Lean body mass and muscle function in head and neck cancer patients and healthy individuals – results from the DAHANCA 25 study

Abstract

Introduction. Loss of lean body mass is common following radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and may reduce maximal muscle strength and functional performance. However, the associations between lean body mass, muscle strength and functional performance are unclear and no studies in HNSCC patients have compared the levels of these variables to the levels seen in healthy individuals. Purpose. The purpose of the present study was to investigate the associations between lean body mass, maximal muscle strength and functional performance in HNSCC patients and to compare the levels of these variables after radiotherapy and after progressive resistance training with the levels in healthy individuals. Material and methods. Lean body mass (dual energy X-ray absorptiometry), maximal muscle strength (isokinetic dynamometry) and functional performance (10 m max gait speed, 30 s chair rise, 30 s arm curl, stair climb) from HNSCC patients from the DAHANCA 25 trials and data from 24 healthy individuals were included. Results. Lean body mass and maximal muscle strength were significantly associated according to the gender and age-adjusted linear regression model (p < 0.0001). In addition, maximal muscle strength were associated with 30 s arm curl performance, 10 m max gait speed and 30 s chair rise (p < 0.0001). Multiple regression analyses showed that HNSCC patients expressed significant lower levels of the investigated variables after radiotherapy than healthy individuals (p < 0.0001), and that all differences were evened out after training. Conclusions. Significant associations were found between lean body mass, maximal muscle strength and functional performance in HNSCC patients. Patients expressed lower levels of these variables compared with healthy individuals, suggesting that lean body mass is a clinically relevant health factor in HNSCC patients.

Acknowledgments

The authors would like to thank Berit Eide (Department of Oncology, Aarhus University Hospital) and Dorthe Grunske Schmidt (Department of Oncology, Odense University Hospital) for unlimited assistance in patient recruitment, Rasmus Østergaard Nielsen for statistical counseling and Signe Bentsen for her effort in recruiting and conducting tests of healthy individuals (both from Department of Public Health, Section for Sports Science, Aarhus University). The authors report no conflicts of interest. Simon Lønbro was funded by The Danish Head and Neck Cancer Group (DAHANCA), The Lundbeck Foundation Centre for Interventional Research in Radiation Oncology (CIRRO), The Danish Council for Strategic Research, The Danish Cancer Society, Dansk Kræftforskningsfond, Becket Fonden, Arvid Nilssons Fond and Andersen-Isted Fonden.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.