Improving Cancer Care in the HIV Population: Qualitative Research to Identify Provider Knowledge, Attitudes and Practices

Abstract

<h3>Purpose/Objective(s)</h3> Cancer patients living with HIV are less likely to receive cancer treatment and have worse cancer survival than HIV-uninfected patients. There is minimal published data exploring drivers of the disparity and even less on mitigation strategies. We aimed to explore clinician cancer treatment decision-making for patients living with HIV, focusing on oncologist knowledge, attitudes, and practices. <h3>Materials/Methods</h3> We conducted semi-structured in-depth interviews with 25 medical, radiation, and surgical oncologists from two academic medical centers and several community practices. Participants were eligible if they recently had a consultation with a patient with both HIV and cancer as assessed through medical record review at the academic centers and by self-report for community practices. The interview guide explored oncologist attitudes, stigma, knowledge, and practices during the cancer treatment decision-making process. We audio recorded and transcribed interviews and analyzed data using an open, iterative analysis approach with ATLAS.ti. <h3>Results</h3> Study participants were 32% medical oncology, 40% radiation oncology, and 28% surgical oncology. Most (64%) were within 15 years of terminal training and between 30 and 49 years of age (84%). Many (n=14) participants described knowledge gaps on HIV-specific education during medical school and subsequent oncology training as an impediment to providing optimal care to people with HIV. Oncologists noted that patients often had financial, logistic, and psychosocial challenges that were not adequately addressed in the clinical setting. Although oncologists themselves felt comfortable discussing HIV, some (n=8) reported concerns regarding inadvertent HIV disclosure resulting in stigma from patient companions or caregivers unaware of the HIV diagnosis. Less than half of oncologists (n=11) reported collaborating with the patient's HIV care team before and during cancer therapy. <h3>Conclusion</h3> This qualitative study of oncologists in the US demonstrates that oncologists face challenges when caring for people with HIV. Point of care tools, particularly those geared towards enhancing oncologist education and connection with other care teams such as HIV/infectious diseases and social work, may enhance cancer care and reduce cancer disparities for people living with HIV.