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A comparison of cancer stage at diagnosis and treatment initiation between enrollees in an urban HIV clinic and SEER

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Abstract

Purpose

A comparison of stage at cancer diagnosis and cancer treatment rates between people with HIV (PWH) and the general US population is needed to identify any disparities by HIV status.

Methods

We compared 236 PWH in clinical care diagnosed with cancer from 1997 to 2014 to a sample from NCI’s Surveillance, Epidemiology and End Results (SEER) Program, presumed to be HIV negative. We performed G-computation using random forest methods to estimate stage and treatment percent differences (PD) by HIV. We conducted sensitivity analyses among non-AIDS-defining cancers (NADC), by sex and by CD4 ≤ 200 or > 200 cells/mm3.

Results

PWH were less likely to be diagnosed at localized stage (PD = − 16%; 95% CI − 21, − 11) and more likely to be diagnosed at regional stage (PD = 14%; 95% CI 8, 19) than those in SEER. Cancer treatment rates were 13% lower among PWH as compared to SEER (95% CI − 18, − 8). The difference in percent receiving cancer treatment was more pronounced for those with lower CD4 at cancer diagnosis (PD -15%; 95% CI − 27, − 6). Lower treatment rates were observed among NADC, males, and women with CD4 ≤ 200.

Conclusion

Cancer care for PWH could be improved by diagnosis at earlier stages and increasing rates of cancer treatment.

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Fig. 1

Notes

  1. Cancer incidence data were provided by the Maryland Cancer Registry, Center for Cancer Prevention and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201, USA, https://phpa.health.maryland.gov/cancer/Pages/mcr_home.aspx, 410-767-4055. We acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that support the collection and availability of the cancer registry data.

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Acknowledgments

We acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Diseases Control and Prevention for the funds that support the collection and availability of the cancer registry data.

Funding

This work was supported by the National Institutes of Health (Grant Numbers U01-DA036935, P30-AI094189), National Institute of Allergy and Infectious Diseases (Grant No. U01 AI069918) and National Cancer Institute (Grant No. T32 CA009314).

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Keri L. Calkins, Geetanjali Chander, Corinne E. Joshu, Kala Visvanathan, Anthony T. Fojo, Catherine R. Lesko, Richard D. Moore & Bryan Lau

  2. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Geetanjali Chander, Anthony T. Fojo, Richard D. Moore & Bryan Lau

  3. Department of Medical Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Kala Visvanathan

  4. Mathematica, Ann Arbor, MI, USA

    Keri L. Calkins

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  1. Keri L. Calkins
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Correspondence to Keri L. Calkins.

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Calkins, K.L., Chander, G., Joshu, C.E. et al. A comparison of cancer stage at diagnosis and treatment initiation between enrollees in an urban HIV clinic and SEER. Cancer Causes Control 31, 511–516 (2020). https://doi.org/10.1007/s10552-020-01289-x

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  • DOI: https://doi.org/10.1007/s10552-020-01289-x

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