gms | German Medical Science

Objective: Cancer and its treatment are associated with substantial side effects, including muscular atrophy. Decreases of muscular strength have profound effects on functional outcomes.

Material/Methods: This invited presentation focuses on two aspects of strength testing in cancer patients:

1.

Assessment of muscular strength of thigh muscles in typical male cancers (by using Biodex 3©-dynamometer)

2.

Handgrip strength and strength of thigh muscles in patients with Glioblastoma (by using Jamar©- and Biodex 3©-dynamometer)

Results:

1.

Strength of thigh muscles in typical male cancer: 55 male carcinoma patients (64±8a, range 46-77a), 38 patients with localized prostate cancer, and 17 with localized head and neck cancer were included. Significant higher values for peak torque of the knee extensor (p=0.033) and flexor (p=0.049) muscles have been shown for prostate cancer patients. These results indicate that (significant older) prostate cancer patients can show higher values for muscular strength than younger head and neck cancer patients. Their impairment of physical performance may also be related to malnutrition (due to alcohol- and tobaccoabuse, dysphagia or xerostomia).

2.

Muscular strength during treatment of Glioblastoma (GBM): In GBM-patients, neuromuscular dysfunction caused by GBM itself and corticoid treatment, both lead to a decrease in muscular strength. Strength testing was performed in 23 patients (55±11a, BMI=26±3 kg/m²) at baseline and follow up after 15(±9) weeks. 18 patients started with physiotherapy program after baseline testing. 2 patients reported regular home based physical activity. 3 patients reported no regular physical activity. Handgrip strength of right/left hand measured 79±45/68±46 lbs. Handgrip strength of right/left hand decreased by 5 % (±31, lbs)/ 8% (±49, lbs). Peak torque/weight (PT) of right knee extensors measured 166±47 Nm/kg; PT of left knee extensors were 149±59 Nm/kg. PT of right knee flexors measured 79±34 Nm/kg, PT of left knee flexors were 79±45 Nm/kg. At follow up isokinetic strength of knee extension/flexion decreased: extension of right knee: mean= –4% (±16, Nm/kg), extension of left knee: mean= –10% (±20, Nm/kg), flexion of right knee: mean= –1% (±38, Nm/kg), flexion of left knee: mean= –10% (±29, Nm/kg). Some of the patients, who performed physiotherapy or reported home based regular exercise (n=20) were able to increase muscular strength, while muscular strength of all patients who did not perform exercise (n=3) decreased at follow up.

The results of this pilot study especially showed notable deficits in muscular strength of thigh muscles of GBM-patients. Furthermore, at follow up strength of thigh muscles and of handgrip decreased, which shows the impact on clinical course of GBM on muscular strength. Some patients were able to increase their muscular strength in general after performing exercise, while muscular strength of all patients who did no regular exercise during survival time decreased at follow up. This indicates that regular exercise in combination with oncological therapies can improve muscular strength of certain GBM-patients.

Conclusion: A decrease of muscular strength of cancer patients is typically for the course of most cancer entities. Furthermore, necessary cancer treatment modalities often affect skeletal muscle, in terms of muscular strength and sensorimotor functions. Therefore, adequate nutrition and active and passive exercise options should be initiated as soon as possible.