Handgrip strength values depend on tumor entity and predict 180-day mortality in malnourished cancer patients

Cancer-related malnutrition is a prevalent condition associated with loss of muscle mass and impaired functional status, which leads to immunodeficiency, impaired quality of life and worse clinical outcome. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. However, HGS reference values from healthy people are used to assess functional capacity, while population-specific reference values still need to be defined. Herein, we determined sex specific HGS values stratified by age and tumor entity. Additionally we examined the association between HGS and 180-day all-cause mortality in hospitalized cancer patients at risk for malnutrition. We included data from 628 cancer Patients (368 male and 260 female) which were collected from 8 hospitals in Switzerland as part of the previous Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trail (EFFORT).

Depending on the age of patients, HGS varied among female patients from 7 kg to 26 kg and among male patients from 20.5 kg to 44 kg. We found that lung cancer patients had the highest handgrip strength 27.4 kg (±10 kg) compared to other tumor entities, which was consistent among both sex. In the female population there was the lowest mean HGS found in gastrointestinal tumor patients: 16.4 kg (±6.0 kg) whereas male patients had the lowest HGS with prostate carcinoma: 23.6 (±7.4 kg). An incremental decrease of handgrip strength by 10 kg resulted in a 50% increase in 180-day all-cause mortality (odds ratio 1.52 (1.19 to 1.94), p=0.001). HGS also predicted other adverse outcomes including short-term mortality, intensive care unit (ICU) admission, decline in functional status and incidence prevalence of falls after hospital discharge. Our data provide evidence about the prognostic implications of HGS measurement in cancer patients and validate the prognostic value of handgrip strength in regard to long-term mortality. In addition our results provide expected HGS values in the population of hospitalized malnourished cancer patients stratified by tumor entity for health care workers.

Publication History

Article published online:
14 June 2022