Impact of rheumatoid arthritis on survival in older adults with cancer

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PROJECT SUMARY With the use of newer therapies that improve clinical outcomes in rheumatoid arthritis (RA), an increasing number of older adults (1.3 million) are now living with RA, a chronic, inflammatory disease. RA is also associated with an increased risk of certain cancers compared to the general population. Although an increasing number of older adults are living with RA and cancer, clinical trials often exclude older adults. There remains very little evidence-based guidance for management of older adults with comorbid RA and cancer. Although a few studies have examined the survival of patients with both RA and cancer relative to those with cancer alone, these are based on cohorts of patients from several years ago (prior to widespread use of biologics). Given the dramatic changes in treatment of RA and cancer in recent years, an examination of survival for major forms of cancer in more contemporary cohorts of older adults with RA is warranted. Similarly, very little is known about the impact of geriatric syndromes such as frailty on outcomes (e.g., cancer survival) among patients with comorbid RA and cancer. Also, it has been shown that reduced lean mass and high fat mass are prevalent in patients with RA alone or cancer alone and impact survival but very little is known about the changes in body composition among older adults with concurrent RA and cancer. The overall goal of this proposal is to examine the association between RA and overall survival (Aim 1), body composition, frailty, and quality of life (QOL) (Aim 2) in older adults with cancer compared to those with cancer without RA. To achieve this goal, we have developed two complementary aims. Aim 1A will use the nationwide Veterans Affairs databases to assess the differences in survival between the two groups of older adults (cancer with RA versus cancer without RA) and Aim1B will examine the association between frailty and survival among those with RA and cancer. Aim 2 is a cross-sectional study and will include measures of body composition, Fried frailty phenotype, and patient-reported QOL- measures that are unavailable in large databases. We will compare these measures between older adults with RA and cancer to those with cancer without RA. Together with my mentorship team, the career development and research plan, this GEMSSTAR award will enable me to obtain the necessary training in the principles of geriatrics, such as assessment of frailty and sarcopenia, to help advance the research in this area and my career as an investigator focused on improving outcomes for older adults with rheumatic diseases and cancer. Results from this study have the potential to provide critical preliminary data for a future R01 application where we expand our findings in a multicenter prospective cohort to risk stratify older adults with rheumatic diseases and cancer to ultimately develop interventions to improve their quality of life and potentially survival.