COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer

Abstract

Background: The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation.

Main body: The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences).

Conclusion: Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.

Keywords: COVID-19; Frailty; Functional deconditioning; Prehabilitation; SARS-CoV-2; Sarcopenia.

Fig. 1

Schematic of proposed mechanisms causing deterioration in physical function and sarcopenia in patients requiring cancer surgery. Multimodal prehabilitation for COVID survivors may be required to overcome these factors. NACRx, neoadjuvant chemoradiotherapy