ESTRO 37: Handgrip Strength Test May Be a Good Indicator of Survival in Patients With NSCLC
A simple test of handgrip strength may be a good indicator of short- and long-term survival in patients with stage I non–small cell lung cancer (NSCLC), according to new findings presented at the European Society for Radiotherapy & Oncology (ESTRO) 37 Conference (Abstract PV0041).
Patients with NSCLC who were about to be treated with stereotactic body radiotherapy (SBRT) between 2006 and 2012 were asked to grip the handle of a device that measures grip strength as hard as they could for 3 seconds. This was measured three times for each hand. Fifty-nine percent of the patients were men and 41% were women. They had a mean age of 72. The results of the test were adjusted to take account of gender, age, and height.
Findings
In a study of 226 patients who were about to be treated with SBRT at the MAASTRO Clinic in Maastricht, The Netherlands, researchers found that weak handgrip strength was an independent indicator of life expectancy—providing additional information to the World Health Organization (WHO) performance status, which is used routinely at present to measure expected survival, as well as patients’ general well-being and ability to manage the activities of daily life.
Patients with weak handgrips were 1.5 times more likely to die within 5 years, compared to those with strong handgrips. Handgrip strength was even able to indicate life expectancy within 1 year of the measurement being taken.
Stéphanie Peeters, MD, PhD, a radiation oncologist at the MAASTRO Clinic, said, “We have found that handgrip strength is an objective, [inexpensive], and easy way to measure short- and long-term overall survival in stage I patients with non–small cell lung cancer who are being treated with stereotactic body radiotherapy with the aim of curing them. The WHO performance status measurement is quantified by a physician, and therefore may be prone to subjectivity. The handgrip test, on the other hand, is a more objective measure that may provide additional information on the general condition of a patient. Our analysis shows that handgrip strength is a valuable additional measure for predicting overall survival.”
Handgrip weakness was seen in 31% of patients, whereas 69% had no weakness. Handgrip strength varied between 17 kg and 39 kg (mean of 28 kg), and weakness was defined according to what was normal in the general population, taking into account age and gender.
Among those with handgrip weakness, only 12% were still alive 5 years later, while 40% of patients without weakness were still alive.
Other factors that were associated with an increased risk of dying within 5 years were being male, being older, and having a lower body mass index.
“It is not always easy for a physician to get a good idea about the general condition of a patient based on one, or only a few, doctor’s visits. In this study, we have shown that handgrip strength provides additional information to help evaluate survival, which may guide the physician in how to manage the lung tumor. In patients with poor prognosis, it may be decided not to give an active treatment, and having an objective measure such as the handgrip test may give more weight to this important decision. Close surveillance may then be an option,” said Dr. Peeters.
Further work needs to be performed to validate the test in other groups of patients in order to justify the widespread use of the test. In addition, the researchers do not know whether improving a patient’s general health and fitness might help improve their life expectancy. “Future studies could explore the impact on survival of improving the handgrip strength in patients with weakness before the start of a curative treatment,” Dr. Peeters concluded.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
