HIV patients undertreated for lymphoma, other cancers

HIV budding from a

cultured lymphocyte

Image courtesy of the CDC

A new study suggests that cancer patients with HIV are less likely to receive cancer treatment, regardless of insurance status and comorbidities.

Patients with HIV were less likely than their HIV-free peers to receive treatment for Hodgkin lymphoma, diffuse large B-cell lymphoma, and 7 solid tumor malignancies.

Gita Suneja, MD, of the University of Utah in Salt Lake City, and her colleagues reported these findings in Cancer.

The team used the National Cancer Data Base to study non-elderly US adults diagnosed with 10 common cancers from 2003 to 2011. There were a total of 10,265 HIV-infected patients and 2,219,232 HIV-free patients.

The researchers examined associations between HIV status and lack of cancer treatment, taking into account insurance status and comorbidities.

The results showed a lack of treatment among HIV patients for all of the cancers studied except anal cancer (relative risk [RR]=1.20, P=0.333).

So HIV-infected patients were more likely to lack cancer treatment for:

• Hodgkin lymphoma (RR=1.92, P<0.001)
• Diffuse large B-cell lymphoma (RR=1.82, P<0.001)
• Head and neck cancer (RR=1.48, P=0.013)
• Upper gastrointestinal tract cancer (RR=2.62, P<0.001)
• Colorectal cancer (RR=1.70, P=0.006)
• Lung cancer (RR=2.46, P<0.001)
• Breast cancer (RR=2.14, P=0.015)
• Cervical cancer (RR=2.81, P<0.001)
• Prostate cancer (RR=2.16, P<0.001).

The researchers said factors that predicted a lack of cancer treatment among HIV-infected individuals varied between those with solid tumors and those with lymphomas.

Advanced stage at the time of cancer diagnosis (stage IV vs stage I) meant HIV patients with solid tumors were less likely to receive cancer treatment, but lymphoma patients were more likely to receive cancer treatment.

Having a higher modified Charlson-Deyo comorbidity score (1 or 2+ vs 0) predicted a lack of cancer treatment for HIV-infected patients with lymphoma but not those with solid tumors.

And older age (45-64 vs 18-44) was associated with a lack of treatment for HIV-infected patients regardless of cancer type, but this was only significant for lymphoma patients.

For the entire cohort, black race (vs white) and a lack of private insurance (Medicaid, Medicare, uninsured, or unknown insurance status) were significant predictors for a lack of cancer treatment among HIV patients.

Still, the researchers noted that, even among privately insured patients, HIV-infected individuals were less likely to receive cancer treatment.

Dr Suneja and her colleagues said several factors may contribute to these findings. For one, HIV-infected patients have historically been excluded from cancer clinical trials, thereby limiting the applicability of trial results for this population.

In addition, cancer treatment guidelines specific to HIV-infected patients are not available for most cancer types. And clinicians may lack experience treating HIV-infected patients with cancer.

Furthermore, the psychosocial and economic challenges associated with the dual management of cancer and HIV treatment may make adherence to treatment a challenge.

HIV budding from a

cultured lymphocyte

Image courtesy of the CDC

A new study suggests that cancer patients with HIV are less likely to receive cancer treatment, regardless of insurance status and comorbidities.

Patients with HIV were less likely than their HIV-free peers to receive treatment for Hodgkin lymphoma, diffuse large B-cell lymphoma, and 7 solid tumor malignancies.

Gita Suneja, MD, of the University of Utah in Salt Lake City, and her colleagues reported these findings in Cancer.

The team used the National Cancer Data Base to study non-elderly US adults diagnosed with 10 common cancers from 2003 to 2011. There were a total of 10,265 HIV-infected patients and 2,219,232 HIV-free patients.

The researchers examined associations between HIV status and lack of cancer treatment, taking into account insurance status and comorbidities.

The results showed a lack of treatment among HIV patients for all of the cancers studied except anal cancer (relative risk [RR]=1.20, P=0.333).

So HIV-infected patients were more likely to lack cancer treatment for:

• Hodgkin lymphoma (RR=1.92, P<0.001)
• Diffuse large B-cell lymphoma (RR=1.82, P<0.001)
• Head and neck cancer (RR=1.48, P=0.013)
• Upper gastrointestinal tract cancer (RR=2.62, P<0.001)
• Colorectal cancer (RR=1.70, P=0.006)
• Lung cancer (RR=2.46, P<0.001)
• Breast cancer (RR=2.14, P=0.015)
• Cervical cancer (RR=2.81, P<0.001)
• Prostate cancer (RR=2.16, P<0.001).

The researchers said factors that predicted a lack of cancer treatment among HIV-infected individuals varied between those with solid tumors and those with lymphomas.

Advanced stage at the time of cancer diagnosis (stage IV vs stage I) meant HIV patients with solid tumors were less likely to receive cancer treatment, but lymphoma patients were more likely to receive cancer treatment.

Having a higher modified Charlson-Deyo comorbidity score (1 or 2+ vs 0) predicted a lack of cancer treatment for HIV-infected patients with lymphoma but not those with solid tumors.

And older age (45-64 vs 18-44) was associated with a lack of treatment for HIV-infected patients regardless of cancer type, but this was only significant for lymphoma patients.

For the entire cohort, black race (vs white) and a lack of private insurance (Medicaid, Medicare, uninsured, or unknown insurance status) were significant predictors for a lack of cancer treatment among HIV patients.

Still, the researchers noted that, even among privately insured patients, HIV-infected individuals were less likely to receive cancer treatment.

Dr Suneja and her colleagues said several factors may contribute to these findings. For one, HIV-infected patients have historically been excluded from cancer clinical trials, thereby limiting the applicability of trial results for this population.

In addition, cancer treatment guidelines specific to HIV-infected patients are not available for most cancer types. And clinicians may lack experience treating HIV-infected patients with cancer.

Furthermore, the psychosocial and economic challenges associated with the dual management of cancer and HIV treatment may make adherence to treatment a challenge.

HIV budding from a

cultured lymphocyte

Image courtesy of the CDC

A new study suggests that cancer patients with HIV are less likely to receive cancer treatment, regardless of insurance status and comorbidities.

Patients with HIV were less likely than their HIV-free peers to receive treatment for Hodgkin lymphoma, diffuse large B-cell lymphoma, and 7 solid tumor malignancies.

Gita Suneja, MD, of the University of Utah in Salt Lake City, and her colleagues reported these findings in Cancer.

The team used the National Cancer Data Base to study non-elderly US adults diagnosed with 10 common cancers from 2003 to 2011. There were a total of 10,265 HIV-infected patients and 2,219,232 HIV-free patients.

The researchers examined associations between HIV status and lack of cancer treatment, taking into account insurance status and comorbidities.

The results showed a lack of treatment among HIV patients for all of the cancers studied except anal cancer (relative risk [RR]=1.20, P=0.333).

So HIV-infected patients were more likely to lack cancer treatment for:

• Hodgkin lymphoma (RR=1.92, P<0.001)
• Diffuse large B-cell lymphoma (RR=1.82, P<0.001)
• Head and neck cancer (RR=1.48, P=0.013)
• Upper gastrointestinal tract cancer (RR=2.62, P<0.001)
• Colorectal cancer (RR=1.70, P=0.006)
• Lung cancer (RR=2.46, P<0.001)
• Breast cancer (RR=2.14, P=0.015)
• Cervical cancer (RR=2.81, P<0.001)
• Prostate cancer (RR=2.16, P<0.001).

The researchers said factors that predicted a lack of cancer treatment among HIV-infected individuals varied between those with solid tumors and those with lymphomas.

Advanced stage at the time of cancer diagnosis (stage IV vs stage I) meant HIV patients with solid tumors were less likely to receive cancer treatment, but lymphoma patients were more likely to receive cancer treatment.

Having a higher modified Charlson-Deyo comorbidity score (1 or 2+ vs 0) predicted a lack of cancer treatment for HIV-infected patients with lymphoma but not those with solid tumors.

And older age (45-64 vs 18-44) was associated with a lack of treatment for HIV-infected patients regardless of cancer type, but this was only significant for lymphoma patients.

For the entire cohort, black race (vs white) and a lack of private insurance (Medicaid, Medicare, uninsured, or unknown insurance status) were significant predictors for a lack of cancer treatment among HIV patients.

Still, the researchers noted that, even among privately insured patients, HIV-infected individuals were less likely to receive cancer treatment.

Dr Suneja and her colleagues said several factors may contribute to these findings. For one, HIV-infected patients have historically been excluded from cancer clinical trials, thereby limiting the applicability of trial results for this population.

In addition, cancer treatment guidelines specific to HIV-infected patients are not available for most cancer types. And clinicians may lack experience treating HIV-infected patients with cancer.

Furthermore, the psychosocial and economic challenges associated with the dual management of cancer and HIV treatment may make adherence to treatment a challenge.