made great progress treating people who are infected with HIV,
but if they get cancer they’re less likely to get the care
they need, a recent study found.
examined treatment for a variety of cancers, including upper
gastrointestinal tract, colorectal, prostate, lung, head and
neck, cervix, breast, anal and two blood cancers. With the
exception of anal cancer, treatment rates differed
significantly between HIV-infected people and those who weren’t
infected, according to the study.
example, 33 percent of patients with HIV and lung cancer
failed to receive any treatment for the cancer compared with
14 percent of those who weren’t infected. Similarly, 44
percent of people who were HIV positive didn’t receive
treatment for upper GI cancer versus 18 percent of those where
weren’t infected with HIV. Twenty-four percent of men with
prostate cancer who were HIV positive didn’t get treatment
compared with 7 percent of non-HIV infected men.
treatment was defined as radiation, chemotherapy and/or
have made such great strides with treating HIV only to have
them succumb to cancer is devastating," said Dr. Gita
Suneja, a radiation oncologist at the University of Utah’s
Huntsman Cancer Institute in Salt Lake City and the lead
author of the study. It was published online this month in the
study used the National Cancer Data Base to analyze treatment
for adults younger than 65 who were diagnosed with any of the
10 most common cancers to affect HIV patients between 2003 and
2011. The study included 10,265 HIV-infected adults and 2.2
million without HIV.
base, which is sponsored by the American Cancer Society and
the American College of Surgeons, captures roughly 70 percent
of newly diagnosed cancer cases in the United States.
study noted that more than a third of the patients with HIV
had stage 4 cancer — cancer that has metastasized — when
they were diagnosed, while only 19 percent of those without
in antiretroviral therapy to treat HIV have helped reduce the
incidence of cancers such as Kaposi sarcoma that are closely
linked to AIDS, but rates for other cancers often associated
with normal aging have increased among HIV patients. In
addition, people with HIV have a higher incidence of some
lifestyle-related cancers, such as lung cancer, which could be
linked to higher rates of smoking. Cancer is now the second
most common cause of death among HIV-infected people, behind
patients are more likely to be uninsured or underinsured, and
lack of coverage can affect access to cancer care. But having
insurance didn’t eliminate the problem: privately insured
people with HIV were significantly more likely to be untreated
for many cancers than were privately insured people without
HIV, the study found.
know that people with Medicaid or who are uninsured receive
subpar cancer treatment, and that’s a big public health
issue," said Suneja. "But even factoring that in,
HIV-infected people are still less likely to receive cancer
treatment. That means there are other drivers that we couldn’t
measure in the study."
in cancer treatment could exist for several reasons. For one
thing, for most cancers there are no national treatment
guidelines for HIV-infected patients, Suneja said. One of the
few exceptions is anal cancer, the only cancer for which the
study found little discrepancy in treatment among HIV-infected
and non-infected patients. According to the research, the
difference among those not receiving treatment was 4.8 percent
for HIV patients versus 3.1 percent for others.
other cancers, "the oncologist may pause and ask, ‘Does
the HIV infection mean they shouldn’t get standard cancer
treatment?’" Suneja added.