HIV, cancer, and coping: The cumulative burden of a cancer diagnosis among people living with HIV

Knettel, Brandon A.; Corrigan, Kelsey L.; Cherenack, Emily M.; Ho, Noelani; Carr, Stuart; Cahill, Joan; Chino, Junzo; Ubel, Peter A.; Watt, Melissa H.; Suneja, Gita

doi:10.1080/07347332.2020.1867691

Cited by 14 publications

(14 citation statements)

References 38 publications

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“…PLWH with cancer experience a disproportionate burden of barriers to care because of documented experiences related to discrimination and stigma because of their HIV status. 3,17 These societal barriers to care can lead to poorer cancer outcomes, such as higher rates of mortality, and adverse mental health symptoms such as stress, depression, and anxiety. 38 Palliative care can directly address these adverse outcomes as the overall goal of PC is to anticipate, prevent, and reduce physical and psychosocial suffering, regardless of the stage of disease or curative treatment plans.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15] Benefits also include higher satisfaction with cancer care and fewer patients receiving unnecessary invasive measures at the end of life. The benefits of PC are particularly salient in the context of HIV, given that PLWH are more likely to experience a high burden of poor mental health outcomes, including depression, because of several factors including internalized HIV-related stigma, 16,17 experiences of discrimination in the health care setting, 18 the reality of living with a chronic condition, and social inequities that disproportionately burden PLWH in the United States. 19 Therefore, provision of PC is an important component of quality cancer care among PLWH.…”

Section: Introductionmentioning

confidence: 99%

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Palliative Care Use Among People Living With HIV and Cancer: An Analysis of the National Cancer Database (2004-2018)

Islam

Nogueira

Suneja

et al. 2022

JCO Oncology Practice

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PURPOSE: People living with HIV (PLWH) diagnosed with cancer are less likely to receive quality cancer treatment compared with HIV-negative patients. Timely provision of palliative care (PC) during cancer treatment can increase patient's survival and improve quality of life. Our objective was to compare the use of PC by HIV status among adults diagnosed with cancer in the United States. METHODS: More than 19 million individuals age 18-90 years diagnosed with the 11 most common cancers among PLWH were selected from the National Cancer Database (2004-2018). The National Cancer Database defined PC as any surgery, radiation, systemic therapy, or pain management treatment with noncurative intent. Multivariable logistic regression was used to examine associations between HIV status and PC receipt by cancer site and stage after adjustment for covariates. RESULTS: The study population included 52,306 HIV-positive (average age: 56.5 years) and 19,115,520 HIV-negative (average age: 63.7 years) cancer cases. PLWH diagnosed with stage I-III cancer were more likely to receive PC compared with their HIV-negative counterparts (adjusted odds ratio [aO]: 1.96; 95% CI, 1.80 to 2.14); however, they were also less likely to receive curative cancer treatment (aOR, 0.48; 95% CI, 0.40 to 0.59). PLWH diagnosed with stage IV cancer were less likely to receive PC (aOR, 0.70; 95% CI, 0.66 to 0.74) compared with HIV-negative patients. When evaluated by cancer site, PLWH diagnosed with stage IV lung (aOR, 0.80; 95% CI, 0.73 to 0.87) and colorectal (aOR, 0.72, 95% CI, 0.54 to 0.95) cancers were less likely to receive PC than HIV-negative patients. CONCLUSION: PLWH diagnosed with stage IV cancer, particularly lung and colorectal cancers, were less likely to receive PC compared with cancer patients without HIV. PLWH with nonmetastatic disease were more likely to receive PC but less likely to receive curative treatment, reinforcing that clinical strategies are needed to improve the quality of care among PLWH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Palliative Care Use Among People Living With HIV and Cancer: An Analysis of the National Cancer Database (2004-2018)

Islam

Nogueira

Suneja

et al. 2022

JCO Oncology Practice

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“…Stigma from HIV-related cancers may be a barrier to diagnosis beyond SSA as well. 28 After being clinically diagnosed with KS, a major barrier for patients was being referred to a specialty hospital for a skin biopsy, which is critical for the diagnosis of KS. [29][30][31] The difficulties patients faced in receiving a skin biopsy points to the need to decentralize specialty services such as skin biopsy availability to primary care facilities and health centers.…”

Section: Discussionmentioning

confidence: 99%

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study

McMahon

Chemtai

Grant

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described.Methods:We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis.Results:The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support.Conclusions:Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.

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“…There are also differences in the type of treatment provided 84 . Drivers of cancer treatment disparities include social and structural determinants of health that impede access to care, including HIV stigma leading to decreased disclosure, limited training for oncologists and lack of interdisciplinary management with HIV specialists, and exclusion of PLWH from clinical trial eligibility 85,86 …”

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI

Engels,

Shiels,

Barnabas

et al. 2023

Intl Journal of Cancer

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An estimated 38 million people live with human immunodeficiency virus (HIV) worldwide and are at excess risk for multiple cancer types. Elevated cancer risks in people living with HIV (PLWH) are driven primarily by increased exposure to carcinogens, most notably oncogenic viruses acquired through shared transmission routes, plus acceleration of viral carcinogenesis by HIV‐related immunosuppression. In the era of widespread antiretroviral therapy (ART), life expectancy of PLWH has increased, with cancer now a leading cause of co‐morbidity and death. Furthermore, the types of cancers occurring among PLWH are shifting over time and vary in their relative burden in different parts of the world. In this context, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) convened a meeting in September 2022 of multinational and multidisciplinary experts to focus on cancer in PLWH. This report summarizes the proceedings, including a review of the state of the science of cancer descriptive epidemiology, etiology, molecular tumor characterization, primary and secondary prevention, treatment disparities and survival in PLWH around the world. A consensus of key research priorities and recommendations in these domains is also presented.

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HIV, cancer, and coping: The cumulative burden of a cancer diagnosis among people living with HIV

Cited by 14 publications

References 38 publications

Palliative Care Use Among People Living With HIV and Cancer: An Analysis of the National Cancer Database (2004-2018)

Palliative Care Use Among People Living With HIV and Cancer: An Analysis of the National Cancer Database (2004-2018)

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study

State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI

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