Effects of smoking and body mass index on the exposure of fentanyl in patients with cancer

Purpose Emerging evidence suggests muscle depletion predicts survival of patients with cancer. Patients and Methods At a cancer center in Alberta, Canada, consecutive patients with cancer (lung or GI; N = 1,473) were assessed at presentation for weight loss history, lumbar skeletal muscle index, and mean muscle attenuation (Hounsfield units) by computed tomography (CT). Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test predictive accuracy of survival models. Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave a c statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave a c statistic of 0.92 (95% CI, 0.88 to 0.95; P < .001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). Conclusion CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

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Performance of Khorana Score to Predict One-Year Risk of Venous Thromboembolism in over Two Million Patients with Cancer

Blood ◽

10.1182/blood-2020-139706 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 52-53

Author(s):

Yasmin Arafah ◽

Taha Al-Juhaishi ◽

Ghaith Abu Zeinah ◽

Lalitha V. Nayak ◽

Sadeer Al-Kindi

Keyword(s):

Body Mass Index ◽

Platelet Count ◽

Body Mass ◽

Cancer Diagnosis ◽

Leukocyte Count ◽

Hemoglobin Level ◽

Receiver Operating Characteristics ◽

Cancer Type ◽

Operating Characteristics ◽

Patients With Cancer

Background: Risk stratification of venous thromboembolism (VTE) in patients with cancer is essential to evaluate the need for extended thromboprophylaxis. The Khorana score is widely used to guide VTE risk stratification in patients with cancer based on clinical parameters: cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index. We sought to validate Khorana score to predict 1-year risk of VTE in a large multi-institutional, diverse, real-world cohort of patients with cancer. Methods: Using aggregated de-identified electronic medical record data from >300 major hospitals in the in the United States (IBM Watson Explorys), we performed a retrospective cohort study of all patients who had a diagnosis of cancer. We identified cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index (for calculation of Khorana score) within 7 days of cancer diagnosis and followed patients for diagnosis of VTE for 1 year post cancer diagnosis. Logistic regression models were used to evaluate association between patient characteristics and VTE risk. Receiver operating characteristics with area under the curve were used to evaluate model discrimination. All analyses were performed in Statistical Package for Social Sciences. Results: A total of 2,112,260 patients with cancer were included: 52.9% females, 11.1% African Americans, 44.3% intermediate risk cancers (lymphoma, lung, breast, gynecologic, testicular and bladder), 4.5% high risk cancers (stomach and pancreas), 19.8% had Platelet counts ≥ 350,000/µL, 29% had hemoglobin <10 g/dL, 32.3% had leukocyte count >11,000/µL, and 15.1% had body mass index ≥ 35 kg/m2. Overall, 227,170 (10.8%) had a diagnosis of VTE at 1 year following cancer diagnosis. In multivariable analysis (table 1), VTE risk was associated with cancer type (intermediate vs low risk: OR 1.08 [95% CI: 1.07-1.09]; high vs low risk: OR 1.48 [95% CI: 1.45-1.51]), Platelet ≥ 350,000 (OR 1.27 [95% CI: 1.26-1.29]), hemoglobin <10 g/dL (OR 1.43 [95% CI: 1.41-1.44]), leukocyte count > 11,000 (OR 1.15 [95% CI: 1.14-1.16]), body mass index ≥ 35 kg/m2 (OR 1.29 [95% CI: 1.27-1.30]), table 1. Risk of VTE increased linearly with Khorana score between 7.7% (score = 0) to 18% (score = 6), figure 1. Khorana score had weak to modest discrimination (Area Under Receiver Operating Characteristics 0.565 [95% CI: 0.564-0.566]), figure 2. Conclusion: In this very large real-world study of diverse patients with cancer, Khorana score was a weak predictor of 1-year risk of VTE, suggesting that VTE prediction in patients with cancer is very complex. Disclosures No relevant conflicts of interest to declare.

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