Associação entre a coexistência da baixa força muscular e desnutrição definida pelos critérios glim com a qualidade de vida relacionada à saúde em indivíduos com câncer

Abstract

People with cancer are at increased risk of developing malnutrition, reduced muscle mass and strength—conditions associated with poorer health-related quality of life (HRQoL). The etiology is multifactorial, involving metabolic alterations, inflammation, reduced food intake, and treatment effects. Despite the known clinical impact of each condition, no studies have yet evaluated the effects of their coexistence on clinical outcomes and HRQoL in patients with cancer. Objectives: (a) To assess the association between the coexistence of reduced muscle strength and malnutrition, according to GLIM (Global Leadership Initiative on Malnutrition) criteria, and HRQoL in cancer patients; (b) to assess the association between reduced handgrip strength (HGS) and worsening HRQoL; (c) to compare HRQoL between groups with reduced muscle strength, malnutrition, and both conditions coexisting; and (d) to compare HRQoL between patients with metastatic and non-metastatic cancer. Methods: Cross sectional study including individuals with cancer treated at the CASSEMS hospital (Caixa de Assistência dos Servidores de Mato Grosso do Sul). Individuals of both sexes, literate or not, ≥20 years old, and with cognitive and physical capacity to understand and perform the physical tests and respond to questionnaires between November 2024 and June 2025 were included. Sociodemographic, clinical, lifestyle, and anthropometric data were collected through interviews and review of medical records. Muscle strength was measured using a hydraulic hand dynamometer, and muscle mass was assessed through the skeletal muscle mass index. Malnutrition was evaluated using GLIM criteria, and HRQoL was assessed using the EORTC QLQ-C30 tool, with scores ranging from 0 to 100. In functional scales, higher scores reflect better HRQoL, while in symptom scales, they indicate greater symptom burden. A significance level of 5% was adopted for statistical analyses. Results: Isolated malnutrition was associated with fatigue (p=0.019), nausea and vomiting (p=0.036), and loss of appetite (p=0.005). Low strength, whether isolated or combined, was associated with higher scores for fatigue (p<0.001), nausea and vomiting (p<0.001), pain (p=0.016), dyspnea (p=0.030), insomnia (p=0.014), loss of appetite (p=0.002), constipation (p=0.036), and diarrhea (p=0.004), as well as poorer physical (p<0.001), role (p<0.001), and emotional functioning (p=0.013). In adjusted models, coexistence remained associated with worse scores in physical functioning (Δ=−35.1; p=0.002; η²p=0.240), role functioning (Δ=−40.3; p=0.014; η²p=0.216), and emotional functioning (Δ=−27.7; p=0.044; η²p=0.125), in addition to higher levels of fatigue (Δ≈+38; p<0.01; η²p=0.201), nausea and vomiting (Δ≈+30; p≤0.020; η²p=0.209), pain (Δ=+36.0; p=0.027; η²p=0.134), dyspnea (Δ=+18.0; p=0.042; η²p=0.132), and loss of appetite (Δ=+39.6; p=0.015; η²p=0.132). Conclusion: The coexistence of malnutrition and low muscle strength may impair HRQoL in patients with cancer, with handgrip strength being the main determinant of this impact. Early and multidisciplinary interventions aimed at preserving muscle function and managing malnutrition may help maintain HRQoL.