Study Shows Disparities in Cancer Care for HIV-Positive Individuals

A recent study published in the journal Cancer revealed that HIV-infected adults were less likely to be treated for cancer than their non-infected counterparts.

In addition to insurance and comorbidities, there are several factors that play a role in the treatment. They include demographics, psychosocial and economic challenges, access to clinical trials and physician concern.

Researchers observed the treatment for cancer of 10,265 HIV-infected people compared with more than two million without HIV. The study focused on the 10 most common cancers among HIV patients: cancers of the head and neck (oral cavity, pharynx and larynx), upper gastrointestinal tract (pancreas, stomach and esophagus), colorectal, anal, lung, female breast, cervical and prostate; Hodgkin lymphoma; and diffuse large B-cell lymphoma (DLBCL).

Demographics differed between the HIV-infected group and the HIV-uninfected group. HIV-infected patients were often younger, male, non-Hispanic black and Hispanic. Most HIV-infected patients had Medicaid, Medicare or no insurance at all as opposed to private insurance, which was held by a majority of the HIV-uninfected group. Additionally, more HIV-infected patients were diagnosed with stage 4 cancer than HIV-uninfected patients (37.2 vs 18.9 percent). HIV-uninfected patients, on the other hand, were often diagnosed with stage 1 or 2 cancers (57.2 vs 33.2 percent).

Two of the biggest finds were that black patients and with Medicaid, Medicare or no insurance were more likely to be untreated for cancer, regardless of tumor type; and that older age was associated with a lack of treatment for both lymphomas and solid tumors.

The treatment of the upper gastrointestinal tract, colorectal, lung, breast, prostate, Hodgkin lymphoma and DLBCL cancers was significantly less for HIV-infected patients with private insurance compared with HIV-uninfected also privately insured. The only cancer treatment where rates did not differ significantly was for HIV-infected and HIV-uninfected patients with anal cancer.

As a whole, people with Medicaid or no insurance were found to be diagnosed with advanced stages of cancer, less likely to receive treatment and had a worse survival rate, according to a study of nonelderly adults in the Surveillance, Epidemiology and End Results (SEER) database. Since most HIV-infected individuals had Medicaid and Medicare insurance or no insurance at all, this played a role in the accessibility and quality of their treatment; however, other limitations as a result of HIV have impacted patients’ treatments for cancer. For instance, the study’s authors speculate that HIV-infected people may take part in activities, such as intravenous drug use, smoking or drinking, that could negatively affect treatments for cancer.

There are also limitations on guidelines for how to treat HIV-infected patients with cancer because HIV-positive patients have been excluded from clinical trials, they wrote.

A survey of American medical and radiation oncologists also found physicians are less likely to offer cancer treatment to HIV-infected individuals if they have concerns about the efficacy or toxicity of treatment.

HIV-infected patients are more susceptible to various types of cancer because their immune systems have been weakened by the infection. This then affects the body’s ability to fight off other infections that could lead to cancer.

While those with HIV struggle to find adequate care for cancer, the issue is more widespread, which the authors of the study urge needs to be changed.

“Cancer care providers and policy makers need to devote special attention to the HIV-infected patient population to understand and address the factors driving differential cancer treatment,” the authors wrote.

“Cancer treatment not only extends survival from cancer, but also can improve quality of life, even for patients with advanced stage disease.”