publication date: Mar. 2, 2018

Clinical Roundup

NCCN guidelines for patients with HIV seek to reduce cancer care gaps

The National Comprehensive Cancer Network has released a new NCCN Clinical Practice Guidelines in Oncology intended to help make sure people living with HIV who are diagnosed with cancer receive safe, necessary treatment.

In 2010, an estimated 7,760 PLWH in the United States were diagnosed with cancer, representing an approximately 50% higher rate than the general population. However, studies have found PLWH are treated for cancer at significantly lower rates than HIV-negative people with cancer, despite most treatment courses being safe and effective in this population.

The most-common types of cancer occurring in people living with HIV are, in order of incidence: 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 new NCCN Guidelines for Cancer in People Living With HIV includes general advice—while highlighting the importance of working in collaboration with an HIV specialist—as well as specific treatment recommendations for non-small cell lung cancer, anal cancer, Hodgkin lymphoma, and cervical cancer.

Additional recommendations can be found in the recently-released NCCN Guidelines for AIDS-Related Kaposi Sarcoma as well as the AIDS-related B-cell lymphomas section of the NCCN Guidelines for B-cell Lymphomas.

Among the recommendations found in the new NCCN Guidelines:

  • Most PLWH 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.

  • Oncologists and HIV clinicians, along with HIV and oncology pharmacists, if available, should review proposed cancer therapy and ART for possible drug-drug interactions and overlapping toxicity concerns prior to initiation of therapy.

The NCCN Guidelines Panel for Cancer in People Living With HIV included oncologists, radiologists, infectious disease specialists, surgical oncologists, pharmacists, and a patient advocate. The panel stressed the importance of increasing the number of PLWH who participate in clinical trials for cancer treatments. Clinicians working with PLWH who have cancer should use to help patients find appropriate trials.


CancerCare publishes findings from oncology provider study

CancerCare published a white paper highlighting perspectives from oncology providers on the importance and utility of including patient priorities in treatment decisions.

“Decision Making at the Point of Care: Voices of Oncology Providers” was developed as part of CancerCare’s Patient Values Initiative, a multi-pronged effort aimed at reframing the national healthcare policy framework to ensure that patient engagement in treatment decision-making becomes the true standard of care.

This newly published white paper builds on the findings from the first PVI white paper, “Patient Values Initiative: The Many Voices of Value”, published in 2017. The first white paper provided findings from focus group interviews with oncology social workers and patients, highlighting the importance and value of including what’s important to patients in their treatment plans, and reinforced the need for resources to help patients articulate their quality of life priorities before treatment begins.

The latest white paper includes information from in-depth interviews with 15 oncology providers including physicians, advanced practice nurses, practice managers and health IT experts. Focused on the provider perspective, it demonstrates that while many oncology providers have a desire to learn more about their patients, both personally and clinically, there are significant barriers to ensuring that patient priorities are part of treatment decision making.

These barriers include the absence of formal procedures to capture personal information and share it among care team members, the challenges of interoperability between data sources, and the lack of electronic medical records fields that prompt the collection of patients’ quality of life priorities.

Looking to the future, over the next several months, CancerCare will conduct a quantitative survey among oncology clinicians to better understand the findings from this qualitative research.

Along with the perspectives from the patient and provider focus groups, it will inform the development and pilot testing of turnkey, low cost tools to facilitate the communication of patients’ quality of life priorities during treatment planning. The ultimate goal of the PVI is to ensure that genuine patient engagement in cancer treatment decision making becomes the standard of care, so that treatment plans reflect the true priorities, goals and needs of each patient.

CancerCare sponsors included: AbbVie, Bristol Myers Squibb, Celgene Corporation, EMD Serono, Lilly, Merck, Pfizer, PhRMA, Takeda Oncology.


A third of patients with lymph node-positive penile cancer don’t receive recommended care

One third of men with lymph node-positive penile cancer don’t receive a lymph node dissection, the recommended care associated with an overall survival advantage, researchers from Fox Chase Cancer Center have found. The paper appears in JAMA Oncology.

The researchers used the National Cancer Database to evaluate patient care at hospitals nationwide, and found that men had a better overall survival rate after undergoing a lymph node dissection, while neither chemotherapy nor radiation was associated with a survival benefit. But, they found that one third of patients did not undergo a lymph node dissection.

The National Comprehensive Cancer Network guidelines advocate for lymph node dissection or radiotherapy with consideration of perioperative chemotherapy for all patients with lymph node-positive penile cancer without metastasis.

Researchers also found that while the use of chemotherapy has increased over the past decade, rates remain below 50 percent. Older patients in particular were less likely to receive chemotherapy.

Copyright (c) 2020 The Cancer Letter Inc.