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HIV patients less likely to receive treatment for many cancers
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An analysis of more than 2 million cancer patients in the United States suggested that those with HIV are less likely to receive cancer treatment, regardless of insurance status or comorbidities.
This disparity was present among patients with every examined cancer type but anal cancer, according to Gita Suneja, MD, MSHP, assistant professor in the department of radiation oncology at the University of Utah, Huntsman Cancer Center, and colleagues, who said the findings support efforts to improve treatment for this population.
“HIV-infected patients with cancer have lower overall survival compared with HIV-uninfected individuals,” they wrote. “Although this may in part be related to deaths from AIDS-related complications, a recent population-based study found higher cancer-specific mortality among HIV-infected vs. HIV-uninfected patients with cancer. Lack of appropriate cancer treatment may contribute to worse cancer-specific mortality.”
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To test this hypothesis, Suneja and colleagues examined patient data reported to the National Cancer Data Base from 2003 to 2011. The researchers included in their study all adult patients aged younger than 65 years diagnosed with the 10 most frequent cancers, and collected demographic, treatment, comorbidity and insurance status data. The investigators then conducted an analysis to identify predictors for lack of cancer treatment while controlling for comorbidity and insurance status — variables they said have remained unexplored throughout past studies on HIV and cancer.
“HIV-infected individuals frequently have other illnesses, and patients with significant comorbid disease may not be candidates for standard cancer therapy,” Suneja and colleagues wrote. “Similarly, insurance status also plays an important role in access to and delivery of cancer treatment. HIV-infected patients in the United States are more likely to be uninsured or underinsured compared with the HIV-uninfected population, which could be a major contributing factor [in poor patient outcomes].”
The study’s final cohort included 10,265 HIV patients and 2,219,232 patients without HIV. According to the researchers, those with HIV were younger (median age, 47 years vs. 55 years), and were more often non-Hispanic black (41.1% vs. 13.2%) and Hispanic (14% vs. 5.7%). Patients without HIV more often had private insurance and a lower modified Charlson-Deyo comorbidity score.
Multivariate analysis found that HIV patients with every examined cancer type but anal cancer were significantly less likely to receive cancer treatment than those without HIV. This disparity was most apparent among cervix (adjusted OR = 2.81; 95% CI, 1.77-4.45), upper GI (adjusted OR = 2.62; 95% CI, 2.04-3.37) and lung (adjusted OR = 2.46; 95% CI, 2.19-2.76) cancer patients. While predictors of unreceived cancer treatment varied by tumor type, black race and no private insurance were both associated with missed cancer treatment.
“These findings suggest that cancer care providers and policymakers need to devote special attention to the HIV-infected patient population to understand and address the factors driving differential cancer treatment,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
We have long known of the association of HIV infection and cancer risk. With more effective HIV therapy some, but not all, cancers are seen less often. Still, all patients with HIV and cancer deserve the best possible cancer management.
This study adds troubling new information to our concern that HIV-infected persons often receive less appropriate care than those without this infection. Whether this is a reflection of economic issues or other factors is not yet completely clear, but this area should be urgently investigated. Our advances in treating HIV will have less impact if other care is not being provided.
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