Beyond Body Mass Index: Bringing Body Composition into Oncology Practice

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PROJECT SUMMARY/ABSTRACT This Career Development Award will support Elizabeth Feliciano, ScD, in her transition to independence as a translational researcher utilizing electronic data to improve cancer care. Her long-term goals are to elucidate how body composition influences cancer outcomes; develop electronic tools that use routinely collected data to improve prognostication and guide clinical interventions; and collaborate to use these electronic tools in interventions that improve cancer outcomes. Sarcopenia (low skeletal muscle mass) and sarcopenic obesity (sarcopenia with excess adiposity) are common in cancer patients, typically occult, and associated with surgical complications, treatment toxicity, poor quality of life, and reduced survival across a variety of cancer types. Despite being strongly prognostic and modifiable, body composition data is under-utilized in clinical decision-making. To address this, Dr. Feliciano will develop cost-effective, clinic-friendly methods to identify patients with sarcopenia. Next, she will develop a tool that communicates body composition information to a cancer care team. Using rich electronic medical record and imaging data from a cohort of nearly 6,000 non-metastatic colorectal and breast cancer patients, she will: validate software to automatically assess body composition from clinically-acquired imaging (Aim 1); develop a predictive model to identify sarcopenia based on electronic medical data, for use in cancer patients who do not undergo imaging (Aim 2); and integrate body composition information into established risk prediction models for colorectal cancer used in clinical practice and present this information in an understandable and actionable format to clinicians (Aim 3). Dr. Feliciano is well suited to perform this research based on her experience in body composition assessment and cancer epidemiology, an exceptional mentoring team who will ensure scientific rigor and clinical relevance, and the unique setting within an integrated healthcare system with a comprehensive electronic medical record and an ethnically diverse patient population of 4.1-million members. Her institution, Kaiser Permanente Northern California, provides an ideal training ground for her to gain needed skills through coursework, conferences, seminars, and experiential learning in the following domains: advanced analytic methods (predictive modeling, biomedical image analysis, and data visualization); cancer biology and clinical cancer care; and core competencies of an independent investigator (grant-writing, responsible conduct of research, and clinical translation of research).Through the proposed research and training, she will acquire the preliminary data, knowledge, and clinical and scientific partnerships she needs to develop a competitive R01 proposal and to establish a successful research program focused on optimizing use of electronic data to improve cancer care.