# Integration of Geriatric Measures Alongside Disease-Based Measures to Advance Precision Oncology for Older Veterans with Multiple Myeloma

> **NIH VA IK2** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Although leading cancer-focused organizations such as the American Society of Clinical
Oncology now recommend geriatric assessments for all older adults with cancer, these
assessments have not been widely adopted within VA and elsewhere due to limitations in
resources, geriatrics expertise, and time in busy oncology clinics. The VA National Precision
Oncology Program is profiling tumor genetics in myeloma and other cancers to characterize
disease and personalize therapy in unprecedented fashion. However, truly personalized cancer
treatment for older Veterans must be based not only on tumor “genotype,” but also on older adult
“phenotype.” Dr. Clark DuMontier is a geriatrician and clinical investigator focused on integrating
geriatric measures into oncology. The research proposed for this CDA-2 will advance Dr.
DuMontier’s long-term goal of developing feasible and valid tools to help VA oncologists integrate
frailty and multimorbidity alongside myeloma-specific factors to advance precision oncology for
older Veterans with myeloma. The objectives of this application are to electronically measure
frailty and multimorbidity in over 5000 Veterans age ³ 65 years with myeloma newly treated in VA
from 2004-present using healthcare data that is readily available within VA’s nationally integrated
health system. Preliminary findings demonstrate that frailty and multimorbidity can be rapidly
assessed using diagnostic and procedural codes and data from the electronic health record
(EHR). Aim 1 will determine whether an electronic frailty index, the VA-FI, independently predicts
mortality and hospitalizations in older Veterans with myeloma, and whether it modifies the effect
of initial therapy on these outcomes. Analyses will include important myeloma-specific factors
such as triplet or doublet chemotherapy, stage and cytogenetics, sociodemographic variables,
and prognostic labs. Aim 2 will determine whether multimorbidity patterns independently predict
mortality and hospitalizations in myeloma, and whether they modify the effect of specific regimens
on these outcomes. A machine learning analysis will be applied to 67 chronic conditions
measured within the VA database to define these patterns and their impact in older Veterans with
myeloma. Aim 3 will develop and validate a predictive risk model for mortality that incorporates
frailty and multimorbidity with myeloma-specific factors. Once validated, this model will be
translated into a clinical decision support tool embedded in the VA EHR. This tool will help VA
oncologists to rapidly estimate frailty and multimorbidity and enhance individualized prognosis
and treatment decisions for older Veterans with myeloma. The mentored research and training
program described in this CDA-2 will accelerate Dr. DuMontier’s development into an independent
VA investigator in geriatric oncology. His mentorship team includes Drs. Jane Driver, Nikhil
Munshi, Michael Gaziano, and Mary Brophy—leaders in geriatrics, oncology, and bi...

## Key facts

- **NIH application ID:** 10731385
- **Project number:** 5IK2CX002218-04
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Clark William DuMontier
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731385

## Citation

> US National Institutes of Health, RePORTER application 10731385, Integration of Geriatric Measures Alongside Disease-Based Measures to Advance Precision Oncology for Older Veterans with Multiple Myeloma (5IK2CX002218-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10731385. Licensed CC0.

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