A breast cancer patient receives a chemotherapy drip at Cape Fear Valley Medical Center in Fayetteville, North Carolina. P...

People with HIV are far less likely to get cancer treatment, study shows

We’ve made great progress treating people who are infected with HIV, but if they get cancer they’re less likely to get the care they need, a recent study found.

Researchers examined treatment for a variety of cancers, including upper gastrointestinal tract, colorectal, prostate, lung, head and neck, cervix, breast, anal and two blood cancers. With the exception of anal cancer, treatment rates differed significantly between HIV-infected people and those who weren’t infected, according to the study.

For example, 33 percent of patients with HIV and lung cancer failed to receive any treatment for the cancer compared with 14 percent of those who weren’t infected. Similarly, 44 percent of people who were HIV positive didn’t receive treatment for upper GI cancer versus 18 percent of those where weren’t infected with HIV. Twenty-four percent of men with prostate cancer who were HIV positive didn’t get treatment compared with 7 percent of non-HIV infected men.

For example, 33 percent of patients with HIV and lung cancer failed to receive any treatment for the cancer compared with 14 percent of those who weren’t infected.Cancer treatment was defined as radiation, chemotherapy and/or surgery.

“To have made such great strides with treating HIV only to have them succumb to cancer is devastating,” said Dr. Gita Suneja, a radiation oncologist at the University of Utah’s Huntsman Cancer Institute in Salt Lake City and the lead author of the study. It was published online this month in the journal Cancer.

The study used the National Cancer Data Base to analyze treatment for adults younger than 65 who were diagnosed with any of the 10 most common cancers to affect HIV patients between 2003 and 2011. The study included 10,265 HIV-infected adults and 2.2 million without HIV.

The data base, which is sponsored by the American Cancer Society and the American College of Surgeons, captures roughly 70 percent of newly diagnosed cancer cases in the United States.

The study noted that more than a third of the patients with HIV had stage 4 cancer — cancer that has metastasized — when they were diagnosed, while only 19 percent of those without HIV did.

Improvements in antiretroviral therapy to treat HIV have helped reduce the incidence of cancers such as Kaposi sarcoma that are closely linked to AIDS, but rates for other cancers often associated with normal aging have increased among HIV patients. In addition, people with HIV have a higher incidence of some lifestyle-related cancers, such as lung cancer, which could be linked to higher rates of smoking. Cancer is now the second most common cause of death among HIV-infected people, behind AIDS-related causes.

HIV patients are more likely to be uninsured or underinsured, and lack of coverage can affect access to cancer care. But having insurance didn’t eliminate the problem: privately insured people with HIV were significantly more likely to be untreated for many cancers than were privately insured people without HIV, the study found.

“We know that people with Medicaid or who are uninsured receive subpar cancer treatment, and that’s a big public health issue,” said Suneja. “But even factoring that in, HIV-infected people are still less likely to receive cancer treatment. That means there are other drivers that we couldn’t measure in the study.”

Disparities in cancer treatment could exist for several reasons. For one thing, for most cancers there are no national treatment guidelines for HIV-infected patients, Suneja said. One of the few exceptions is anal cancer, the only cancer for which the study found little discrepancy in treatment among HIV-infected and non-infected patients. According to the research, the difference among those not receiving treatment was 4.8 percent for HIV patients versus 3.1 percent for others.

For other cancers, “the oncologist may pause and ask, ‘Does the HIV infection mean they shouldn’t get standard cancer treatment?’” Suneja added.

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BY KAISER HEALTH NEWS February 11, 2014 at 4:56 PM EDT
On Monday the Obama administration announced another delay in rolling out the Affordable Care Act, weakening the requirement to offer coverage next year for large employers and postponing it for smaller ones. Here’s what it means.

The Obama administration pressed the pause button on part of the health law again. Kaiser Health News reporters explain what it means for employers, employees — and politicians. Getty Images
The Obama administration pressed the pause button on part of the health law again. Kaiser Health News reporters explain what it means for employers, employees — and politicians. Getty Images

There have been other delays in health-law implementation. What’s different about this one?
This is the second big change to rules for employers. The ACA requirement for employers with at least 50 workers to offer minimum coverage — or pay a fine — was supposed to take effect in January. But after getting complaints from business ,the administration said last summer it would wait until 2015 to penalize employers that didn’t offer coverage.

Now the administration has moved the deadlines again. Companies with 50 to 99 employees won’t have to offer minimum coverage until 2016. And companies with at least 100 employees are required to offer minimum coverage to only 70 percent of their workers in 2015, down from a previous target of 95 percent.

Will this affect me?

If you work fulltime for a large company, probably not. Most employers with at least 100 workers already offer a medical plan because it helps them hire and retain talent, not because of a government rule.

“For the majority of large employers … neither the employees nor the employer are going to see that much of a difference,” says Steve Wojcik, vice president for public policy at the National Business Group on Health, a big-business coalition.

Employers with staffs under 50 have always been exempt from the coverage requirement. (Still, many do offer health insurance.) They are likely to be untouched, although growing businesses that had been reluctant to go over the 50-worker threshold may feel freer to hire.

Companies most affected are those in the 50-to-99 employee slot and large retailers and restaurant chains, many of which don’t offer coverage to many employees now.

“I imagine we’ll have some employers in that space who were not offering coverage before and were gearing up to offer it in 2015,” said Edward Fensholt, director of compliance services for Lockton Benefit Group. “They’ll probably be delighted with the delay.”

I work a flexible schedule for a big retailer. Does this delay my access to company health coverage?

It might. But it also might delay a cut in your hours. Once the ACA is fully implemented, large companies must offer coverage to anybody who puts in at least 30 hours a week. Analysts expect big-box chains, restaurants and hotels to offer insurance to some workers who currently lack it but also to limit hours for others to avoid coverage requirements.

Shrinking the big-employer target in 2015 from insuring nearly all workers to 70 percent gives more time for those adjustments to take place, analysts say.

There are elections in November. Isn’t this mainly about Democratic damage control?

That’s what Republicans say. Besides seeing the delay as new evidence that the law is fatally flawed, they depict it as political camouflage for vulnerable Democrats, as a way to avoid potential October stories blaming job-market disruption on the health law.

House Ways and Means Committee Chairman Dave Camp, R-Mich., said Democrats don’t believe they “can survive politically if Obamacare is allowed to fully go into effect. This is just one more admission that the law is bad for hardworking taxpayers and American employers.”

Democrats say the extension is about giving employers more leeway to comply with a very complex law.

Do I have to still buy coverage if my employer doesn’t offer it?

In most cases, yes. Unless you get an exemption, you must enroll by March 31 or pay a penalty.

People whose companies don’t offer coverage can purchase insurance in online state and federal marketplaces. If they earn less than $46,960 for an individual or $78,120 for a family of three, they could qualify for a subsidy.

Why do employers get a reprieve from ACA requirements but not individuals?

It’s a question many are asking. Some believe the administration will yield to pressure to delay the mandate for individuals, especially since so many of the online marketplaces proved difficult to navigate.

“How are you going to penalize people who didn’t make it through the system?” wonders Joseph Antos, a health care economist at the American Enterprise Institute.

Insurance companies, which need as much participation as possible to make individual coverage financially sustainable, would sharply oppose such a move. Unfortunately for Democrats, that nuance might be lost on voters.

“It’s hard to explain to the electorate that [postponing the individual mandate] would subvert the risk pool,” said Dan Mendelson, head of consultant Avalere Health.

Will this pacify critics?

No. True, the National Retail Federation’s Neil Trautwein said the administration should get “a gold medal” for “its agility and flexibility” in working with employers.

But the change doesn’t affect that many companies. And it delivers a new talking point to opponents who say the law is unworkable.

“Employers know they have the administration on the run,” said Robert Laszewski, an insurance consultant and former industry executive. “Putting this off one more year isn’t going to mollify them. They are more mad now because they are more convinced they are right.”

Jay Hancock, Julie Appleby and Mary Agnes Carey wrote this report.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.