Cancer Treatment Disparities in Elderly HIV-Infected Americans Warrant Attention

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Cancer treatment rates for HIV-infected seniors were lowest among the younger subset of patients, who would likely benefit most from treatment, in terms of life expectancy.
Cancer treatment rates for HIV-infected seniors were lowest among the younger subset of patients, who would likely benefit most from treatment, in terms of life expectancy.

A study published in Clinical Infectious Diseases found that cancer treatment rates for HIV-infected seniors were lowest among the younger subset of patients, who would likely benefit most from treatment in terms of life expectancy.

Data from 930,359 Americans aged 66 to 99 years diagnosed with 1 of the 10 most common cancers were studied. Surveillance, Epidemiology, and End Results (SEER) Medicare claims from 1991 to 2011 were used to determine HIV status and receipt of cancer treatment 6 months after diagnosis.

Investigators found that HIV-infected individuals were less likely to receive cancer treatment, at 70% vs 75% for uninfected individuals (P <.01). The difference grew to 65% of HIV-infected vs 81% uninfected (P <.01) for those ≤70 years of age, and the time from diagnosis to treatment was also larger (median, 42.5 vs 36 days for HIV-uninfected; P <.01).

After accounting for potential confounders, these individuals were still 20% less likely to get cancer treatment (hazard ratio, 0.81; 95% CI, 0.71-0.92).

The percentage of this total effect that was a result of HIV itself was 75%, with the remaining 25% determined to be nonsignificant and mediated by cancer stage and comorbidities.

Important indicators of HIV progression and antiretroviral drug claims were not available in the SEER database so the extent to which HIV severity or ART use is associated with cancer treatment was not studied. Also, analyzing the details of complex treatment algorithms was beyond the study scope, but investigators believe future work should address "whether the types or completeness of treatment, and subsequent survival, differ by HIV status and effective ART use."

The population-based design of the study allowed investigators to research several common cancers at once in a representative population, and this study is 1 of the largest possible samples of older HIV-infected adults with cancer. The elderly population is at high risk for cancer, yet data specific to cancer treatment in aging patients with HIV are limited.

The results "highlight the need for a multi-level evaluation of barriers to care and for multidisciplinary teams to manage these complex cases, particularly younger individuals with common cancers who currently experience low treatment rates."

Reference

Rositch A, Jiang S, Coghill A, Suneja G, Engels E. Disparities and determinants of cancer treatment in elderly Americans living with HIV/AIDS. [published online April 27 2018]. Clin Infect Dis. Doi 1sd.1093/cid/ciy373

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