Women with HIV Less Likely to Receive Recommended Treatments for Gynaecologic Cancers

25 January 2018

The majority of women living with HIV diagnosed with gynaecological cancer do not receive treatment recommended by cancer guidelines, according to research conducted in the United States and published in AIDS Journal. Women whose care did not match guideline standards had poorer survival compared to women who received the recommended care. Toxicity and patient factors were the main reasons why women did not receive treatment recommended in guidelines.

“To our knowledge, there is no case series describing guideline-specific care and outcomes in HIV-infected women with gynecologic cancers,” comment the authors. “As these cancers increase, our ability to meet the standard of care and to understand the impact of standard-of-care treatment in this population is critical.”

The development of highly effective and safe antiretroviral therapy means that most people living with HIV have a good chance of surviving well into old age. Diseases associated with ageing, including a range of non-AIDS-defining cancers, are an increasingly important cause of serious illness and death in people with HIV.

Previous research has shown that people living with HIV who have cancer are less likely to receive guideline-recommended treatment compared to cancer patients in the general population. With the exception of cervical cancer, the treatment and outcomes of gynaecological cancers in women living with HIV have received little attention in the medical literature.

Investigators designed a retrospective study involving women who were diagnosed with gynaecological cancer while receiving HIV care at two clinics in Baltimore between 2000 and 2015. A total of 57 women were diagnosed with gynaecological cancer: 26% with vulvar cancers; 46% with cervical cancers; 16% with ovarian cancers and 12% with uterine cancers.

The majority (53%) were diagnosed with stage I cancers, the remaining 47% with stage II-IV cancers. Women with ovarian cancer were much more frequently diagnosed with later-stage cancers: 89% were diagnosed with stage II-IV cancers.

Overall, 49% of women received guideline-adherent care. Women with stage I disease were more likely to receive care that met guidelines compared to women with stage II-IV disease (73% vs 22%). Common reasons why women did not receive care that met guidelines standards were toxicity (38%), patient-related issues such as loss to follow-up (31%), co-morbidities (17%), practitioner-related issues (10%) and cancer progression (3%). Toxicity was the main reason (43%) why women with stage II-IV cancers didn’t receive the recommended treatment.

“Further research is necessary to define treatment-related limitations and interactions for women receiving both cART [combination antiretroviral therapy] and cancer-related treatments, and also to compare matched patients who are not infected with HIV,” conclude the authors. “As treatment for gynecological cancers continue to evolve, this will include not only chemotherapy, radiation, and surgery, but will incorporate targeted and immunotherapies. This study highlights the critical need to expand our understanding of best practice for the treatment of HIV-infected women with gynecological cancers, particularly those with advanced disease.”

Read the full article online here.