(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.

项目总结/摘要 联合抗逆转录病毒疗法（ART）的引入导致艾滋病相关性 mortality.然而，随着艾滋病毒感染者（PWH）年龄的增长，非艾滋病定义癌症（NADC） 持续增加，现已成为威尔斯亲王医院的主要死因。最近的研究表明 PWH和癌症之间在癌症治疗开始和生存方面的持续差异， 一般人。这可能部分是由于医学和放射肿瘤学家对放射治疗的担忧。 癌症治疗对威尔斯亲王医院的安全性和有效性。或者，有可能化疗加放疗 单独的CRT和放疗（RT）治疗PWH的效果可能较差，或与更大的 毒性众所周知，积极的癌症结局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， 安全性，定义为避免严重不良事件（SAE）。同样重要的是要评估正在进行的健康状况， 艾滋病毒携带者癌症幸存者的需求，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开始率， 然而，对于癌症，还没有发表的研究全面评估 在癌症护理提供过程中，与没有艾滋病毒感染者相比， （HIV-），也没有研究评估可能导致 每一步的差距。我们提出以下具体目标，以解决这些关键知识 接受CRT/RT治疗的PWH中四种最常见NADC（肛门、头颈部、肺或前列腺）的间隙 癌症）：目的1：评估PWH和匹配的癌症治疗开始时间的差异。 艾滋病病毒-癌症，以及威尔斯亲王医院延迟治疗的风险因素。目标2：评估短期差异 PWH和匹配的HIV患者之间的SAE和癌症治疗完成情况-开始CRT/RT的患者。目的 3：评估PWH与癌症和匹配的癌症复发的长期死亡风险。 艾滋病患者。目的4：比较患有癌症的威尔斯亲王与（a）患有艾滋病毒的威尔斯亲王之间的慢性健康状况风险。 癌症和（B）无癌症的PWH。除了评估威尔斯亲王医院与爱滋病病毒感染者之间的结果差异外， 癌症患者，研究目的还将评估关键潜在风险因素的影响，包括： 方案、免疫抑制、治疗剂量和完成情况，可能与CRT/RT相关 结果。这项观察性队列研究将确定> 3，000名被诊断患有癌症的PWH，1：1匹配的HIV- 患有相同癌症的人士，以及曾接受 退伍军人管理局或凯撒永久，两个最大的单一付款人综合医疗保健系统， 美国的研究结果将提供数据，为癌症护理和治疗提供目标 艾滋病毒/艾滋病干预措施，并告知艾滋病毒特异性癌症治疗指南，以提高PWH的癌症生存率。