Gynecologic cancer in HIV-infected women: treatment and outcomes in a multi-institutional cohort. (14th January 2018)

• Record Type: Journal Article
• Authors: Levinson, Kimberly L.; Riedel, David J.; Ojalvo, Laureen S.; Chan, Wesley; Angarita, Ana M.; Fader, Amanda N.; Rositch, Anne F.
• Is Part Of: AIDS. Volume 32:Number 2(2018)
• Publication Date: 2018-01-14
• Subjects: HIV -- ovarian neoplasms -- practice guideline -- survival -- uterine cervical neoplasms -- uterine neoplasms -- vulvar neoplasms; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001664
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: To evaluate gynecologic cancer treatments in HIV-infected women for adherence to National Comprehensive Cancer Network (NCCN) guidelines and to describe survival by adherence to guidelines. Design: Beyond cervical cancer, there are little data on treatment and outcomes for these women. This is a retrospective cohort study of HIV-infected women with gynecologic cancers. Methods: HIV-infected women with gynecologic cancers from 2000 to 2015 were identified at two urban, comprehensive cancer centers. Chart reviews extracted demographic, HIV, and cancer-related variables. Cancer treatment was evaluated for adherence to NCCN guidelines. Overall survival was compared between those who received NCCN adherent and nonadherent cancer care. Results: Fifty-seven women were identified; 15 vulvar (26%), 26 cervical (46%), nine ovarian (16%), and seven endometrial (12%) cancers. Median time from HIV to cancer diagnosis was 8.5 years, and 88% of women were black. Thirty patients (53%) had stage I, and 27 (47%) had stage II–IV disease. Overall, 28 women (49%) received NCCN-adherent care; 22 of 30 stage I (73%) and six of 27 stage II–IV patients (22%). Among 29 women not receiving NCCN-adherent care, 69% were due to patient-related factors or toxicity. Among women with II–IV cancers, 48-month survival was higher in women who received NCCN-adherent care than those who did not (60 versus 28%). Conclusion: Most HIV-infected women with advanced gynecologic cancers did not receive NCCN-adherent care and had worse survival compared to those who did. Focus on treatment-related toxicities and patient-related barriers to cancer care are necessary in this population. Abstract : Supplemental Digital Content is available in the text