**1. Introduction**

Malnutrition is a highly prevalent condition among oncology patients [1]. Up to 70% of cancer patients are at increased risk for malnutrition [2,3], a condition that is strongly associated with higher mortality and morbidity, functional decline, prolonged hospital stays and increased health care costs [4–9]. The pathophysiology of malnutrition in cancer patients is complex and involves different direct and indirect mechanisms, including inflammation, direct tumor effects, chemotherapy-induced effects and a decrease in appetite [10–12]. In addition, a reduced nutrient intake leads to protein and energy deficits, which in turn lead to muscle wasting and impairment of muscle strength [13,14].

Handgrip strength (HGS) measured through dynamometry is an important tool for the assessment of sarcopenia [15]. HGS has been proposed as an easy-to-use, noninvasive,

**Citation:** Tribolet, P.; Kaegi-Braun, N.; Gressies, C.; Baumgartner, A.; Wagner, K.-H.; Stanga, Z.; Schuetz, P. Handgrip Strength Values Depend on Tumor Entity and Predict 180-Day Mortality in Malnourished Cancer Patients. *Nutrients* **2022**, *14*, 2173. https://doi.org/10.3390/nu14102173

Academic Editors: Omorogieva Ojo and Amanda R Amorim Adegboye

Received: 21 April 2022 Accepted: 20 May 2022 Published: 23 May 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

objective and inexpensive tool to detect and monitor changes in nutritional status, and to predict functional decline during hospitalization and post-discharge [16–19]. HGS correlates with nutritional status and may detect changes in functional capacity in an early stage, before changes in the body composition are manifest [20]. Therefore, the use of HGS has been advocated by different international guidelines as an important adjunct in the assessment of malnutrition [21–24]. Moreover, for the population of cancer patients, studies have suggested that lower HGS is associated with higher risks for mortality and sarcopenia, as well as a decrease in quality of life (Qol) [25].

Based on published data of cancer patients, HGS reference values for this population are expected to be lower compared to healthy people [26–30], but there is a lack of data on reference values for this specific patient population. Herein, we investigated sex-specific HGS levels by tumor entity and additionally studied the prognostic information regarding 180-day all-cause mortality and other adverse outcomes from cancer patients included in the Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial (EFFORT) [31]. Knowledge of such data may provide health care workers with information about expected results when managing cancer patients in their clinical routine.

#### **2. Material and Methods**

#### *2.1. Study Design and Setting*

This is a secondary analysis of the EFFORT trial, which was a pragmatic, investigatorinitiated, open-label, randomized controlled trial conducted in eight Swiss hospitals between April 2014 and February 2018. The original study investigated the effects of a protocol-guided individualized nutritional treatment algorithm on medical outcomes in patients at nutritional risk. The protocol and the main results [31,32], as well as several predefined secondary analyses [33–42], have been previously published. The EFFORT trial was registered with ClinicalTrials.gov, number NCT02517476.

The Ethics Committee of Northwest/Central Switzerland (EKNZ) approved the study protocol in January 2014 (EKNZ; 2014\_001). The eight participating sites were secondary and tertiary care hospitals in Switzerland and included the University Clinic in Aarau, the University Hospital in Bern, the cantonal hospitals in Solothurn, Lucerne, St. Gallen, Baselland, Muensterlingen and the hospital in Lachen.
