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. 2023 Aug;14(4):1682-1694.
doi: 10.1002/jcsm.13248. Epub 2023 Jun 15.

Hand grip strength in patients with advanced cancer: A prospective study

Sara Hadzibegovic  1   2   3   4 , Jan Porthun  2   5   6 , Alessia Lena  1   2   3   4 , Pia Weinländer  2   3   4   5 , Laura C Lück  2   3   4   5 , Sophia K Potthoff  2   3   4   5 , Lukas Rösnick  2   3   4   5 , Ann-Kathrin Fröhlich  2   3   4   5 , Luisa Valentina Ramer  2   3   4   5 , Frederike Sonntag  2   3   4   5 , Ursula Wilkenshoff  1   2   7 , Johann Ahn  8 , Ulrich Keller  9   10   11 , Lars Bullinger  8   10 , Amir A Mahabadi  12 , Matthias Totzeck  12 , Tienush Rassaf  12 , Stephan von Haehling  13   14 , Andrew J S Coats  15 , Stefan D Anker  3   4   16 , Eric J Roeland  17 , Ulf Landmesser  1   2   3   7 , Markus S Anker  1   2   3   4
Affiliations

Hand grip strength in patients with advanced cancer: A prospective study

Sara Hadzibegovic et al. J Cachexia Sarcopenia Muscle. 2023 Aug.

Abstract

Background: Hand grip strength (HGS) is a widely used functional test for the assessment of strength and functional status in patients with cancer, in particular with cancer cachexia. The aim was to prospectively evaluate the prognostic value of HGS in patients with mostly advanced cancer with and without cachexia and to establish reference values for a European-based population.

Methods: In this prospective study, 333 patients with cancer (85% stage III/IV) and 65 healthy controls of similar age and sex were enrolled. None of the study participants had significant cardiovascular disease or active infection at baseline. Repetitive HGS assessment was performed using a hand dynamometer to measure the maximal HGS (kilograms). Presence of cancer cachexia was defined when patients had ≥5% weight loss within 6 months or when body mass index was <20.0 kg/m2 with ≥2% weight loss (Fearon's criteria). Cox proportional hazard analyses were performed to assess the relationship of maximal HGS to all-cause mortality and to determine cut-offs for HGS with the best predictive power. We also assessed associations with additional relevant clinical and functional outcome measures at baseline, including anthropometric measures, physical function (Karnofsky Performance Status and Eastern Cooperative of Oncology Group), physical activity (4-m gait speed test and 6-min walk test), patient-reported outcomes (EQ-5D-5L and Visual Analogue Scale appetite/pain) and nutrition status (Mini Nutritional Assessment).

Results: The mean age was 60 ± 14 years; 163 (51%) were female, and 148 (44%) had cachexia at baseline. Patients with cancer showed 18% lower HGS than healthy controls (31.2 ± 11.9 vs. 37.9 ± 11.6 kg, P < 0.001). Patients with cancer cachexia had 16% lower HGS than those without cachexia (28.3 ± 10.1 vs. 33.6 ± 12.3 kg, P < 0.001). Patients with cancer were followed for a mean of 17 months (range 6-50), and 182 (55%) patients died during follow-up (2-year mortality rate 53%) (95% confidence interval 48-59%). Reduced maximal HGS was associated with increased mortality (per -5 kg; hazard ratio [HR] 1.19; 1.10-1.28; P < 0.0001; independently of age, sex, cancer stage, cancer entity and presence of cachexia). HGS was also a predictor of mortality in patients with cachexia (per -5 kg; HR 1.20; 1.08-1.33; P = 0.001) and without cachexia (per -5 kg; HR 1.18; 1.04-1.34; P = 0.010). The cut-off for maximal HGS with the best predictive power for poor survival was <25.1 kg for females (sensitivity 54%, specificity 63%) and <40.2 kg for males (sensitivity 69%, specificity 68%).

Conclusions: Reduced maximal HGS was associated with higher all-cause mortality, reduced overall functional status and decreased physical performance in patients with mostly advanced cancer. Similar results were found for patients with and without cancer cachexia.

Keywords: cachexia; cancer; functional assessment; hand grip strength; methodology; prognostication.

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Conflict of interest statement

UW is supported by a Clinical Fellowship Grant from the BIH (Berlin Institute of Health) and has received speaker fees and/or contributions to congresses from Abbott, AstraZeneca, Bayer, Berlin Chemie, Bristol Myers Squibb, GE Healthcare, Pfizer, Philips and Servier, all outside the submitted work. JA reports travel support from Janssen, BMS and Alexion. UK served on advisory boards for Roche, Janssen‐Cilag, Celgene, Takeda, BMS, Gilead, Hexal, Pfizer, AstraZeneca and Pentixapharm; received clinical research support from Janssen‐Cilag, Novartis, Takeda, BMS, Roche and Pfizer; and received travel support from Roche, BMS, Gilead, Takeda, Janssen‐Cilag and Celgene. LB has received honoraria from AbbVie, Amgen, Astellas, Bristol Myers Squibb, Celgene, Daiichi Sankyo, Gilead, Hexal, Janssen, Jazz Pharmaceuticals, Menarini, Novartis, Pfizer, Roche, Sanofi and Seattle Genetics and received research support from Bayer and Jazz Pharmaceuticals. AAM reports honoraria and lecture fees from Amgen, Berlin Chemie, Daichi Sankyo, Edwards Lifesciences, Novartis and Sanofi, all not related to this work. MT reports honoraria, lecture fees and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie and Daiichi Sankyo, all not related to this work. TR reports honoraria, lecture fees and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiichi Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions and Pfizer, all not related to this work. SvH has been a paid consultant for and/or received honoraria payments from AstraZeneca, Bayer, Boehringer Ingelheim, Brahms, Chugai, Grünenthal, Helsinn, Hexal, Novartis, Pharmacosmos, Respicardia, Roche, Servier, Sorin and Vifor. He also reports research support from Amgen, AstraZeneca, Boehringer Ingelheim, Innovative Medicines Initiative (IMI) and the German Center for Cardiovascular Research (DZHK). AJSC declares having received honoraria and/or lecture fees from AstraZeneca, Boehringer Ingelheim, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia and Viatris. SDA reports grants and personal fees from Vifor and Abbott Vascular; reports personal fees for consultancies, trial committee work and/or lectures from Actimed, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bioventrix, Brahms, Cardiac Dimensions, Cardior, Cordio, CVRx, Edwards, Farraday, Impulse Dynamics, Janssen, Novartis, Occlutech, Pfizer, Respicardia, Servier, Vectorious and V‐Wave; and declares that he is named co‐inventor of two patent applications regarding MR‐proANP (DE 102007010834 and DE 102007022367), but he does not benefit personally from the related issued patents. EJR has served as a member of the Scientific Advisory Board for Napo Pharmaceuticals, Care4ward, Actimed Therapeutics and Meter Health and has also served as a consultant for Veloxis Therapeutics, BYOMass, Takeda and Enzychem Lifesciences Pharmaceutical Company. UL reports research grant to the institution from Amgen, Bayer and Novartis and speaker or consulting honorary from AstraZeneca, Bayer, Boehringer Ingelheim, Amgen, Sanofi, Novartis and Novo Nordisk. MSA reports personal fees from Servier, outside the submitted work. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Maximal hand grip strength (HGS) in healthy controls and cancer patients.
Figure 2
Figure 2
Overview at which try the maximal hand grip strength was achieved in all cancer patients.
Figure 3
Figure 3
(A) Bland–Altman plots for maximal hand grip strength (HGS) in 49 cancer patients at baseline and 1 day later. (B) Bland–Altman plots for maximal HGS in 22 cancer patients at baseline and after 3–6 months.
Figure 4
Figure 4
Individual parallel plots of (A) maximal hand grip strength (HGS) at the first and second days of assessment and (B) maximal HGS at baseline and follow‐up after 3–6 months.
Figure 5
Figure 5
(A) Kaplan–Meier survival analysis in all cancer patients according to sex‐specific maximal hand grip strength (HGS) cut‐off points. (B) Kaplan–Meier survival analysis in cachectic cancer patients according to sex‐specific maximal HGS cut‐off points. (C) Kaplan–Meier survival analysis in non‐cachectic cancer patients according to sex‐specific maximal HGS cut‐off points. CI, confidence interval; HR, hazard ratio.
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