{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:22:47Z","timestamp":1793316167222,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Skeletal muscle index (SMI), grip strength, and physical performance have been shown to predict clinically relevant outcomes in geriatric oncology. However, their predictive ability for chemotherapy toxicity is poorly understood. We examined whether SMI, grip strength, or physical performance are independently associated with severe toxicity among older adults receiving chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Older adults (\u226565y) who had received chemotherapy at an academic cancer center between June 2015 and June 2022 were included in the analysis. SMI prior to chemotherapy was determined via computed tomography (CT), using the entire cross-sectional area of the muscle (cm\n                      <jats:sup>2<\/jats:sup>\n                      ) at the third lumbar vertebra (L3) divided by the square of patient height in meters. Grip strength and lower extremity physical performance were measured prior to chemotherapy. Multivariable logistic regression was used to examine the independent associations between SMI, low grip strength, and low physical performance with severe (grade\u22653) chemotherapy toxicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 115 older adults in the study, 71.3% were males. The most common disease site was genitourinary (53.9%) and most participants received chemotherapy with palliative intent (67.8%). A total of 69 (60.0%) participants experienced at least one grade \u22653 toxicity during the study. In multivariable analyses, low grip strength per the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was significantly associated with grade \u22653 toxicity (adjusted odds ratio (OR): 2.77, 95%CI: 1.03\u20137.45, p\u2009=\u20090.044). SMI either as a continuous (OR: 1.03, 95%CI: 0.97\u20131.09, p\u2009=\u20090.40) or categorical variable (OR: 1.17, 95%CI: 0.47\u20132.89, p\u2009=\u20090.74) was not predictive of grade \u22653 toxicity. Similarly, low physical performance did not have significant associations with grade \u22653 toxicity (OR: 2.06, 95%CI: 0.86\u20134.95, p\u2009=\u20090.11).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low grip strength may predict grade \u22653 toxicity among older adults receiving chemotherapy. Integrating grip strength into geriatric assessment may help clinicians identify older adults who might be at greater risk for severe chemotherapy toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336968","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T18:29:02Z","timestamp":1763576942000},"page":"e0336968","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Skeletal muscle index, grip strength, and physical performance as predictors of severe chemotherapy toxicity among older adults with malignancy"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4050-8701","authenticated-orcid":true,"given":"Efthymios","family":"Papadopoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8786-9152","authenticated-orcid":true,"given":"Dmitry","family":"Rozenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy Kin On","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon Hiu Ching","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-6046","authenticated-orcid":true,"given":"Shabbir M. H.","family":"Alibhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"pone.0336968.ref001","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ejca.2015.12.030","article-title":"Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review","volume":"57","author":"SS Shachar","year":"2016","journal-title":"Eur J Cancer"},{"issue":"8","key":"pone.0336968.ref002","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1093\/gerona\/glaa305","article-title":"Physical Function and All-Cause Mortality in Older Adults Diagnosed With Cancer: A Systematic Review and Meta-Analysis","volume":"76","author":"Y Ezzatvar","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"10","key":"pone.0336968.ref003","first-page":"5623","article-title":"Physical function predicts mortality in patients with cancer: a systematic review and meta-analysis of observational studies","volume":"29","author":"J Nakano","year":"2021","journal-title":"Support Care Cancer"},{"issue":"10","key":"pone.0336968.ref004","doi-asserted-by":"crossref","first-page":"5298","DOI":"10.1016\/j.clnu.2021.08.023","article-title":"Low skeletal muscle mass is a predictor of treatment related toxicity in oncologic patients. A meta-analysis","volume":"40","author":"A Surov","year":"2021","journal-title":"Clin Nutr"},{"issue":"1","key":"pone.0336968.ref005","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1002\/jcsm.12371","article-title":"Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy","volume":"10","author":"WPM Dijksterhuis","year":"2019","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"2","key":"pone.0336968.ref006","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.critrevonc.2010.04.003","article-title":"Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study","volume":"78","author":"MTE Puts","year":"2011","journal-title":"Crit Rev Oncol Hematol"},{"issue":"1","key":"pone.0336968.ref007","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1186\/s12885-018-4860-1","article-title":"Dynapenia could predict chemotherapy-induced dose-limiting neurotoxicity in digestive cancer patients","volume":"18","author":"D Botsen","year":"2018","journal-title":"BMC Cancer"},{"issue":"1","key":"pone.0336968.ref008","doi-asserted-by":"crossref","DOI":"10.1634\/theoncologist.2019-0241","article-title":"Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study","volume":"25","author":"F Retornaz","year":"2020","journal-title":"Oncologist"},{"issue":"21","key":"pone.0336968.ref009","doi-asserted-by":"crossref","first-page":"4448","DOI":"10.3390\/nu14214448","article-title":"Association of Low Handgrip Strength with Chemotherapy Toxicity in Digestive Cancer Patients: A Comprehensive Observational Cohort Study (FIGHTDIGOTOX)","volume":"14","author":"P Martin","year":"2022","journal-title":"Nutrients"},{"issue":"5","key":"pone.0336968.ref010","first-page":"4947","article-title":"Prospective comparison of the value of CRASH and CARG toxicity scores in predicting chemotherapy toxicity in geriatric oncology","volume":"18","author":"J Zhang","year":"2019","journal-title":"Oncol Lett"},{"issue":"13","key":"pone.0336968.ref011","doi-asserted-by":"crossref","first-page":"3377","DOI":"10.1002\/cncr.26646","article-title":"Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score","volume":"118","author":"M Extermann","year":"2012","journal-title":"Cancer"},{"issue":"25","key":"pone.0336968.ref012","doi-asserted-by":"crossref","first-page":"3457","DOI":"10.1200\/JCO.2011.34.7625","article-title":"Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study","volume":"29","author":"A Hurria","year":"2011","journal-title":"J Clin Oncol"},{"issue":"1","key":"pone.0336968.ref013","first-page":"119","article-title":"The value of physical performance measurements alongside assessment of sarcopenia in predicting receipt and completion of planned treatment in non-small cell lung cancer: an observational exploratory study","volume":"26","author":"JT Collins","year":"2018","journal-title":"Support Care Cancer"},{"issue":"10","key":"pone.0336968.ref014","doi-asserted-by":"crossref","DOI":"10.1634\/theoncologist.2019-0701","article-title":"Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study","volume":"25","author":"J Feliu","year":"2020","journal-title":"Oncologist"},{"issue":"8","key":"pone.0336968.ref015","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1007\/s12603-015-0653-2","article-title":"Body Composition and Anti-Neoplastic Treatment in Adult and Older Subjects - A Systematic Review","volume":"20","author":"S G\u00e9rard","year":"2016","journal-title":"J Nutr Health Aging"},{"issue":"19","key":"pone.0336968.ref016","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1200\/JCO.21.00102","article-title":"Sarcopenia in the Older Adult With Cancer","volume":"39","author":"GR Williams","year":"2021","journal-title":"J Clin Oncol"},{"issue":"11","key":"pone.0336968.ref017","doi-asserted-by":"crossref","first-page":"3264","DOI":"10.1158\/1078-0432.CCR-06-3067","article-title":"Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity","volume":"13","author":"CMM Prado","year":"2007","journal-title":"Clin Cancer Res"},{"issue":"3","key":"pone.0336968.ref018","doi-asserted-by":"crossref","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"LP Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"10","key":"pone.0336968.ref019","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.39116","article-title":"Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients","volume":"6","author":"JC Baltussen","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"5","key":"pone.0336968.ref020","first-page":"362","article-title":"Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology","volume":"67","author":"CG Ethun","year":"2017","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0336968.ref021","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.56106","article-title":"Primary Treatment Modification and Treatment Tolerability Among Older Chemotherapy Recipients With Advanced Cancer","volume":"7","author":"MR Mohamed","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"6","key":"pone.0336968.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0286381","article-title":"The impact of sarcopenia on clinical outcomes in men with metastatic castrate-resistant prostate cancer","volume":"18","author":"E Papadopoulos","year":"2023","journal-title":"PLoS One"},{"issue":"12","key":"pone.0336968.ref023","doi-asserted-by":"crossref","first-page":"7852","DOI":"10.3390\/curroncol31120578","article-title":"The Role of Frailty and Myosteatosis in Predicting All-Cause Mortality in Older Adults with Cancer","volume":"31","author":"E Papadopoulos","year":"2024","journal-title":"Curr Oncol"},{"issue":"14","key":"pone.0336968.ref024","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1002\/cncr.33523","article-title":"Examining the ability of the Cancer and Aging Research Group tool to predict toxicity in older men receiving chemotherapy or androgen-receptor-targeted therapy for metastatic castration-resistant prostate cancer","volume":"127","author":"SMH Alibhai","year":"2021","journal-title":"Cancer"},{"issue":"4","key":"pone.0336968.ref025","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jocd.2018.09.007","article-title":"A Valid and Precise Semiautomated Method for Quantifying Intermuscular Fat Intramuscular Fat in Lower Leg Magnetic Resonance Images","volume":"23","author":"AKO Wong","year":"2020","journal-title":"J Clin Densitom"},{"issue":"5","key":"pone.0336968.ref026","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1139\/H08-075","article-title":"A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care","volume":"33","author":"M Mourtzakis","year":"2008","journal-title":"Appl Physiol Nutr Metab"},{"issue":"1","key":"pone.0336968.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00223-019-00545-w","article-title":"Assessment of Muscle Function and Physical Performance in Daily Clinical Practice\u00a0: A position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)","volume":"105","author":"C Beaudart","year":"2019","journal-title":"Calcif Tissue Int"},{"issue":"7","key":"pone.0336968.ref028","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1111\/jgs.16517","article-title":"Putative Cut-Points in Sarcopenia Components and Incident Adverse Health Outcomes: An SDOC Analysis","volume":"68","author":"PM Cawthon","year":"2020","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0336968.ref029","doi-asserted-by":"crossref","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"JM Guralnik","year":"1994","journal-title":"J Gerontol"},{"issue":"4","key":"pone.0336968.ref030","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ageing\/afz046","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"issue":"12","key":"pone.0336968.ref031","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1200\/JCO.2012.45.2722","article-title":"Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index","volume":"31","author":"L Martin","year":"2013","journal-title":"J Clin Oncol"},{"issue":"11","key":"pone.0336968.ref032","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1002\/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6","article-title":"The mini-cog: a cognitive \u201cvital signs\u201d measure for dementia screening in multi-lingual elderly","volume":"15","author":"S Borson","year":"2000","journal-title":"Int J Geriatr Psychiatry"},{"issue":"4","key":"pone.0336968.ref033","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"ZS Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"pone.0336968.ref034","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s13014-019-1372-3","article-title":"Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75\/08 substudy","volume":"14","author":"CM Panje","year":"2019","journal-title":"Radiat Oncol"},{"issue":"12","key":"pone.0336968.ref035","doi-asserted-by":"crossref","first-page":"3891","DOI":"10.1245\/s10434-016-5360-7","article-title":"Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer","volume":"23","author":"S Chemama","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"pone.0336968.ref036","article-title":"Skeletal muscle radio-density is an independent predictor of response and outcomes in follicular lymphoma treated with chemoimmunotherapy","volume":"10","author":"MP Chu","year":"2015","journal-title":"PLoS One"},{"issue":"5","key":"pone.0336968.ref037","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1200\/JCO.2006.09.2403","article-title":"Revised response criteria for malignant lymphoma","volume":"25","author":"BD Cheson","year":"2007","journal-title":"J Clin Oncol"},{"issue":"3","key":"pone.0336968.ref038","doi-asserted-by":"crossref","first-page":"102201","DOI":"10.1016\/j.jgo.2025.102201","article-title":"Impairments in geriatric assessment and their associations with different grip strength cutoffs and components of the Short Physical Performance Battery among older adults with cancer","volume":"16","author":"S Cobbing","year":"2025","journal-title":"J Geriatr Oncol"},{"issue":"2","key":"pone.0336968.ref039","doi-asserted-by":"crossref","first-page":"101426","DOI":"10.1016\/j.jgo.2023.101426","article-title":"Do clinicians address impairments in muscle strength and physical performance for older adults with cancer?","volume":"14","author":"E Papadopoulos","year":"2023","journal-title":"J Geriatr Oncol"},{"key":"pone.0336968.ref040","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.archger.2019.03.005","article-title":"Relationship between grip strength and global muscle strength in community-dwelling older people","volume":"82","author":"JM Porto","year":"2019","journal-title":"Arch Gerontol Geriatr"},{"issue":"1","key":"pone.0336968.ref041","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s40279-020-01361-1","article-title":"Frailty and Physical Fitness in Elderly People: A Systematic Review and Meta-analysis","volume":"51","author":"D Navarrete-Villanueva","year":"2021","journal-title":"Sports Med"},{"issue":"9","key":"pone.0336968.ref042","doi-asserted-by":"crossref","first-page":"2907","DOI":"10.1111\/jgs.18831","article-title":"National Institute on Aging efforts toward ensuring representation of diverse older adults in clinical studies","volume":"72","author":"C Nagy","year":"2024","journal-title":"J Am Geriatr Soc"},{"issue":"7","key":"pone.0336968.ref043","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1001\/jamaoncol.2016.6914","article-title":"Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis","volume":"3","author":"KM Mustian","year":"2017","journal-title":"JAMA Oncol"},{"issue":"1","key":"pone.0336968.ref044","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jpainsymman.2024.08.033","article-title":"Effects of Exercise in Adults With Cancer Pain: A Systematic Review and Network Meta-Analysis","volume":"69","author":"J Wang","year":"2025","journal-title":"J Pain Symptom Manage"},{"issue":"1","key":"pone.0336968.ref045","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/crt2.44","article-title":"First PACS\u2010integrated artificial intelligence\u2010based software tool for rapid and fully automatic analysis of body composition from CT in clinical routine","volume":"7","author":"NL Beetz","year":"2021","journal-title":"JCSM Clinical Reports"},{"key":"pone.0336968.ref046","article-title":"Sarcopenia and Cachexia in Older Patients with Cancer: Pathophysiology, Diagnosis, Impact on Outcomes, and Management Strategies","author":"E Papadopoulos","year":"2025","journal-title":"Drugs Aging"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336968","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T18:29:08Z","timestamp":1763576948000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336968"}},"subtitle":[],"editor":[{"given":"Simone","family":"Agostini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336968","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]}}}