Screening for poor muscle strength in older Indian patients with solid tumor using SARC-F questionnaire and handgrip

Sarcopenia is age-related loss of muscle mass and function. It is highly prevalent in older adults with cancer and is associated with adverse outcomes. Various consensus guidelines are available for assessing sarcopenia. Sarcopenia screening is not routinely done in geriatric oncology clinic. Data on the SARC-F questionnaire and its functional correlation with objective parameters are lacking from older Indian patients with cancer.

This was a retrospective observational study done in the geriatric oncology clinic at the Tata Memorial Hospital in Mumbai, India. We included patients aged ≥60 years who had undergone geriatric assessment (GA) and had completed the SARC-F questionnaire. Function was objectively assessed with hand grip and Timed-Up-and-Go test (TUG). We aimed to assess the utility of SARC-F by correlating it with the objective functional parameters and to find the association between grip strength and clinicodemographic parameters and vulnerabilities in various geriatric domains.

Between November 2022 and October 2023, we enrolled 1025 patients. The mean age was 67 years (standard deviation, 5.8), 78.2% were male. Primary malignancies included gastrointestinal (36.7%), lung (27.7%), genitourinary (17.2%), and head and neck (16.2%). Palliative intent therapy was planned in 62.9% of patients. SARC-F was positive for sarcopenia in 24.2% (n = 248), while 58.8% (n = 603) participants had low handgrip strength, and 52.9% (n = 520) had prolonged TUG scores. SARC-F has a low sensitivity in identifying patients with low handgrip (sensitivity 29.6%, specificity 83.6%, negative predictive value [NPV] 45.4%, positive predictive value [PPV] 72.1%). SARC-F also has low sensitivity in identifying patients with prolonged TUG scores (sensitivity 35.9%, specificity 95.4%, NPV 57.03%, PPV 89.9%). Multivariate analysis using logistic regression showed that low handgrip strength significantly correlated with age, sex, TUG score, mid arm circumference, calf circumference, albumin level, clinical frailty scale, and the Cancer and Aging Research Group chemotherapy toxicity risk score.

Simple objective measures of grip strength and TUG should be incorporated apart from SARC-F for screening of sarcopenia and assessing muscle strength in geriatric oncology clinic.