Impact of rheumatoid arthritis on survival in older adults with cancer

项目概要 随着新疗法的使用，改善类风湿关节炎（RA）的临床结局， 许多老年人（130万）现在患有RA，一种慢性炎症性疾病。RA也是 与一般人群相比，某些癌症的风险增加。虽然 随着越来越多的老年人患有类风湿关节炎和癌症，临床试验往往排除老年人。那里 仍然很少有证据为基础的指导管理老年人共病RA和癌症。 虽然一些研究已经检查了RA和癌症患者的生存率， 对于单独的癌症，这些是基于几年前的患者队列（在广泛使用 生物制剂）。鉴于近年来RA和癌症治疗的巨大变化， 在更现代的RA老年人队列中，主要癌症的生存率是有保证的。同样地， 关于老年综合征如虚弱对结果的影响知之甚少（例如，癌症存活率） 在患有类风湿关节炎和癌症的患者中。此外，已经表明，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普遍存在，并影响生存率，但对 同时患有类风湿关节炎和癌症的老年人身体组成的变化。 本提案的总体目标是检查RA与总生存率之间的关系（目标1）， 老年癌症患者的身体组成、虚弱程度和生活质量（QOL）（目标2）， 没有RA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。 成年人（患有RA的癌症与不患有RA的癌症）和Aim 1B将检查虚弱与 RA和癌症患者的生存率。目标2是一项横断面研究，将包括身体的措施 组合物，Fried虚弱表型和患者报告的QOL-无法在大样本中获得的测量 数据库。我们将比较这些措施之间的老年人与类风湿关节炎和癌症的人 没有RA。 连同我的导师团队，职业发展和研究计划，这个GEMSSTAR奖将 使我能够获得老年医学原理方面的必要培训，例如评估虚弱程度， 肌肉减少症，以帮助推进这一领域的研究和我的职业生涯作为一个调查员专注于改善 老年风湿性疾病和癌症患者的预后。这项研究的结果有可能 为未来的R 01应用提供关键的初步数据，我们将在多中心研究中扩展我们的发现。 前瞻性队列研究，对患有风湿性疾病和癌症的老年人进行风险分层， 干预措施，以改善他们的生活质量和潜在的生存。

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.