Abstract PO-123: Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018)

Abstract

Abstract Background: Prior studies demonstrate that people living with HIV (PLWH) are less likely to receive any curative cancer treatment compared to their HIV-negative counterparts. Data regarding trends of palliative treatment use among PLWH with cancer are lacking. Timely intervention with palliative care can increase survival and improve patient-reported quality of life among all cancer patients, particularly those with metastatic disease. Our objective was to compare the use of palliative care by HIV status among patients with cancer in the United States. Methods: We used data from more than 19 million patients 18-90 years of age in the National Cancer Database diagnosed between 2004 and 2018. The eleven most common cancers diagnosed among PLWH were selected, including Kaposi Sarcoma, cancers of the head and neck, upper gastrointestinal tract, colorectum, anus, lung, female breast, cervix, and prostate, Hodgkin lymphoma, and diffuse large B-cell lymphoma (DLBCL). HIV status was determined from reported comorbidities using the ICD-9-CM diagnosis codes 04200-044.90, 07593, V0800 and ICD-10-CM codes B20-B22, B24, Z21. Palliative care was defined as any surgery, radiation, systemic therapy, or pain management treatment with non-curative intent. Multivariate logistic regression was used to examine associations between HIV-status and palliative care use by cancer site and stage-at diagnosis and adjusted for age at diagnosis, race/ethnicity, gender, insurance, geographic region, comorbidity index, and cancer diagnosis year. Results: The study population included 52,306 HIV-positive (Avg. age: 56.5 years) and 19,115, 520 HIV-negative (Avg. age: 63.7 years) cancer cases. PLWH with cancer were more likely to be Non-Hispanic (NH)-Black (35.1% vs. 10.8%, p<0.001) and Hispanic (11.2% vs. 5.6%, p<0.001) compared to HIV-negative cancer patients. PLWH with stage 1-3 cancer at diagnosis were more likely to receive palliative care compared to their HIV negative counterparts (aOR:1.96, 95% CI:1.80-2.14). Conversely, PLWH with stage-4 cancer at diagnosis were less likely to receive palliative care (aOR:0.70, 95% CI:0.66-0.74). When evaluated by cancer site, stage-4 lung (aOR:0.80, 95% CI: 0.73-0.87) and colorectal (aOR: 0.72, 95% CI: 0.54-0.95) HIV-positive cancer patients were less likely to receive palliative care than HIV-negative cancer patients. PLWH diagnosed with stage I-III cancer who received palliative care were less likely to receive curative cancer treatment (aOR:0.48, 95% CI:0.40-0.59). Conclusion: Overall, utilization of palliative care is low among PLWH with cancer. PLWH diagnosed with stage-four cancer, particularly lung and colorectal cancer patients, are less likely to receive palliative care compared to their HIV-negative counterparts. PLWH with non-metastatic disease are more likely to receive palliative care, reinforcing prior data that curative treatment is not offered. Efforts to address the overall low utilization and better understand disparate utilization by cancer stage among PLWH should be prioritized. Citation Format: Jessica Y. Islam, Leticia Nogueria, Gita Suneja, Anna Coghill, Tomi Akinyemiju. Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-123.