treatment utilization in lung cancer
target: Sarcopenia , as defined by reduced muscle mass alone , was found to be very prevalent in patients with lung cancer , regardless of body mass index , and where present was associated with poorer functional status and overall survival .
  The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results .
  There are very limited data on the correlation between degree of sarcopenia and muscle function , which has a non-linear relationship in older non-cancer population s. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer .
background: OBJECTIVES There is growing awareness of the relationship between sarcopenia ( loss of muscle mass and function ) , and outcomes in cancer , making it a potential target for future therapies .
  In order to inform future research and practice , we undertook a systematic review of factors associated with loss of muscle mass , and the relationship between muscle function and muscle mass in lung cancer , a common condition associated with poor outcomes .