Patients With HIV Plus Cancer May Not Receive Equitable Treatment

Cancer patients with HIV do not receive curative or palliative care in the same way as their HIV-negative peers, according to a study published in JCO Oncology Practice. 

The study showed that patients with stage I-III cancer were less likely to receive curative treatment if they had HIV, and patients with stage IV cancer were less likely to receive palliative care if they had HIV.

Recent National Comprehensive Cancer Network guidelines have recommended that cancer patients with HIV be offered the same therapy as cancer patients without HIV. 

To assess treatment difference between these groups, researchers analyzed data from the US National Cancer Database. 

The study included more than 19 million people, ages 18 to 90 years, who were diagnosed with 11 common cancers — prostate, breast, upper gastrointestinal tract, anal, colorectal, lung, cervical, and head and neck cancers, as well as Kaposi sarcoma, Hodgkin lymphoma, and diffuse large B-cell lymphoma. 

In this cohort, there were 52,306 HIV-positive cases and 19,115,520 HIV-negative cases. 

Overall, patients with HIV were more likely than those without HIV to receive palliative care (adjusted odds ratio [aOR], 1.25; 95% CI, 1.20-1.30).

Among patients with stage I-III cancer, those with HIV were more likely to receive palliative care (aOR, 1.96; 95% CI, 1.80-2.13) but less likely to receive curative cancer treatment (aOR, 0.51; 95% CI, 0.49-0.53). 

Among patients with stage IV cancer, those with HIV were less likely to receive palliative care than those without HIV (aOR, 0.70; 95% CI, 0.66-0.74). 

When the researchers looked at data by cancer site, they found that HIV-positive patients with stage IV lung cancer had 20% lower odds of receiving palliative care than their HIV-negative counterparts (aOR, 0.80; 95% CI, 0.73-0.87). 

Among patients with stage IV colorectal cancer, those with HIV had 28% lower odds of receiving palliative care (aOR, 0.72; 95% CI, 0.54-0.95). 

“The present study demonstrates an opportunity to improve equitable delivery of high-quality cancer care to HIV-positive cancer patients,” the researchers wrote. “Withholding cancer treatment, both curative and palliative, can lead to loss of quantity and quality of life, leading to downstream impacts on the social and economic livelihood of HIV-positive patients and their families. HIV status should not guide cancer treatment guidelines, and PLWH [people living with HIV] should have equal access to guideline-adherent, high-quality cancer care.”

Reference

Islam JY, Nogueira L, Suneja G, Coghil A, Akinyemiju T. Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018). JCO Oncology Practice. Published online July 22, 2022. doi:10.1200/OP.22.00181

This article originally appeared on Cancer Therapy Advisor