VCOM Carolinas Research Day 2023

Clinical Studies

Improving Cancer Care in the HIV Population: Qualitative Research to Identify Provider Knowledge, Attitudes, and Practices Valencia Henry, MS, OMS-II, 1 Maya J. Stephens, 2 Patrick Galyean, 3 Jeanette Young, 3 Susan Zickmund, PhD 3 Brandon A. Knettel, PhD 4,5 John Bartlett, MD 4 Melissa H. Watt, PhD, 6 Kathryn I. Pollak, PhD 7,8 Peter A. Ubel, MD 8 Angela Fagerlin, PhD 9 Gita Suneja, MD, MS 2.6 1 Edward Via College of Osteopathic Medicine-Carolinas Campus, 2 University of Utah, Department of Radiation Oncology, 3 University, of Utah, Department of Population Health Sciences , 4 University, of Utah, Division of Epidemiology, 5 University of Miami Department of Population Health Sciences, 6 Duke University Global Health Institute, 7 Duke University Department of Population Health Sciences Background Results Result’s Cont’d

Abstract # CLIN-10

Figure 1. Participant Impediments to providing optimal oncologic care to people with HIV

❖ As many more people live longer with HIV, the prevalence of cancer has increased among people living with HIV(PLWH). Further, PLWH are at higher risk of developing certain cancers than the general population and cancer is now the leading cause of non-AIDS death in the U.S. HIV population. 1,2 ❖ Compared with the general cancer population PLWH are more likely to get cancer, up to three times less likely to receive cancer treatment, and have worse cancer outcomes, including twice the likelihood of recurrence and mortality 2 ❖ There is minimal published data exploring drivers of the disparity and even less on mitigation strategies.

❖ Study participants were 32%(8) medical 40%(10)radiation oncology, and 28%(7) surgical oncology.

oncology,

Patient financial, logistic, and psychosocial challenges that are not adequately addressed in the clinical setting.

❖ Most participants (64%) were within 15 years of terminal training and between 30 and 49 years of age

Concerns regarding inadvertent HIV disclosure resulting in stigma from patient companions or caregivers unaware of the HIV diagnosis

Knowledge gaps on HIV-specific education during medical training

❖ Less than half of oncologists (n=11) reported collaborating with the patient’s HIV care team before and during cancer therapy.

Impediments to providing optimal oncologic care to people with HIV

. “I guess there are certain considerations from a social standpoint; I want to make sure that the family members who are with the patient know and that the patients’ are okay with discussing their HIV diagnosis. Sometimes, that’s a difficult thing to approach because they are literally there in the room.” – P2 “Yeah, definitely no formal coursework in treating oncologic patients with HIV. More you know, when we would have patients who are HIV positive, kind of interactions with the attendings.” – P3 “I make sure my note is sent to the HIV doctor; I want to make sure I know who the patient’s ID doctor is. If everything is within normal limits, I do not reach out unless I have to .” – P13 “I think the hard thing for any cancer patient is that cancer care is really complicated. And then, when you add in HIV care that is also complicated, that can be a big psychological and emotional burden for people. Subsequently, I think that having resources to address that part of care too, not just the medical aspect is a really important aspect of care as well.” – P12 Oncologists face challenges when caring for people with HIV

Objective/ Aim

Conclusion

We aimed to explore clinician cancer treatment decision-making for patients living with HIV, focusing on oncologist knowledge, attitudes, and. practices

References 1. Suneja G, Lin CC, Simard EP, Han X, Engels EA, Jemal A. Disparities in cancer treatment among patients infected with the human immunodeficiency virus. Cancer. 2016;122(15):2399-2407. doi:10.1002/cncr.30052 2. Suneja G, Shiels MS, Angulo R, et al. Cancer Treatment Disparities in HIV-Infected Individuals in the United States. J Clin Oncol. 2014;32(22):2344-2350. doi:10.1200/JCO.2013.54.864 3. Smith CJ, Ryom L, Weber R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet Lond Engl. 2014;384(9939):241-248. doi:10.1016/S0140 6736(14)60604-8 4. Suneja G, Boyer M, Yehia BR, et al. Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists. J Oncol Pract. 2015;11(3):e380-387. doi:10.1200/JOP.2014.002709 5. Biggar RJ, Engels EA, Ly S, et al. Survival after cancer diagnosis in persons with AIDS. J Acquir Immune Defic Syndr 1999. 2005;39(3):293-299. doi:10.1097/01.qai.0000164033.02947.e3 6. Robbins HA, Shiels MS, Pfeiffer RM, Engels EA. Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. AIDS Lond Engl. 2014;28(6):881-890. doi:10.1097/QAD.0000000000000163 Acknowledgements ❖ This qualitative study of oncologists in the US demonstrates that oncologists face challenges when caring for people with HIV. ❖ Point of care tools, particularly those geared towards enhancing oncologist education and connection with other care teams such as HIV/infectious diseases and social work, may enhance cancer care and reduce cancer disparities for people living with HIV.

Materials & Methods

❖ We conducted semi-structured in-depth interviews with 25 medical, radiation, and surgical oncologists from two academic medical centers and several community practices. ❖ Participants were eligible if they recently had a consultation with a patient with both HIV and cancer as assessed through medical record review at the academic centers and by self-report for community practices. ❖ The interview guide explored oncologist attitudes, stigma, knowledge, and practices during the cancer treatment decision making process. ❖ We audio recorded and transcribed interviews and analyzed data using an open, iterative analysis approach with ATLAS.ti.

This study was funded by the ASTRO Minority Summer Fellowship Award. and the National Cancer Institute/National Institutes of Health (K08CA228631)

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