Nurses Can Help in Multidisciplinary Management of HIV-Infected Cancer

As part of a multidisciplinary team, nurses often reference guidelines to assist in treatment decisions for patients with cancer. Now, they also have guidance on how to treat individuals that comprise an underserved population of patients: those living with HIV and cancer.

The National Comprehensive Cancer Network (NCCN) recently released clinical practice guidelines on how health care teams can ensure patients living with HIV who are diagnosed with cancer receive safe and necessary treatment.

In 2010, an estimated 7760 people living with HIV in the United States were diagnosed with cancer—approximately 50% more than the general population–yet these patients had significantly lower rates of treatment compared with HIV-negative patients with cancer.

“We know that people living with HIV and cancer are less likely to receive cancer treatment compared with uninfected cancer patients,” Gita Suneja, MD, from the Duke Cancer Institute and co-chair of the NCCN Guidelines Panel for Cancer in People Living With HIV, said in an interview with Oncology Nursing News.

Treatment courses for such individuals have been proven safe and effective, yet they still represent an underserved population.

“A survey of oncologists revealed that nearly 25% would not offer cancer treatment to people living with HIV because of concerns regarding risks and uncertainly on benefits of cancer treatment,” said Suneja. The majority of the surveyed doctors felt that appropriate management guidelines were not available to help with treatment decision-making; therefore it became apparent that NCCN guidelines could fill a major knowledge gap in the oncology community.”

The most-common types of cancer occurring in people living with HIV include non-Hodgkin’s lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer, and cervical cancer.

The guidelines focus on the collaboration between the patient, their cancer care team and HIV specialists to ensure that they get safe and appropriate treatment.

“One main takeaway from the guideline is that HIV status alone should not be used for cancer treatment decision-making. Although modifications to treatment may be necessary, for example to avoid drug interactions with antiretroviral therapy or to prevent development of opportunistic infections, cancer treatment is generally safe and effective in people living with HIV,” said Suneja.

“Another major takeaway is that cancer patients living with HIV should be co-managed by an oncologist and HIV specialist. This requires deliberate communication to ensure that both HIV and cancer are treated optimally.”

The guidelines also added specific treatment recommendations for non-small cell lung cancer (NSCLC), anal cancer, Hodgkin lymphoma, and cervical cancer.

Among the guidelines, the NCCN specifically recommended for:

• Most people living with HIV who develop cancer should be offered the same cancer therapies as HIV-negative individuals, and modifications to cancer treatment should not be made solely on the basis of HIV status;
• Care for patients diagnosed with HIV should be co-managed with an oncologist and an HIV specialist; and
• Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and antiretroviral therapy for possible drug interactions and overlapping toxicity concerns prior to initiation of therapy.

Suneja firmly believes these guidelines will promote evidence-based, multidisciplinary management of those with HIV-infected cancer.

“Survival from HIV has drastically improved with the widespread availability of antiretroviral therapy,” she said. “Similarly, cancer treatment has evolved considerably over the last several decades. Cancer doctors may not realize that the life expectancy of an HIV-infected patient now approaches that of an uninfected patient. Similarly, HIV doctors may not realize that cancer treatment may improve survival and quality of life, even in patients with advanced stage disease. As physicians, we need to provide better, more interdisciplinary care to HIV-infected cancer patients to ensure the best outcome from both HIV and cancer.”