University of Washington Seattle, WA, United States
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Maya Swaminathan1, Sarah Holt2, John Gore2, Yaw Nyame2, Jonathan Wright2, George Schade2, Ami Shah3, Jeffrey Sparks4, Una Makris5, Petros Grivas6, Maria Suarez-Almazor7, Sarah Psutka2 and Namrata Singh8, 1University of Washington, Seattle, WA, 2Department of Urology, University of Washington, Seattle, WA, 3Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Ellicott City, MD, 4Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 5UT Southwestern Medical Center and Dallas VA, Dallas, TX, 6Division of Medical Oncology, Dept. of Medicine, UW; Clinical Research Division; Fred Hutchinson Cancer Center, Seattle, WA, 7MD Anderson Cancer Center, Houston, TX, 8University of Washington, Bellevue, WA
Background/Purpose: Rheumatoid arthritis (RA) is associated with an increased risk of developing certain cancers, including bladder cancer (Beydon et al. 20231). However, few studies have examined the outcomes following a bladder cancer diagnosis in patients with RA. RA is also associated with an increased risk of frailty. Bladder cancer is the second most common urologic cancer with a mean age of diagnosis of 73 years and a high burden of frailty and comorbidity. Importantly, among patients with bladder cancer, frailty is associated with an increased risk of mortality. We sought to evaluate associations between RA and all-cause and cancer-specific mortality in older adults with bladder cancer, adjusted for frailty.
Methods: In this retrospective cohort study, using the Surveillance Epidemiology and End Results cancer registry and linked Medicare claims data (SEER-Medicare), we included patients ³65 years old with incident bladder cancer diagnosed between 2004 and 2017. Patients with a pre-existing diagnosis of RA were identified based on the presence of ³2 ICD-10 codes ≥ 30 days and < 365 days apart. A validated claims-based Frailty Index (Kim et al. 20172) and National Cancer Institute (NCI) Comorbidity Index were derived from claims in the 12 months prior to bladder cancer diagnosis. Patients with a frailty score > 0.2 were categorized as frail. Separate Cox proportional hazards regression models evaluated the association between RA and frailty and 1) overall mortality and 2) bladder cancer-specific mortality, after adjusting for demographics, socioeconomic status, comorbidities, cancer stage, and receipt of guideline-directed bladder cancer treatment per stage. We evaluated the interaction between RA and frailty and performed stratified analyses by frailty status.
Results: We identified 99,418 patients with bladder cancer of whom 1751 (1.8%) had pre-existing RA (Table 1). Among patients with RA, 923 (52.7%) were frail while 33,518 (34.3%) of patients without RA were frail (p< 0.0001).Median follow-up for survivors overall was 5.3 years (interquartile range, IQR, 2.8-8.8) during which time 61,499 patients died. The 5-year overall survival was 73.0% versus 71.9% for patients with and without RA respectively (p< 0.0001) and was 73.0% versus 68.6% for patients with and without frailty (p=0.0001).Among non-frail patients, RA was associated with an increased risk of cancer-specific (aHR 1.22, 95% CI 1.07 – 1.41) and overall mortality (aHR 1.18, 95% CI 1.08-1.29) (Table 2). However, among frail patients, RA was not associated with an increased risk of cancer-specific (aHR 0.92, 95% CI 0.82 – 1.05) or overall mortality (aHR 0.97, 95% CI 0.90-1.04).
Conclusion: RA was associated with a higher risk of bladder cancer-specific and overall mortality in non-frail pts with bladder cancer. Limitations of our study include retrospective nature, potential selection bias, and unmeasured confounding. Our hypothesis-generating results support further evaluation of the association between RA, frailty, and survival in older adults with bladder cancer.
Table 1: Demographic and clinical characteristics of patients with bladder cancer with rheumatoid arthritis
Table 2: Cox regression model for mortality among older adults with bladder cancer stratified by frailty status.
M. Swaminathan: None; S. Holt: None; J. Gore: None; Y. Nyame: None; J. Wright: None; G. Schade: None; A. Shah: Arena Pharmaceuticals, 5, Eicos Sciences, 5, Kadmon Corporation, 5, Medpace LLC, 5; J. Sparks: AbbVie, 2, Amgen, 2, Boehringer Ingelheim, 2, Bristol-Myers Squibb, 2, 5, Gilead, 2, Inova Diagnostics, 2, Janssen, 2, Optum, 2, Pfizer, 2, ReCor, 2; U. Makris: None; P. Grivas: AstraZeneca, 2, Bristol-Myers Squibb(BMS), 2, Genentech, 2, GlaxoSmithKlein(GSK), 2, Janssen, 2, Pfizer, 2, Roche, 2; M. Suarez-Almazor: Celgene, 1, Eli Lilly, 2, Pfizer, 2, Syneos Health, 1; S. Psutka: None; N. Singh: None.
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