title: Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists.
abstract: OBJECTIVE
  HIV-infected individuals with non-AIDS-defining cancers are less likely to receive cancer treatment compared with uninfected individuals. We sought to identify provider-level factors influencing the delivery of oncology care to HIV-infected patients.
  
  
  METHODS
  A survey was mailed to 500 randomly selected US medical and radiation oncologists. The primary outcome was delivery of standard treatment, assessed by responses to three specialty-specific management questions. We used the χ(2) test to evaluate associations between delivery of standard treatment, provider demographics, and perceptions of HIV-infected individuals. Multivariable logistic regression identified associations using factor analysis to combine several correlated survey questions.
  
  
  RESULTS
  Our response rate was 60%; 69% of respondents felt that available cancer management guidelines were insufficient for the care of HIV-infected patients with cancer; 45% never or rarely discussed their cancer management plan with an HIV specialist; 20% and 15% of providers were not comfortable discussing cancer treatment adverse effects and prognosis with their HIV-infected patients with cancer, respectively; 79% indicated that they would provide standard cancer treatment to HIV-infected patients. In multivariable analysis, physicians comfortable discussing adverse effects and prognosis were more likely to provide standard cancer treatment (adjusted odds ratio, 1.52; 95% CI, 1.12 to 2.07). Physicians with concerns about toxicity and efficacy of treatment were significantly less likely to provide standard cancer treatment (adjusted odds ratio, 0.67; 95% CI, 0.53 to 0.85).
  
  
  CONCLUSIONS
  Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients. Policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment.
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD gita.suneja@icloud.com.
authors: Gita
authors: G
authors: Suneja
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Matthew
authors: M
authors: Boyer
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Baligh R
authors: BR
authors: Yehia
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Meredith S
authors: MS
authors: Shiels
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Eric A
authors: EA
authors: Engels
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Justin E
authors: JE
authors: Bekelman
authors: University of Utah, Salt Lake City, UT; Marshall University, Huntington, WV; University of Pennsylvania; Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; and National Cancer Institute, Bethesda, MD.
authors: Judith A
authors: JA
authors: Long
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002983:Clinical Competence; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000639:trends*; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology