Low handgrip strength in advanced cancer: associated factors and clinical implications in palliative care

Handgrip strength (HGS) is a widely used clinical and prognostic tool in oncology and is associated with several outcomes in palliative care (PC).

To evaluate the factors associated with low HGS in patients with advanced cancer receiving PC.

A cross-sectional study was conducted at the Brazilian National Cancer Institute between 2023 and 2025, including patients with advanced cancer receiving PC. HGS was measured using a Jamar® hydraulic dynamometer. HGS values below the first tertile were classified as low HGS. Clinical, sociodemographic, functional, and nutritional data were collected. Analyses, stratified by sex, included logistic regression, with odds ratios (ORs) and 95% confidence intervals (CI) as estimators.

Five hundred twenty-seven patients were included, with a median age of 66 years, predominantly women (58%), and with primary tumor sites in the gastrointestinal tract (24%) and gynecological (21%). The cutoff points defining low HGS (1^st tertiles) were: ≤ 12 kg for women and ≤ 20 kg for men. A higher risk of low HGS was observed among older women (OR: 2.29; 95% CI: 1.31-4.01) and those with Karnofsky Performance Status (KPS) 40-50% (OR: 5.06; 95% CI: 3.01-8.49); as well as among older men (OR: 4.02; 95% CI: 2.36-8.35) and those with KPS 40-50% (OR: 3.89; 95% CI: 2.52-6.34).

Advanced age and lower KPS were independently associated with low HGS in patients with advanced cancer receiving palliative care. These findings support HGS as an objective indicator of physical vulnerability in this population.