Impact of rheumatoid arthritis on survival in older adults with cancer

类风湿性关节炎对老年癌症患者生存的影响

• 批准号: 10723352
• 负责人: Namrata Singh
• 金额: $ 15.15万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723352
• 关键词: Adult; Age; Aging; Area; Award; Biological Products; Body Composition; Body measure procedure; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Trials; Cohort Studies; Complex; Cox Proportional Hazards Models; Cross-Sectional Studies; Data; Databases; Development; Diagnosis; Disease; Elderly; Exclusion; Fatigue; Fatty acid glycerol esters; Funding; Future; General Population; Geriatrics; Goals; Hospitalization; Individual; Infection; Inflammatory; Intervention; Investigation; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Medical; Mentors; Mentorship; Methods; Oncology; Outcome; Patients; Phenotype; Physicians; Population; Positioning Attribute; Prospective cohort; Quality of life; Reporting; Research; Research Personnel; Rheumatism; Rheumatoid Arthritis; Rheumatology; Risk; Risk Factors; Risk Marker; Scientist; Stage at Diagnosis; Syndrome; Thinness; Training; United States Department of Veterans Affairs; cancer diagnosis; cancer survival; cancer type; career; career development; clinical care; clinical practice; cohort; comorbidity; demographics; evidence base; frailty; high risk; improved; improved outcome; indexing; malignant breast neoplasm; mortality; mortality risk; multiple chronic conditions; novel therapeutics; personalized approach; research and development; rheumatologist; risk stratification; sarcopenia; sarcopenic obesity; sex; skills

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.

项目概要 随着新疗法的使用改善了类风湿性关节炎 (RA) 的临床结果，越来越多的人 目前有 130 万名老年人患有 RA，这是一种慢性炎症性疾病。 RA 也是 与一般人群相比，与某些癌症的风险增加有关。虽然一个 越来越多的老年人患有 RA 和癌症，临床试验通常排除老年人。那里 对于患有 RA 和癌症共病的老年人的治疗，基于证据的指导仍然很少。 尽管有一些研究考察了 RA 和癌症患者相对于其他患者的生存率 仅针对癌症，这些基于几年前的患者队列（在广泛使用癌症之前） 生物制剂）。鉴于近年来 RA 和癌症治疗的巨大变化，一项检查 在更现代的患有 RA 的老年人群中，主要癌症形式的生存是有保证的。相似地， 关于衰弱等老年综合症对结果（例如癌症生存）的影响知之甚少 患有 RA 和癌症共病的患者。此外，研究表明，减少瘦体重和高脂肪 肿块在单纯 RA 或单纯癌症患者中普遍存在，并影响生存，但人们对此知之甚少 患有 RA 和癌症的老年人身体成分的变化。 该提案的总体目标是检查 RA 与总生存期之间的关联（目标 1）， 与患有癌症的老年人相比，患有癌症的老年人的身体成分、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，我们制定了两个互补的目标。目标 1A 将使用 全国退伍军人事务数据库，用于评估两组老年人之间的生存差异 成人（患有 RA 的癌症与不患有 RA 的癌症）和 Aim1B 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，将包括身体测量 成分、Fried 衰弱表型和患者报告的 QOL 测量值在大范围内无法获得 数据库。我们将比较患有 RA 和癌症的老年人与患有癌症的老年人之间的这些测量结果 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 使我能够获得老年病学原理方面的必要培训，例如虚弱评估和 肌肉减少症，以帮助推进这一领域的研究以及我作为一名专注于改善的研究人员的职业生涯 患有风湿病和癌症的老年人的结果。这项研究的结果有可能 为未来的 R01 应用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最终发展 旨在改善他们的生活质量和潜在生存率的干预措施。