Impact of rheumatoid arthritis on survival in older adults with cancer

项目总结 随着改善类风湿性关节炎(RA)临床结果的新疗法的使用，越来越多的人 许多老年人(130万)现在患有类风湿性关节炎，这是一种慢性炎症性疾病。Ra也是 与普通人群相比，与某些癌症的风险增加有关。尽管有一个 随着越来越多的老年人患有类风湿关节炎和癌症，临床试验往往排除了老年人。那里 对于患有类风湿性关节炎和癌症的老年人的治疗，仍然缺乏循证指导。 尽管有几项研究研究了RA和癌症患者的存活率相对于 仅就癌症而言，这些研究是基于几年前(在广泛使用之前)的患者队列 生物制品)。鉴于近年来RA和癌症治疗的戏剧性变化，一项关于 主要形式的癌症在更现代的老年类风湿关节炎队列中的存活率是有保证的。同样， 人们对虚弱等老年综合征对预后的影响(例如，癌症存活率)知之甚少。 在患有类风湿关节炎和癌症的患者中。此外，研究还表明，减少瘦体重和高脂肪 肿块在单独患有RA或单独患有癌症的患者中很常见，并影响生存，但人们对此知之甚少 并发类风湿性关节炎和癌症的老年人身体成分的变化。 这项提案的总体目标是检查RA和总体存活率之间的关联(目标1)， 老年癌症患者的身体成分、脆弱程度和生活质量(目标2)比较 没有类风湿关节炎的癌症。为了实现这一目标，我们制定了两个相辅相成的目标。目标1A将使用 全国退伍军人事务数据库，以评估两组老年人之间的生存差异 成人(患有类风湿性关节炎的癌症与不患有类风湿性关节炎的癌症)和Aim1B将研究脆弱和 类风湿关节炎和癌症患者的存活率。目标2是一项横断面研究，将包括身体测量。 成分、油炸脆性表型和患者报告的生活质量--这些测量在大范围内是不可用的 数据库。我们将比较患有类风湿性关节炎和癌症的老年人与癌症患者之间的这些指标 没有RA。 与我的导师团队、职业发展和研究计划一起，这个GEMSSTAR奖将 使我能够获得必要的老年病学原理方面的培训，如评估虚弱和 石棺，以帮助推进这一领域的研究，以及我作为一名调查员的职业生涯，专注于改善 患有风湿病和癌症的老年人的结局。这项研究的结果有可能 为未来的R01应用程序提供关键的初步数据，我们将在多中心扩展我们的发现 对患有风湿病和癌症的老年人进行风险分层的前瞻性队列研究 干预措施，以提高他们的生活质量和潜在的存活率。

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.