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. 2025 Aug;23(4):102369.
doi: 10.1016/j.clgc.2025.102369. Epub 2025 Apr 30.

Association Between Rheumatoid Arthritis, Frailty Status, and Mortality in Older Adults with Bladder Cancer

Maya Swaminathan  1 , Sarah K Holt  2 , John L Gore  2 , Yaw A Nyame  2 , Jonathan Wright  2 , Ami Shah  3 , Jeffrey A Sparks  4 , Una E Makris  5 , Petros Grivas  6 , Maria Suarez-Almazor  7 , Sarah Psutka  2 , Namrata Singh  8
Affiliations

Association Between Rheumatoid Arthritis, Frailty Status, and Mortality in Older Adults with Bladder Cancer

Maya Swaminathan et al. Clin Genitourin Cancer. 2025 Aug.

Abstract

Background: To evaluate the associations between rheumatoid arthritis (RA) and all-cause (ACM) and cancer-Specific mortality (CSM) in older adults with bladder cancer and examine how frailty may affect these associations.

Methods: Retrospective cohort study derived from the Surveillance Epidemiology and End Results (SEER) cancer registry and linked to Medicare claims data (SEER-Medicare). The cohort consisted of patients ≥ 65 years diagnosed with bladder cancer between 2004 and 2017. RA and frailty status were derived using validated administrative algorithms. ACM and CSM as derived from the SEER registry.

Results: Frailty modified the relationship between RA and mortality outcomes (interaction P value for ACM: .002 and for CSM: .007). We observed that RA was associated with a higher risk of CSM (aHR 1.17, 95% CI, 1.01-1.35) and ACM (aHR 1.12, 95% CI, 1.05-1.20) in nonfrail patients. In frail patients with bladder cancer, RA was not independently associated with CSM (aHR 0.81, 95% CI, 0.62-1.06) or ACM (aHR 0.93, 95% CI, 0.83-1.05).

Conclusion: Frailty is associated with adverse health outcomes. As people are living longer, it is becoming increasingly prevalent among patients with chronic conditions such as RA. We observed that RA is associated with increased risk of ACM and CSM among nonfrail older adults with bladder cancer. The lack of an association between RA and mortality in frail patients with RA suggests that the effect of frailty on mortality may overpower the effect that RA may exert-this information can help prognosticate outcomes in patients with bladder cancer, RA, and frailty.

Keywords: Epidemiology; Medicare; Multimorbidity; Survival; Urothelial carcinoma.

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Conflict of interest statement

Disclosure Petros Grivas (unrelated to this manuscript, but related to bladder cancer): Consulting: MSD, Bristol Myers Squibb, AstraZeneca, EMD Serono, Pfizer, Janssen, Roche, Astellas Pharma, Gilead Sciences, BostonGene, Fresenius Kabi, Lucence Health, PureTech, G1 Therapeutics, Aadi Biosciences, CG Oncology, Strata Oncology, ImmunityBio, Asieris Pharmaceuticals, AbbVie, Bicycle Therapeutics; Daiichi Sankyo, Replimune, Foundation Medicine, Eli Lilly; Institutional research funding: Pfizer, Bristol Myers Squibb, Merck, QED Therapeutics, Mirati Therapeutics, EMD Serono, G1 Therapeutics, Gilead Sciences, Acrivon Therapeutics, ALX Oncology, Genentech Sarah Psutka (unrelated to this manuscript): Consulting/Advisory: Janssen/Johnson & Johnson, CG Oncology, Merck, ImmunityBio; Research Funding: Bladder Cancer Advocacy Network; National Institute on Aging; Janssen (Global PI SunRise-4 Trial); Steba Biotech (Site PI ENLIGHTED Trial).

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