Advanced stage at diagnosis and elevated mortality among US patients with cancer infected with HIV in the National Cancer Data Base. Issue 16 (3rd May 2019)

• Record Type: Journal Article
• Authors: Coghill, Anna E.; Han, Xuesong; Suneja, Gita; Lin, Chun Chieh; Jemal, Ahmedin; Shiels, Meredith S.
• Is Part Of: Cancer. Volume 125:Issue 16(2019)
• Page Start: 2868
• Page End: 2876
• Publication Date: 2019-05-03
• Subjects: cancer patient mortality -- cancer stage -- health insurance and mortality -- HIV and cancer -- National Cancer Data Base; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32158
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: People living with HIV (PLWH) are at an increased risk of developing several cancers, but to the authors' knowledge less is known regarding how HIV impacts the rate of progression to advanced cancer or death. Methods: The authors compared stage of disease at the time of presentation and mortality after diagnosis between 14, 453 PLWH and 6, 368, 126 HIV‐uninfected patients diagnosed with cancers of the oral cavity, stomach, colorectum, anus, liver, pancreas, lung, female breast, cervix, prostate, bladder, kidney, and thyroid and melanoma using data from the National Cancer Data Base (2004‐2014). Polytomous logistic regression and Cox proportional hazards regression were used to evaluate the association between HIV, cancer stage, and stage‐adjusted mortality after diagnosis, respectively. Regression models accounted for the type of health facility at which cancer treatment was administered and the type of individual health insurance. Results: HIV‐infected patients with cancer were found to be more likely to be uninsured (HIV‐infected: 5.0% vs HIV‐uninfected: 3.3%; P < .0001) and were less likely to have private health insurance (25.4% vs 44.7%; P < .0001). Compared with those not infected with HIV, the odds of being diagnosed at an advanced stage of disease were significantly elevated in PLWH for melanoma and cancers of the oral cavity, liver, female breast, prostate, and thyroid (odds ratio for stage IV vs stage I range, 1.24‐2.06). PLWH who were diagnosed with stage I to stage III disease experienced elevated mortality after diagnosis across 13 of the 14 cancer sites evaluated, with hazard ratios ranging from 1.20 (95% CI, 1.14‐1.26) for lung cancer to 1.85 (95% CI, 1.68‐2.04), 1.85 (95% CI, 1.51‐2.27), and 2.93 (95% CI, 2.08‐4.13), respectively, for cancers of the female breast, cervix, and thyroid. Conclusions: PLWH were more likely to be diagnosed with advanced‐stage cancers and to experience elevated mortality after a cancer diagnosis, even after accounting for health care–related factors. Abstract : Individuals living with HIV are more likely to be diagnosed with advanced‐stage cancers and to experience elevated mortality after their cancer diagnosis, even after accounting for health care–related factors. In the current study, the authors compare stage of disease at the time of presentation and mortality after diagnosis between 14, 453 individuals infected with HIV and 6, 368, 126 HIV‐uninfected patients diagnosed with cancers of the oral cavity, stomach, colorectum, anus, liver, pancreas, lung, female breast, cervix, prostate, bladder, kidney, and thyroid and melanoma using data from the National Cancer Data Base.