(PQ3) Addressing Cancer Treatment Disparities for Persons with HIV

项目摘要/摘要 联合抗逆转录病毒疗法(ART)的引入导致与艾滋病相关的发病率急剧下降 死亡率。然而，作为艾滋病毒(PWH)年龄的人，非艾滋病定义癌症(NADC)的死亡率 持续增加，现已成为威尔斯亲王医院的主要死亡原因。最近的研究表明 威斯康星综合征和癌症患者在癌症治疗开始和存活率方面的持续差异 普通民众。这可能部分是由于医学和放射肿瘤学家对 癌症治疗重症肝炎的安全性和有效性。或者，也有可能在放疗的同时进行化疗 单纯治疗(CRT)和放射治疗(RT)对PWH的疗效可能较差，或与较大的 毒性。众所周知，癌症的积极结果取决于所有步骤的成功导航。 在癌症护理提供过程中，包括：及时开始治疗、完成治疗和治疗 安全，定义为避免严重不良事件(SAE)。评估持续的健康状况也是至关重要的 携带艾滋病毒的癌症幸存者的需要，包括长期慢性健康状况的风险(即晚期不良 效果)癌症治疗后。先前的研究已经评估了某些癌症治疗的起始率 然而，目前还没有发表的研究全面评估癌症患者 与未感染艾滋病毒的人相比，威斯康星患者癌症护理过程中其他关键步骤的结果 (HIV-)，也没有研究评估患者和提供者可能导致 每一步的差距。我们提出了以下具体目标，以解决这些关键知识 接受CRT/RT治疗的PWH中四种最常见的NADC(肛门、头颈、肺或前列腺)的差距 癌症)：目标1：评估PWH和匹配的癌症治疗开始时间的差异 艾滋病毒-癌症，以及威尔斯亲王医院延误治疗的风险因素。目标2：评估短期内的差距 PWH和启动CRT/RT的匹配HIV患者之间的SAE和癌症治疗完成情况。目标 3：比较Ph与癌症和配对患者的死亡率和癌症复发的长期风险。 HIV-病人。目的4：比较重症肝炎合并癌症、(A)HIV-和 癌症和(B)无癌症的PWH。除了评估PWH和HIV之间的结果差异外- 癌症患者的研究目标还将评估关键潜在风险因素的影响，包括：ART 可能与CRT/RT相关的治疗方案、免疫抑制、治疗剂量和完成情况 结果。这项观察性队列研究将确定&>3,000名PWH被诊断为癌症，1：1匹配的艾滋病毒- 患有相同癌症和4：1匹配的威尔斯亲王医院而没有患癌症的人，并曾接受 退伍军人管理局或Kaiser Permanente，全球最大的两个单一支付者集成医疗系统 美国。研究结果将提供数据，为癌症护理和治疗提供目标 干预措施，并告知针对艾滋病毒的癌症治疗指南，以提高威斯康星医院的癌症存活率。

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.