Assessing Sarcopenia In Advanced-Stage Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy - A Case Series

PURPOSE: In advanced ovarian cancer, low muscle mass is associated with poorer treatment outcomes and increased mortality. However, screening for cancer-related sarcopenia, typically defined in a cancer context as low muscle mass, is not routinely conducted. The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends an algorithm for sarcopenia screening and diagnosis in clinical settings. However, it is unknown if this algorithm is appropriate for use in cancer settings. Our aim was to explore the application of the EWGSOP2 algorithm to assess sarcopenia in six patients with advanced-stage ovarian cancer undergoing neoadjuvant chemotherapy (NACT). METHODS: Assessments took place between cycles two and three of NACT. The EWSOP2 algorithm assessments included sarcopenia risk (Strength, Assistance with Walking, Rising From a Chair, Climbing Stairs, and Falls [SARC-F] screening questionnaire), muscle strength (handgrip strength and five times sit-to-stand test [5TSTS]), muscle mass (skeletal muscle index; SMI in cm2/m2 from a single computed tomography [CT] image), and physical performance (4-meter gait speed test). Standard cutpoints were applied to each assessment to identify participants as ‘at risk’, or with probable, confirmed or severe sarcopenia. RESULTS: Of six participants, none were identified as ‘at risk’ for sarcopenia based on SARC-F scores. None of the participants scored below the recommended cut-point of <16 kg for handgrip strength while two participants had a 5TSTS time slower than the 15-second cut-point. The same two participants who scored >15 seconds for 5TSTS also walked slower than the recommended gait speed (<0.8 m/s). Five of the six participants (83%) had low muscle mass (SMI <38.5 cm2/m2 cut-point). In our sample, 33% of participants were severely sarcopenic based on EWGSOP2 criteria (had low muscle strength, mass, and physical performance). CONCLUSION: Ovarian cancer patients with low muscle mass during NACT may not be identified as sarcopenic based on the EWGSOP2 diagnostic algorithm. More valid methods should be applied to assess sarcopenia in these patients.