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Novel Adaption of the SARC-F Score to Classify Pediatric Hemato-Oncology Patients with Functional Sarcopenia
Emma J Verwaaijen1, Patrick van der Torre1, Josef Vormoor1,2,3
1Princess Máxima Center for Pediatric Oncology, 3584CS Utrecht, The Netherlands.
Insights
A new screening tool, the pediatric SARC-F (PED-SARC-F), accurately identifies functional sarcopenia in children undergoing cancer treatment. This tool helps detect muscle loss early, enabling timely interventions to improve patient outcomes and daily function.
Area of Science:
- Pediatric Oncology
- Geriatric Medicine Adaptation
- Clinical Assessment Tools
Background:
- Sarcopenia negatively impacts treatment adherence, outcomes, and daily life in pediatric hemato-oncology patients.
- Early identification of sarcopenia risk is crucial for preventing severe physical decline.
- The SARC-F score is a validated screening tool for sarcopenia in the elderly population.
Purpose of the Study:
- To evaluate the accuracy of the pediatric SARC-F (PED-SARC-F) for detecting sarcopenia in pediatric hemato-oncology patients.
- To establish a clinical cut-off point for the PED-SARC-F in this population.
- To correlate PED-SARC-F scores with objective measures of muscle strength, mass, and physical performance.
Main Methods:
- Cross-sectional study involving 215 pediatric hemato-oncology patients (ages 3-20).
- Patients underwent physiotherapy assessment including PED-SARC-F, muscle strength (dynamometry), physical performance tests, and muscle mass (bio-impedance analysis).
- Statistical analyses included correlation coefficients, logistic regression, and ROC curve analysis to determine accuracy and optimal cut-off points.
Main Results:
- PED-SARC-F scores showed moderate correlations with muscle strength (rs = -0.37 to -0.47) and physical performance (rs = -0.45 to -0.66), and a weak correlation with muscle mass (rs = -0.27).
- The PED-SARC-F demonstrated excellent diagnostic accuracy for functional sarcopenia (AUC = 0.90).
- A cut-off score of ≥5 yielded high specificity (96%) and sensitivity (74%) for identifying functional sarcopenia.
Conclusions:
- The adapted pediatric SARC-F (PED-SARC-F) is a valuable and accurate tool for screening functional sarcopenia in pediatric hemato-oncology patients.
- A cut-off point of ≥5 on the PED-SARC-F is recommended for clinical use in this population.
- Early detection via PED-SARC-F facilitates timely interventions to mitigate the adverse effects of sarcopenia.
Abstract:
Sarcopenia in pediatric hemato-oncology patients is undesirable because of the consequences it may have for treatment continuation and outcome, physical abilities and participation in daily life. An easy-to-use screening tool for sarcopenia will facilitate the identification of children at risk who need interventions to prevent serious physical deterioration. In the elderly, the use of the SARC-F score as a case-finding tool for sarcopenia is recommended. The aim of this cross-sectional study was to investigate the accuracy of the pediatric SARC-F (PED-SARC-F) for identifying sarcopenia in pediatric hemato-oncology patients, including the determination of a cut-off point for clinical use. Patients 3−20 years of age, under active treatment or within 12 months after treatment cessation were eligible. Patients had a physiotherapy assessment including a PED-SARC-F (0−10) and measurements of muscle strength (handheld dynamometry), physical performance (various tests) and/or muscle mass (bio-impedance analysis), as part of the standard of care. Spearman’s correlation coefficient (rs) between the PED-SARC-F and physiotherapy outcomes were calculated. Structural sarcopenia was defined as low appendicular skeletal muscle mass (ASMM) in combination with low muscle strength and/or low physical performance. Functional sarcopenia indicated low muscle strength combined with low physical performance. Multiple logistic regression models were estimated to study the associations between the PED-SARC-F and structural/functional sarcopenia. To evaluate which cut-off point provides the most accurate classification, the area under the receiver operating characteristic curve (AUCs), sensitivity and specificity per point were calculated. In total, 215 assessments were included, 62% were performed in boys and the median age was 12.9 years (interquartile range: 8.5−15.8). The PED-SARC-F scores correlated moderately with the measurements of muscle strength (rs = −0.37 to −0.47, p < 0.001) and physical performance (rs = −0.45 to −0.66, p < 0.001), and weakly with ASMM (rs = −0.27, p < 0.001). The PED-SARC-F had an AUC of 0.90 (95% confidence interval (CI) = 0.84−0.95) for functional sarcopenia and 0.79 (95% CI = 0.68−0.90) for structural sarcopenia. A cut-off point of ≥5 had the highest specificity of 96% and a sensitivity of 74%. In conclusion, we adapted the SARC-F to a pediatric version, confirmed its excellent diagnostic accuracy for identifying functional sarcopenia and defined a clinically useful cut-off point in pediatric hemato-oncology patients.
