(PQ3) Addressing Cancer Treatment Disparities for Persons with HIV

(PQ3) 解决艾滋病毒感染者的癌症治疗差异

• 批准号: 10428369
• 负责人: Elizabeth Chiao
• 金额: $ 80.81万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10428369
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Adverse event; Aftercare; Age; Antitumor Response; CD4 Lymphocyte Count; Cancer Survivor; Cardiac; Caring; Cause of Death; Chronic; Clinical Trials; Cohort Studies; Data; Diagnosis; Disease; Dose; Electronic Health Record; Etiology; Event; General Population; Goals; HIV; HIV Infections; HIV diagnosis; HIV risk; Head Cancer; Head and Neck Cancer; Health; Health system; Hospitalization; Immune system; Immunologics; Immunosuppression; Institution; Integrated Health Care Systems; Intervention; Kidney; Knowledge; Late Effects; Life Expectancy; Lung; Lymphocyte; Lymphopenia; Malignant Neoplasms; Malignant neoplasm of anus; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medical Oncologist; Metabolic; Neck Cancer; Non-Small-Cell Lung Carcinoma; Outcome; Outcome Study; Patients; Persons; Process; Publishing; Radiation Oncologist; Radiation therapy; Recovery; Recurrence; Regimen; Risk; Risk Factors; Safety; Sampling; Second Primary Cancers; Serious Adverse Event; Single-Payer System; Site; Time; Toxic effect; United States; United States Department of Veterans Affairs; antiretroviral therapy; cancer care; cancer initiation; cancer recurrence; cancer risk; cancer survival; cancer therapy; care delivery; care outcomes; care providers; chemotherapy; common treatment; comorbidity; data resource; demographics; dosage; high risk; improved; improved outcome; mortality; mortality risk; neutrophil; novel; provider factors; study population; survival disparity; survivorship; therapy outcome; treatment disparity; treatment guidelines

PROJECT SUMMARY/ABSTRACT The introduction of combination antiretroviral therapy (ART) has led to a dramatic decline in AIDS-associated mortality. However, as persons with HIV (PWH) age, mortality from non-AIDS-defining cancer (NADC) continues to increase and is now the leading cause of death for PWH. Recent studies have demonstrated persistent disparities in both initiation of cancer therapy and survival among PWH and cancer compared with the general population. This may be due in part to medical and radiation oncologists' concerns regarding the safety and efficacy of cancer treatment for PWH. Alternatively, it is possible that chemotherapy with radiation therapy (CRT) and radiation therapy (RT) alone may be less effective in PWH or associated with greater toxicity. It is well established that positive cancer outcomes are dependent on successful navigation of all steps in the cancer care delivery process, including: timely treatment initiation, treatment completion, and treatment safety, defined by avoidance of serious adverse events (SAEs). It is also critical to evaluate the ongoing health needs of cancer survivors with HIV, including the risk of long-term chronic health conditions (i.e., late adverse effects) after cancer treatment. Prior studies have evaluated cancer treatment initiation rates for certain cancers, however, there have been no published studies that have comprehensively evaluated differences in outcomes at other key steps in the cancer care delivery process for PWH compared with people without HIV (HIV-), nor have there been studies that have evaluated patient- and provider-factors that might contribute to disparities at each step. We propose the following Specific Aims which will address these critical knowledge gaps for the four most common NADCs in PWH treated with CRT/RT (anal, head and neck, lung, or prostate cancer): Aim 1: To evaluate differences in the timing of cancer treatment initiation between PWH and matched HIV- with cancer, and risk factors for delayed treatment in PWH. Aim 2: To evaluate disparities in short-term SAEs and cancer treatment completions between PWH and matched HIV- patients who initiated CRT/RT. Aim 3: To evaluate the long-term risk of mortality and cancer recurrence comparing PWH with cancer and matched HIV- patients. Aim 4: To compare risk of chronic health conditions among PWH with cancer, with (a) HIV- with cancer and (b) PWH without cancer. In addition to evaluating differences in outcomes between PWH and HIV- patients with cancer, study aims will also evaluate the impacts of key potential risk factors, including: ART regimens, immunosuppression, and treatment dosage and completion, which may be associated with CRT/RT outcomes. This observational cohort study will identify >3,000 PWH diagnosed with cancer, 1:1 matched HIV- persons with the same cancers, and 4:1 matched PWH without cancer who have received care from the Veteran's Administration or Kaiser Permanente, the two largest single-payer integrated healthcare systems in the United States. Study findings will provide data to provide targets for cancer care delivery and treatment interventions, and inform HIV-specific cancer treatment guidelines to improve cancer survival among PWH.

项目摘要/摘要 抗逆转录病毒疗法（ART）的引入导致艾滋病相关的急剧下降 死亡。但是，作为患有艾滋病毒（PWH）年龄的人，非辅助癌症的死亡率（NADC） 继续增加，现在是PWH死亡的主要原因。最近的研究表明 与 普通人群。这可能部分是由于医学和辐射肿瘤学家对 PWH癌症治疗的安全性和功效。另外，有可能与放射线化疗 仅治疗（CRT）和放射疗法（RT）在PWH中的有效性可能较低，或者与更大的相关 毒性。众所周知，积极的癌症结果取决于成功导航的所有步骤 在癌症护理提供过程中，包括：及时治疗开始，治疗完成和治疗 安全，由避免严重不良事件（SAE）定义。评估正在进行的健康也是至关重要的 患有艾滋病毒的癌症幸存者的需求，包括长期慢性健康状况的风险（即晚期不良 癌症治疗后的效果）。先前的研究已经评估了癌症治疗的起始率 但是，癌症尚无全面评估的已发表研究 与没有艾滋病毒的人相比 （HIV-），也没有进行研究的研究 每个步骤的差异。我们提出以下特定目标，这些目标将解决这些关键知识 用CRT/RT处理的PWH中四个最常见的NADC（肛门，头部和颈部，肺或前列腺 癌症）：目标1：评估PWH与匹配之间癌症治疗开始的差异 HIV-患有癌症，以及PWH延迟治疗的危险因素。目标2：短期评估差异 PWH和匹配的HIV患者之间的SAE和癌症治疗完成。目的 3：评估比较PWH与癌症的死亡率和癌症复发的长期风险并匹配 HIV患者。目标4：将PWH与癌症的慢性健康状况的风险与（a）HIV-与（a）HIV-与 癌症和（b）没有癌症的PWH。除了评估PWH和HIV之间的结局差异之外 癌症患者，研究目标还将评估关键潜在危险因素的影响，包括：ART 方案，免疫抑制和治疗剂量和完成，可能与CRT/RT有关 结果。这项观察性队列研究将确定> 3,000个被诊断为癌症的PWH，1：1匹配的HIV- 患有相同癌症的人，4：1与没有癌症的PWH匹配，他们从 退伍军人政府或Kaiser Permanente，这是两个最大的单付款人综合医疗系统 美国。研究结果将提供数据，以提供癌症护理输送和治疗的目标 干预措施，并告知HIV特异性癌症治疗指南，以改善PWH中的癌症生存率。