Health-related quality of life among adult cancer patients with and without HIV: Analysis of SEER-MHOS data (2007–2017)

Abstract

Introduction

People with HIV (PWH) are more likely to die due to cancer compared to people without HIV. Disparities in cancer care, including access to palliative care, for PWH contribute to poor health-related quality of life (HRQoL) and survival. However, limited research exists examining patient-reported HRQoL among PWH with cancer. We examined HRQoL among patients diagnosed with non-AIDS defining cancers with and without HIV.

Materials and methods

We used the 2007–2017 Surveillance, Epidemiology, and End Results and the Medicare Health Outcomes Survey (SEER-MHOS) linkage data to assess HRQoL among patients (ages ≥18) diagnosed with breast, colorectal, gastrointestinal, head and neck, lung, lymphoma, and prostate cancers. HRQoL outcomes included the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and the eight scale scores of the Veterans RAND 12-Item Health Survey (VR-12), and the VR-6D health utility score. Higher HRQoL scores indicate better health status. Adjusting for patient characteristics, we computed mean HRQoL scores using multivariable linear regression models and the predictive margins method. The minimally important difference (MID) in HRQoL scores between patients with and without HIV by cancer types was assessed.

Results

The sample (N = 43,973) included 310 (0.7%) patients with HIV and had an average age at cancer diagnosis of 70.8 years. PWH reported lower scores in at least one HRQoL outcome compared to patients without HIV for all cancers examined. Differences in HRQoL for PWH compared to patients without HIV exceeded the MID for cancers of the breast (PCS: -2.7; MCS: -9.1; VR-6D: −0.08), colorectum (PCS: -2.3; MCS: -6.2; VR-6D: −0.06), gastrointestinal tract (MCS: -5.9; VR-6D: −0.04), head and neck (PCS: -4.1; MCS: -7.5; VR-6D: −0.07), lungs (PCS: -2.5; MCS: -6.3; VR-6D: −0.06), lymphatic system (PCS: -2.3; MCS: -2.6; VR-6D: −0.04), and prostate (MCS: -8.0; VR-6D: −0.07).

Discussion

Our findings demonstrated that PWH across all cancers examined reported substantially lower mental and/or physical HRQoL compared to patients without HIV. Future work can explore strategies for symptom monitoring and management among PWH.