Black patients, uninsured less likely to receive chemotherapy for HIV–associated lymphoma
Patients who are older, black or without private insurance tended to be less likely to receive chemotherapy treatment for HIV–related lymphomas, according to an analysis of data from the National Cancer Data Base.
Further, chemotherapy prolonged OS for patients with certain HIV–associated lymphomas.
Adam J. Olszewski
“Non-Hodgkin lymphoma is one of the most serious complications of infection with HIV because of its aggressive course and need for intensive chemotherapy,” Adam J. Olszewski, MD, assistant professor at the Alpert Medical School of Brown University, and colleagues wrote. “Recent data indicate disparities in cancer treatments among HIV–infected patients that are particularly important in the setting of curative chemotherapy for NHL.”
Olszewski and colleagues compared demographic, treatment and survival trends for 10,769 HIV–positive patients (33.2% black; 38.6% privately insured) and 311,081 HIV–negative patients (7% black; 38.5% privately insured) diagnosed with NHL between 2004 and 2012.
During the study period, the incidence of HIV–associated lymphoma decreased from 1,329 to 896 diagnoses per year. Diagnoses decreased by more than 50% in white individuals compared with 17% in Hispanic individuals and 7% in black individuals (P < .00001).
The declines were greatest in diagnoses of primary central nervous system lymphoma, diffuse large B-cell lymphoma (DLBCL), and indolent B-cell and T-cell histologies. The proportion of cases that were Burkitt lymphoma increased from 13% to 19% (P < .00001).
Seventy-four percent of HIV–positive patients received chemotherapy. This included 90% of patients with Burkitt lymphoma, 81% of patients with DLBCL, 61% of patients with primary effusion lymphoma and 35% of patients with primary central nervous system lymphoma. Researchers evaluated factors associated with nonreceipt of chemotherapy among patients with DLBCL and Burkitt lymphoma because these two subtypes require immediate systemic treatment.
Nonreceipt of chemotherapy was associated with black race (HR = 1.41; 95% CI, 1.18-1.68), age 60 to 74 years (HR = 1.63; 95% CI, 1.24-2.14), and age 75 years or older (HR = 2.27; 95% CI, 1.58-3.26).
Further, patients were less likely to receive chemotherapy if they were uninsured (HR = 2.11; 95% CI, 1.67-2.67), or had Medicaid (HR = 1.55; 95% CI, 1.29-1.87) or Medicare (HR = 1.55; 95% CI, 1.26-1.92).
Patients with HIV–associated lymphoma were more likely to receive chemotherapy if they were treated at academic hospitals (OR for nonreceipt = 0.68; 95% CI, 0.51-0.92) and hospitals with three or more HIV–positive lymphoma cases per year (OR for nonreceipt= 0.71; 95% CI, 0.58-0.86).
Chemotherapy prolonged OS for patients with HIV–associated DLBCL (P = .007), Burkitt lymphoma (P = .0002), and primary central nervous system lymphoma (P = .019). However, chemotherapy receipt was not associated with a significant survival improvement for patients with primary effusion lymphoma.
Researchers acknowledged that the National Cancer Data Base does not provide complete population-based data, which may have limited findings.
“Significant sociodemographic disparities in treatment delivery need to be addressed in view of the evolving epidemiology,” Olszewski and colleagues wrote.
These data may help address care disparities, disease prevention and survivorship issues that surround HIV and HIV–associated lymphomas, Clifford J. Gunthel, MD, associate professor of medicine, and Mary Jo Lechowicz, MD, vice chair for education in the hematology and oncology department, both of Winship Cancer Institute at Emory University, wrote in an accompanying editorial.
“As the future of HIV care moves more in the direction of HIV elimination and cure, it is not difficult to envision how the treatment of HIV–associated lymphoma could combine these goals,” they wrote. “This may be the time to have the goal of dual cure — HIV and cancer — for our patients.” – by Nick Andrews
Disclos ure: Olszewski reports fees from Bristol-Myers Squibb and other support from Genentech. Lechowicz reports fees form Seattle Genetics, Spectrum, and Solignix. One other researcher reports grant support and fees from Biogen, Gilead, Millennium, Otsuka and Pharmacyclics.