Short-term decline in weaker-side handgrip strength is associated with shorter survival in patients with advanced cancer admitted to a palliative care unit: a prospective cohort study

Objective To investigate the association between short-term longitudinal changes in handgrip strength (HGS) and subsequent survival among patients with advanced cancer admitted to a palliative care unit. Methods This was a single-centre prospective cohort study of 48 patients admitted to a palliative care unit at Watari Hospital, a general hospital in Japan. HGS, the Functional Independence Measure (FIM; motor and cognitive domains) and pain were assessed within 1 week of admission and weekly thereafter. HGS was measured bilaterally, and the hands with the lower and higher measured values were operationally defined as the weaker-side HGS (wHGS) and stronger-side HGS, respectively. Any decrease in HGS between the first and second assessments was classified as a decline. Using landmark analysis, the primary analysis examined the association between changes in HGS and subsequent survival using Kaplan-Meier curves and Cox proportional hazards models. Exploratory secondary analyses applied the same approach. Results The wHGS decline group had a significantly shorter median survival than the non-decline group (30 vs 63 days; p=0.009), and their mortality risk remained significantly higher after adjusting for age and sex (HR 2.23; p=0.016). This association remained significant after additional adjustment for the C-reactive protein-to-albumin ratio (HR 2.10; p=0.026). In the secondary analysis, second to third changes in the FIM motor domain were significant although the sample size was limited (n=28). Conclusions Short-term decline in wHGS among patients in palliative care unit may be a prognostic indicator. It may provide supplementary prognostic information.