Inequities in palliative care delivery to patients with HIV and Stage IV cancers in the US (2004-2020)

Jessica Y Islam; Yi Guo; Kea Turner; Amir Alishahi Tabriz; Yu Chen Lin; Denise C Vidot; Susan T Vadaparampil; Anna E Coghill; Marlene Camacho-Rivera ScD; Gita Suneja

doi:10.1093/jncics/pkae118

Inequities in palliative care delivery to patients with HIV and Stage IV cancers in the US (2004-2020)

JNCI Cancer Spectr. 2024 Nov 23:pkae118. doi: 10.1093/jncics/pkae118. Online ahead of print.

Authors

Jessica Y Islam^{1

2

3}, Yi Guo⁴, Kea Turner^{3

5}, Amir Alishahi Tabriz^{3

5}, Yu Chen Lin⁵, Denise C Vidot⁶, Susan T Vadaparampil^{3

4}, Anna E Coghill^{1

2

3}, Marlene Camacho-Rivera ScD⁷, Gita Suneja⁸

Affiliations

¹ Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
² Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
³ Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
⁴ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
⁵ Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁶ School of Nursing and Health Studies, University of Miami, Miami, FL, USA.
⁷ Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, New York, NY, USA.
⁸ Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

PMID: 39579085
DOI: 10.1093/jncics/pkae118

Abstract

Background: People with HIV (PWH) diagnosed with stage-IV cancer are less likely to receive palliative care (PC) compared to those without HIV. Our objective was to evaluate inequities in PC receipt among PWH with stage IV cancer in the US.

Methods: We used the National Cancer Database (2004-2020), including adult (18-89 years) PWH with the 14 most common cancers that occur among PWH. PC was defined as treatment provided with non-curative intent. Our main exposures included % quartiles of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios(aPR) with 95% confidence intervals (95% CI), adjusting for age, sex, year of diagnosis, race/ethnicity, and cancer type.

Results: Among the included 10,120 PWH with stage IV cancer, 72% were men, 51% were either non-Hispanic(NH)-Black or Hispanic/Latinx, 38% were aged ≥60 years, and 97% resided in urban areas. Fourteen percent received PC. NH-Black PWH living in zip-codes with lower quartiles of educational attainment were more likely to receive PC compared to those in the highest quartile (Q1vs.Q4: aPR:1.93;95% CI:1.29-2,86) For income overall, compared to those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving PC (Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52), particularly among NH-Black adults (Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01).

Conclusions: PC use among PWH with stage-IV cancer is low. Contextual poverty plays a role in PC delivery to PWH and cancer, particularly among NH-Black PWH.