Session: 905. Outcomes Research—Malignant Conditions (Lymphoid Disease): Poster III
Hematology Disease Topics & Pathways:
Adult, Diseases, Non-Hodgkin Lymphoma, immunodeficiency, Immune Disorders, Lymphoid Malignancies, Study Population
Methods: This was a retrospective cohort study of PLWH diagnosed with KS or NHL between 2004 and 2018. Baseline characteristics including demographics, insurance coverage, Ryan White assistance, CD4+ T-cell counts, HIV viral load, HAART treatment, performance status, and disease stage were collected. Participants were classified as having private insurance, Medicare, Medicaid, or no insurance. Treatment regimens were assessed as “optimal” or “suboptimal” using the National Comprehensive Cancer Network guidelines for AIDS-related KS and lymphomas as benchmark. Hazard ratios (HR) for survival were calculated using Cox proportional hazards regression models.
Results: Among 191 participants with AIDS-defining cancers, 107 had KS, and 96 had aggressive NHL. 18% had private insurance, 14% had Medicare, 46% had Medicaid, and 23% had no health insurance; 44% received Ryan White assistance. Participants with Medicare and those without Ryan White assistance were older. Those with Ryan White assistance also had better performance status (defined as having an Eastern Cooperative Oncology Group score of 0 to 2). There were no significant differences in CD4+ T-cell counts, HIV viral loads, HAART adherence, treatment delays, regimen selection, and response rates across the insurance and Ryan White groups. The median treatment delay for all participants was 20 days. In general, participants with Medicare had lower overall survival than privately insured participants (HR 2.99, 95% confidence interval [CI] 1.14-7.87, p = 0.027). Participants without Ryan White assistance also had lower overall survival (HR 2.82, 95% CI 1.49-5.35, p = 0.002) and progression-free survival (HR 2.56, 95% CI 1.47-4.44, p < 0.001) than those with assistance. Other factors that influenced overall survival were age (adjusted HR 1.04 per year of age; 95% CI 1.01-1.06; p = 0.007), Hispanic ethnicity (adjusted HR 0.46 compared to Whites; 95% CI 0.24-0.91; p = 0.025), and poor performance status (adjusted HR 6.14; 95% CI 3.39-11.12; p < 0.00001).
Conclusions: Our study is among the first to examine the impact of insurance coverage on outcomes in AIDS-defining malignancies. We find that PLWH with Medicare and those not receiving Ryan White assistance have lower survival. These differences may be ascribed in part to discrepancies in age, performance status, and prevalence of AIDS- and non-AIDS-related comorbidities. Reassuringly, our analysis suggests Ryan White assistance, despite its coverage limitations, is not associated with increases in treatment delays or suboptimal regimens. Nevertheless, the importance of dedicated care for this population at a multidisciplinary HIV/AIDS and comprehensive cancer center should not be undervalued. Future research should focus on whether the observed differences can be more broadly replicated in the United States.
Disclosures: No relevant conflicts of interest to declare.
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