Abstract PO-045: Experiences of oncologists treating cancer patients living with HIV: Opportunities to improve care and reduce disparities
Authors: Khouri Ashley , Young Jeanette , Galyean Patrick , Knettel Brandon , Cherenack Emily M. , Ariotti Anthony , Ho Noelani , Zickmund Susan , Watt Melissa , Pollak Kathryn , Ubel Peter , Fagerlin Angela , Suneja Gita 
Published: January 2022

Abstract
Introduction: Prior database studies have demonstrated that cancer patients with comorbid human immunodeficiency virus (HIV) have higher cancer-specific mortality and are less likely to receive cancer treatment. People living with HIV (PLWH) who achieve viral suppression have near normal life expectancy, highlighting the critical importance of reducing cancer treatment disparities. The purpose of this study is to understand how oncologists make treatment decisions for cancer patients living with HIV and to elicit recommendations for improving care in this population. Methods: We conducted in-depth interviews with 25 attending medical, radiation, and surgical oncologists from Duke University, University of Utah, and community practices in Florida, Georgia, Louisiana, Pennsylvania, and Virginia who had recently engaged in a consultation with PLWH and cancer. In semi-structured interviews, we explored three domains: (1) care coordination with other healthcare professionals, (2) knowledge and attitudes regarding patients with comorbid HIV and cancer, and (3) recommendations for improvements in care delivery. Two analysts coded the data using ATLAS.ti. We utilized applied thematic analysis to identify inductive themes across the three domains. Results: Many participants (n=11) reported always communicating with a patient's Infectious Disease (ID) doctor, and others (n=5) said they only communicate with ID if the patient's HIV is not well-controlled. Ten medical oncologists noted they found it helpful to speak to an HIV pharmacist, particularly about drug-drug interactions. Participants also discussed efforts to connect patients with supportive services, such as transportation, payment assistance, and mental health counseling. Many participants described concerns in discussing the patient care plan in the presence of caregivers, given the possibility that patients have not disclosed their HIV status. None of the participants had formal training in management of comorbid cancer and HIV, and most noted that they learned through their own clinical practice. Participants made suggestions for improving treatment decision-making for PLWH, including: more evidence of the risk-benefit ratio of treatment (e.g. treatment goals, life expectancy calculators), greater access to social work and mental health resources, streamlined access to communication with HIV providers, and multidisciplinary HIV cancer rounds. Conclusions: This is the first physician-focused qualitative study interviewing oncologists caring for PLWH. Communication among multiple healthcare providers, particularly oncologist and ID doctor, are noted to be common but not universal in the care of comorbid HIV and cancer. Formal training in cancers in PLWH is lacking in medical training. Future steps to reduce disparities in cancer treatment and outcomes for PLWH may include the establishment of multidisciplinary HIV cancer rounds, facilitating connection and communication between healthcare providers, and enhancing supportive care resources for patients.
Citation Format: Ashley Khouri, Jeanette Young, Patrick Galyean, Brandon Knettel, Emily M. Cherenack, Anthony Ariotti, Noelani Ho, Susan Zickmund, Melissa Watt, Kathryn Pollak, Peter Ubel, Angela Fagerlin, Gita Suneja. Experiences of oncologists treating cancer patients living with HIV: Opportunities to improve care and reduce disparities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-045.