Lower Handgrip Strength is Associated with Worse Quality of Life and More Fatigue and Disability in Long-term Colorectal Cancer Survivors

Abstract

\n Colorectal cancer (CRC) treatment negatively affects anthropometric measures, which in turn can result, either directly or indirectly, in fatigue and a lower health-related quality of life (HRQoL). Since anthropometric measures are modifiable, we examined which of these are associated with HRQoL, fatigue, and disability in long-term CRC survivors. In this cross-sectional study, body mass index (BMI), waist circumference, waist-to-hip ratio, body fat percentage, handgrip strength (HGS) and mid-upper arm muscle area of 155 stage I-III CRC survivors at 2–10 years after treatment were assessed during home visits (response rate 42%). HRQoL was measured by the EORTC QLQ-C30, fatigue by the Checklist Individual Strength (CIS), and disability by the World Health Organization Disability Assessment Schedule II (WHODAS-II). Associations between anthropometric measures and HRQoL, fatigue and disability were analyzed by confounder-adjusted linear regression. Mean time since CRC diagnosis was 5.7 years (SD\u2009=\u20091.8), and mean age was 70.1 years (SD\u2009=\u20098.9). After adjustment for patient and treatment characteristics, only HGS was independently associated with HRQoL. Each increase in participants’ HGS of 5 kg was significantly associated with an increase of 2.3 points (95% CI\u2009=\u20090.3, 4.3) in global quality of life, 2.9 points (95% CI\u2009=\u20090.9, 5.0) in physical functioning, 3.3 points (95% CI\u2009=\u20091.3, 5.3) in social functioning, and a decrease of 5.9 points (95% CI = -8.7, -3.0) in fatigue symptoms and 2.5 points (95% CI = -4.1, -0.9) in disability. We conclude that HGS, as a measure of physical functioning in CRC survivors, was independently associated with HRQoL, fatigue and disability. Future prospective research should focus underlying and causal factors in the association between HGS and HRQoL after CRC treatment and on possible interventions to promote HRQoL outcomes through improving physical functioning.