Health-related quality of life and patient reported outcomes among people living with HIV and cancer

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PROJECT SUMMARY Advances in HIV treatment have improved life expectancy among people with HIV (PWH). As PWH live longer, they are at increased risk for cancer and cancer-related mortality compared with the general population. However, it remains unclear what factors may contribute to persistent survival disparities and poor cancer outcomes among PWH in the US. Integrating measurement of patient-reported outcomes (PROs) into routine and supportive cancer care is a potential strategy to improve PWH’s quality of life, cancer outcomes, and survival. PROs encompass data reported directly by patients to describe how they feel and function, such as symptoms, physical function, and health-related quality of life. In the general (i.e., HIV-uninfected) cancer patient population, PRO scores are associated with several adverse cancer clinical outcomes including poor response to therapy, cancer progression, and shorter survival. Given that PWH are also more likely to be diagnosed with non-AIDS defining cancers at later stages and experience elevated mortality, it is urgent to investigate opportunities, such as the role of PROs, to improve survival and ultimately reduce preventable cancer deaths among PWH. However, to our knowledge, no research exists in the context PROs and overall health-related quality of life among PWH with cancer. To address this research gap, our objective is to evaluate physical and mental health symptomology (PROs) throughout the cancer diagnosis trajectory and associations with cancer outcomes among HIV-positive cancer patients. We propose a two-pronged approach: we will leverage an existing, NCI-sponsored, data linkage between the Surveillance, Epidemiology, and End Results (SEER) cancer registry data and Centers for Medicare and Medicaid Services (CMS)’ Medicare Health Outcomes Survey (MHOS) (Aims 1 and 2) and conduct primary data collection among HIV positive cancer patients treated at an NCI-designated cancer center (Aim 3). We will carry out the following specific aims: Aim 1: Compare changes in patient reported outcomes (PROs) after a cancer-diagnosis among non-AIDS defining cancer patients living with and without HIV; Aim 2: Estimate associations of PROs (pre-diagnosis, post-diagnosis, and change in PROs) with overall survival among older patients diagnosed with non-AIDS defining cancers with HIV; and Aim 3: Explore the role of HIV-specific clinical and social factors in patient reported outcome assessments among a broad age range of HIV positive cancer patients treated at one NCI-designated cancer center. Findings from this research will provide preliminary data to inform the development of future large-scale R01-level research opportunities focused on improving symptom control among PWH with cancer and evaluating the integration of tailored patient-reported outcome data collection into routine supportive care of this vulnerable population.