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Survival after Cancer Diagnosis in People
with AIDS
The
survival of persons with AIDS (PWA) has recently improved because
of better antiretroviral therapies. Similarly, the prognosis of
cancer
has also improved. To determine if survival
in PWA with cancer has also improved, researchers compared cancer
survival in adults with and without AIDS using data from New York
City from 1980 through 2000.
Analyses were made for AIDS-related
cancers (Kaposi sarcoma,
non-Hodgkin
lymphoma [NHL], and cervical
cancer) and for 8 non-AIDS-related
cancers (lung, larynx, colorectum, anus, Hodgkin lymphoma,
breast, prostate, and testis).
Results
· Death hazard ratios compared survival in PWA with cancer
with that in cancer patients without AIDS, adjusted for age, sex,
race, and calendar-time of cancer occurrence.
· The 24-month survival
rate of PWA with cancer (9015 AIDS cancers and 929 non-AIDS-related
cancers of 8 types) improved significantly for most cancer types.
· By
1996 through 2000, the 24-month survival rate in PWA was 58% for
Kaposi sarcoma, 41% for peripheral NHL, 29% for central nervous
system NHL, and 64% for cervical cancer.
· For
non-AIDS-related cancers, survival of PWA was lowest for lung cancer
(10%) but was >50% for most other cancer types.
· In
1996 through 2000, significant differences in survival between cancer
patients with and without AIDS still remained for Hodgkin lymphoma
and lung, larynx, and prostate cancers.
The
authors conclude that recent improvements in AIDS and cancer care
have greatly narrowed the gap in survival between cancer patients
with and without AIDS. “Clinicians should be encouraged by the improving
prognosis and be diligent about detecting and treating cancer in
PWA,” they note.
Discussion
In
PWA with AIDS-related and non-AIDS-related cancers, overall survival
improved throughout the AIDS epidemic, especially in 1996 through
2000 relative to earlier years. Nonetheless, even in 1996 through
2000, for many cancers there remained increases in the risk of dying
within 24 months in PWA compared with persons without AIDS who had
the same cancers.
In
this study, the researchers also found improvements in the survival
of PWA with most types of non-AIDS-related cancers. With adjustments,
some of the improvements were attenuated, but for most cancers,
the 24-month death hazard was much lower in 1996 through 2000 than
in earlier years. These study authors are more optimistic than some
investigators.
Lung
cancer is the most frequent non-AIDS-related cancer in PWA
and has been the focus of other published studies. These
studies reported little or no change in survival despite improving
ARTs, suggesting that the tumors may be diagnosed late or be more
aggressive in PWA and that PWA with cancer may receive less intensive
therapy. The authors of this study also did not find survival for
lung cancer to be improving significantly.
For
cancers with a good prognosis, however, there is the prospect of
prolonged survival even if the patient also has AIDS. When ARTs
are effective in maintaining reasonable levels of immunity, optimal
cancer treatments can be used. For PWA with cancers with a poor
prognosis, decision making is more difficult, but aggressive approaches
can be still considered.
From the *Viral Epidemiology Branch, Division of Cancer Epidemiology and
Genetics, National Cancer Institute (NCI), National Institutes of
Health (NIH), Department of Health and Human Services (DHHS), Bethesda,
MD; †Epidemiology Program, New York City Department of Health and
Mental Hygiene, New York, NY; ‡New York State Cancer Registry, New
York State Department of Health, Albany, NY; §Computer Sciences
Corporation, Rockville, MD; and ∥Biostatistics Branch, DCEG,
NCI, NIH, DHHS, Bethesda, MD.
The authors present this as their original work not
under consideration elsewhere and have no conflict of interest with
any aspect of this study.
06/29/05
Reference
R
Biggar and others. Survival after Cancer Diagnosis in Persons with
AIDS. Journal of Acquired Immune Deficiency Syndromes 39(3):
293-299. July 1, 2005.
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