Josh Friedman , 2025-06-25 18:00:00
Key takeaways:
- People with HIV had a lower likelihood of receiving treatment for cancer if they lived in areas with low income and low educational attainment.
- Disparities persisted despite insurance type and treatment center.
More than 15% of individuals living with HIV and cancer have not received recommended first-line cancer therapy, according to results of a retrospective analysis.
Among patients with HIV and cancer, those who lived in the lowest quartiles for income or educational attainment had significantly lower odds of getting cancer treatment compared with those in the top quartiles.
Data derived from Islam JY, et al. Cancer. 2025;doi:10.1002/cncr.35881.
Jessica Y. Islam
“People living with HIV, as long as their HIV is well-controlled, should receive the same exact [cancer] care as someone who is not living with HIV,” Jessica Y. Islam, PhD, MPH, assistant professor of cancer epidemiology at Moffitt Cancer Center, told Healio.
Inequity has ‘persisted over time’
Islam and colleagues published a report in Journal of Clinical Oncology in 2024 that found people with HIV had significantly higher odds of not getting cancer treatment for multiple malignancy types compared with those who did not have HIV between 2001 and 2019.
“This inequity by HIV status has persisted over time,” Islam said.
Other studies have shown individuals with HIV and cancer have worse cancer-specific survival than those without HIV, according to study background.
Patients with HIV not getting recommended cancer screening and treatment has factored into those data.
“What is it about people living with HIV [not getting treatment]?” Islam asked. “Is it the biology, or are there social factors that are playing into this? The social piece is important because of the historical distribution of HIV infection within the United States. We know that within the U.S., the HIV epidemic persists among marginalized populations such as Black and Hispanic adults, men who have sex with men, and other demographic groups that are disenfranchised from the health care system.
“Those barriers within people living with HIV already exist,” she continued. “When we come into the cancer space, how does that play out within this population?”
Islam and colleagues used the National Cancer Database, a registry sponsored by the American College of Surgeons and American Cancer Society that includes more than 70% of U.S. cancer cases, to investigate.
They included 31,549 individuals diagnosed with HIV and cancer (43.2% aged 60 years and older; 50.5% white; 37.5% Black; 68.4% men) in their study.
The database included two socioeconomic factors based on zip code — percentage of adults who did not have a high school degree and median household income.
Receipt of first-line cancer treatment based on these measures served as the primary endpoint.
Poverty impacts cancer treatment
In all, 16.5% of the study population did not receive first-line treatment for their cancer.
Patients who lived in the lowest quartile of educational attainment had significantly lower odds of receiving cancer treatment compared with the highest quartile (adjusted OR = 0.73; 95% CI, 0.66-0.82). Those in the second lowest quartile also had significantly lower odds than the highest quartile (aOR = 0.85; 95% CI, 0.77-0.95).
Additionally, patients who lived in the lowest quartile of income had significantly lower odds of getting recommended cancer therapy compared with the top quartile (aOR = 0.73; 95% CI, 0.65-0.81). Those in the second lowest quartile also had significantly lower odds compared with the highest quartile (aOR = 0.83; 95% CI, 0.74-0.94).
“My initial hypothesis going into this project was that people who are living in lower resource settings will be less likely to receive treatment. That did not surprise me,” Islam said. “What did surprise me was this association has persisted. I did expect the association to kind of dwindle over time, but we see that it’s still something occurring in present day.”
Disparities persisted despite insurance type, cancer treatment facility and distance to care.
“The most striking one was stratification by cancer treatment facility type, where we saw that for those who received care at an academic research program — which should be the highest quality of care — poverty still played a role within their odds of receiving cancer treatment,” Islam said. “That was true for both lowest educational attainment and lowest median income.”
Researchers acknowledged study limitations, including being restricted to zip-code level data.
Islam emphasized the need for research based on more “granular” data.
“For example, at an academic research cancer treatment facility, what are the interactions with different health care providers, or within the system that may be contributing to this disparity that we can intervene on?” she said.
‘Keep them engaged’
Islam and colleagues have conducted qualitative interviews with patients to discuss their experiences receiving care.
“These are folks who may have been living with HIV for over 2 decades,” Islam said. “Someone who’s living with a chronic disease, specifically HIV, and they’ve survived this long, they’ll hear a big diagnosis like cancer and think, ‘I’ve survived this long, and I want to live the rest of my life comfortably without any symptomology associated with getting such a hard treatment.’ Sometimes they decline treatment.”
Other individuals have reported feelings of discrimination.
“That may not have occurred specifically at the cancer hospital, but just bringing in experiences from their HIV care over time, it does impact how they perceive their cancer treatment experience,” Islam said.
Those past experiences also may stop patients from disclosing their HIV history.
Lindsay N. Fuzzell, PhD, applied research scientist at Moffitt, and colleagues published a report in JNCI Cancer Spectrum in 2021 that found only 36.1% of patients with HIV and cancer at Moffitt between 2009 and 2019 disclosed their HIV status.
“A policy-level change to improve this issue could be instituting a requirement that we blanket test for patients with HIV or just other chronic immune-suppressive conditions,” Islam said.
Knowing HIV status will not guarantee treatment, though. Islam emphasized the importance of interventions to increase the number of patients getting the care they need.
“Those who are living with HIV may have other health-related social needs that may not be coming up during their conversations,” Islam said. “Providers should always consider referring them to social services or ensuring they know that’s an option to keep them engaged with their cancer treatment to completion.”
References:
For more information:
Jessica Y. Islam, PhD, MPH, can be reached at jessica.islam@moffitt.org.
Sources/Disclosures
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Data derived from Islam JY, et al. Cancer. 2025;doi:10.1002/cncr.35881.
Disclosures:
The authors report no relevant financial disclosures.
