Integrated Assessment of Cachexia, Body Composition, and Patient-Reported Outcomes in Unplanned Hospitalizations of Metastatic Cancer Patients: The PRO-HAND Study

Handgrip strength declines with age and is associated with frailty, sarcopenia, cancer cachexia, nutritional deterioration, and adverse clinical outcomes in patients with cancer. In this prospective observational cohort study, consecutive adult patients with histologically or cytologically confirmed metastatic solid malignancies undergoing unplanned hospitalization will be assessed at the time of admission. Handgrip strength will be measured within the first 48 hours of admission using a calibrated hydraulic hand dynamometer. Measurements will be performed on the dominant hand, with patients seated, the elbow flexed at 90 degrees, and the wrist in a neutral position, according to standardized procedures. Three consecutive measurements will be obtained, and the highest value will be recorded for analysis.

In addition to handgrip strength, admission-time assessments will include routine laboratory parameters, the handgrip strength-cachexia index, the CRP-triglyceride-glucose index, bioelectrical impedance analysis-derived body composition measures, and validated patient-reported outcome instruments, including SARC-F, FACT-G, PSQI, PG-SGA, visual analogue scale pain score, and visual analogue scale appetite score. Patients will be followed for short-term clinical outcomes, including 30-day all-cause mortality, 90-day all-cause mortality, and 30-day unplanned hospital readmission after index discharge.