Background/Purpose: Individuals with rheumatoid arthritis (RA) have a higher prevalence of frailty, even at younger ages, compared to the general population1. Among persons with lung cancer, frailty is associated with decreased survival2. However, this association has not yet been assessed among patients with lung cancer and pre-existing RA. The objective of this study was to better characterize the contribution of frailty to survival differences among older adults with RA and lung cancer.

Methods: Using nationwide electronic medical records data from the Veterans Health Administration, we included patients aged ≥ 50 years with a lung cancer diagnosis. RA was defined by ≥ 2 RA ICD-9/10 codes 1–365 days apart prior to cancer diagnosis. The validated Veterans Affairs Frailty Index (VA-FI) was used to characterize patient’s frailty status. VA-FI is a validated electronic frailty index developed to measure frailty using administrative claims and electronic health records data in Veterans. Patients were characterized as robust, pre-frail, or frail. Cox proportional hazards regression models were used to assess the association between frailty status and survival, adjusting for demographics, smoking history, rheumatic disease comorbidity index (RDCI), prior cancer history, and tumor stage.

Results: We identified 2,864 patients with pre-existing RA and lung cancer; 77.7% were > 65 years, 94.9% were male, 79.2% were White, 93.1% non-Hispanic. Based on the VA-FI, 34% were categorized as robust, 26% pre-frail, and 39% frail (Table 1). Age-adjusted mortality rates per 1,000 person-years were 403.3 for robust, 398.9 for pre-frail, and 410.8 for frail patients. In multivariable analysis, compared with robust persons, pre-fail persons had a mild increased risk of mortality (aHR 1.11; 95% CI: 1.00-1.24), while frail patients had a statistically significant higher risk (aHR 1.27; 95% CI: 1.12-1.43) (Table 2).

Conclusion: Among Veterans with RA and lung cancer, frailty was common and associated with worse survival. These findings highlight the prognostic importance of frailty and suggest it may be routinely assessed to guide risk stratification and clinical decision-making in this population.

Table 1: Baseline Characteristics of Patients with RA and Frailty Veterans Affairs Frailty Index

Table 2: Age-Adjusted Mortality Rates and Multivariable Adjusted Hazard Ratio

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-frailty-and-survival-among-older-adults-with-rheumatoid-arthritis-and-lung-cancer/