Severe sarcopenia and symptom burden prior to chemotherapy among older adults (70+) with advanced cancer: A URCC NCORP nationwide study.

12015 Background: Sarcopenia – defined as significant loss of strength, muscle mass and physical function– leads to reduced mobility, increased falls, difficulty performing activities of daily living, loss of independence, worse prognosis, and higher mortality among older cancer patients. Older patients with sarcopenia are at an even greater risk for these negative outcomes when additional co-morbid symptoms are present. Despite this, sarcopenia is not routinely screened for in this population. This study aims to describe the proportion of older patients with advanced cancer prior to chemotherapy who present with severe sarcopenia and the additional co-morbid symptoms they are most likely to be experiencing. Methods: In a randomized controlled trial (NCT02054741), 718 older adults (age 70+) with advanced cancer and age-related conditions were recruited prior to starting chemotherapy from community oncology practices across the United States who were affiliated with the University of Rochester NCI Community Oncology Research Program (NCORP) Research Base. We analyzed data from a subset of 159 participants prior to chemotherapy who completed assessments for muscle strength (chair stand; seconds [s]), skeletal muscle index (CT scan; SMI [cm 2 /m 2 ]); physical performance (timed up and go; TUG [s]) at baseline. Severe sarcopenia was diagnosed if participants met all three clinically accepted criteria: 1) chair stand > 16.7s for five rises, 2) SMI < 41 cm 2 /m 2 (women) and < 43 cm 2 /m 2 (men; BMI < 24.9 kg/m 2 ) or < 53 cm 2 /m 2 (men; BMI >25 kg/m 2 ), and 3) TUG > 13.5s. Symptoms (i.e., fatigue, insomnia, pain, anorexia, dyspnea, cognitive issues, nausea, sensory neuropathy, constipation, and diarrhea) were assessed via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Results: Fifty-two of the 159 participants (33%; mean age: 76.7 years; 60% male) had severe sarcopenia. Chi-square analyses revealed participants with severe sarcopenia were significantly more likely to report fatigue (94% vs. 81%; p = 0.03), anorexia (73% vs. 55%; p = 0.03), and pain (73% vs. 60%; p = 0.13) compared to those without severe sarcopenia. Logistic regression indicated those with severe sarcopenia were almost 4x more likely to experience fatigue (OR [95%CI]: 3.75 [1.06-13.28]) and twice as likely to experience anorexia (OR [95%CI]: 2.21 [1.07-4.54]) compared to those without severe sarcopenia. Conclusions: One-third of older adults with advanced cancer are likely to present with severe sarcopenia, fatigue, anorexia, and pain prior to the initiation of chemotherapy. Clinicians should consider screening older adults for sarcopenia and other comorbid symptoms to inform cancer treatment decisions prior to the initiation of therapy, and supportive care interventions should be prescribed to mitigate these symptoms. Funding: NCI UG1CA189961 T32CA102618.