{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:03Z","timestamp":1788847683512,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K23AR079588"],"award-info":[{"award-number":["K23AR079588"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R03AG082857"],"award-info":[{"award-number":["R03AG082857"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54GM115458"],"award-info":[{"award-number":["U54GM115458"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["PR200793"],"award-info":[{"award-number":["PR200793"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["BX003635"],"award-info":[{"award-number":["BX003635"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study investigated the association between frailty and cancer incidence and mortality in patients with rheumatoid arthritis (RA). It aimed to identify how frailty influences cancer risk and cancer\u2010specific outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed data from the Veterans\u2019 Affairs Rheumatoid Arthritis Registry (2002\u20132023). Frailty status was categorized at baseline using the Veterans Affairs Frailty Index (VA\u2010FI): robust (VA\u2010FI &lt;0.10), prefrail (VA\u2010FI 0.11\u20130.20), and frail (VA\u2010FI &gt;0.20). Cancer incidence and cancer\u2010related deaths were evaluated using competing risk models, adjusting for demographics, lifestyle factors (eg, smoking), RA characteristics (eg, seropositivity, Disease Activity Score\u201028), medication use, and comorbidities. We additionally studied domain\u2010specific frailty exposures and linear frailty modeling in sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2,723 individuals met eligibility criteria (mean age: 63.8\u2009\u00b1\u200911.2 years; 87.6% male; 15.4% Black). Age\u2010adjusted cancer incidence rates per 1,000 person\u2010years were 12.3 (robust), 15.5 (prefrail), and 19.9 (frail). In fully adjusted models, prefrailty (subdistribution hazard ratio [sHR] 1.37, 95% confidence interval [CI] 1.02\u20131.84) and frailty (sHR 1.83, 95% CI 1.23\u20132.71) were significantly associated with higher cancer incidence. Cancer\u2010related mortality rates were 7.8 (robust), 10.6 (prefrail), and 9.8 (frail) per 1,000 person\u2010years, with no significant associations for overall frailty. Domain\u2010specific and sensitivity analyses were consistent with these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Frailty was independently associated with increased cancer incidence in RA, suggesting frailty may help identify patients at higher risk for malignancy.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr80147-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80147","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:43:32Z","timestamp":1787809412000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Frailty With the Risk of Incident Cancer and Cancer\u2010Related Mortality in Veterans With Rheumatoid Arthritis"],"prefix":"10.1002","author":[{"given":"Bhavik","family":"Bansal","sequence":"first","affiliation":[{"name":"The University of Texas Southwestern Medical Center  Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Baraff","sequence":"additional","affiliation":[{"name":"Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8707-7649","authenticated-orcid":false,"given":"Katherine","family":"Wysham","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Puget Sound Health Care System  Seattle Washington"},{"name":"University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Andrews","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9649-3588","authenticated-orcid":false,"given":"Bryant R.","family":"England","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"},{"name":"Department of Veterans Affairs Nebraska\u2010Western Iowa Health Care System  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-2272","authenticated-orcid":false,"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"},{"name":"Department of Veterans Affairs Nebraska\u2010Western Iowa Health Care System  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Baker","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"},{"name":"Department of Veterans Affairs Nebraska\u2010Western Iowa Health Care System  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8406-3556","authenticated-orcid":false,"given":"Alexa","family":"Meara","sequence":"additional","affiliation":[{"name":"Ohio State University  Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Una","family":"Makris","sequence":"additional","affiliation":[{"name":"University of California at San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Presley","sequence":"additional","affiliation":[{"name":"Ohio State University  Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela","family":"Orkaby","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System  Boston Massachusetts"},{"name":"Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-363X","authenticated-orcid":false,"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100768"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15225441"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0728-9"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyae006"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2010.08.009"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.17208.2"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25282"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2021-002111"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2023.107742"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-50019-1"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000381134"},{"issue":"5","key":"e_1_2_6_13_1","first-page":"24","article-title":"Insights and implications of the VA Rheumatoid Arthritis Registry","volume":"32","author":"Mikuls TR","year":"2015","journal-title":"Fed Pract"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gly232"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glab071"},{"issue":"3","key":"e_1_2_6_16_1","first-page":"76","article-title":"Summary of Veterans Health Administration cancer data sources","volume":"46","author":"Zullig LL","year":"2019","journal-title":"J Registry Manag"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15020485"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7501"},{"issue":"2","key":"e_1_2_6_19_1","first-page":"30","article-title":"Multiple imputation with multivariate imputation by chained equation (MICE) package","volume":"4","author":"Zhang Z.","year":"2016","journal-title":"Ann Transl Med"}],"container-title":["Arthritis Care &amp; 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