Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: People living with HIV are at heightened risk for various malignancies including Kaposi sarcoma, aggressive B-cell non-Hodgkin lymphoma, and cervical cancer. As utilization of Highly Active Anti-Retroviral Therapy (HAART) has improved long term survival of these patients, they also experience an increased risk for non-AIDS-defining cancers, including head and neck cancers (HNC). HNCs represent a significant burden on health systems due to their high incidence and the complexity of treatment, often involving a combination of surgery, radiation, and chemotherapy. Furthermore, patients often require extensive rehabilitation to recover vital functions such as speaking, swallowing, and breathing. While some studies have explored the impact of HIV on non-AIDS-defining cancers such as breast cancer, limited data exist on the clinical outcomes and healthcare costs for HIV-positive patients with HNC, highlighting a critical gap addressed by this study.
Objective: To evaluate the implications of HIV status on all-cause and HNC-specific mortality among Medicare enrollees with head and neck cancer using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Secondary objective includes assessing the impact of HIV status on healthcare costs
Design, Setting, and Participants: This population-based retrospective cohort study utilized SEER-Medicare data from 2010 to 2019, encompassing Medicare claims files (MedPAR, Outpatient, and Carrier) linked to SEER data via unique patient IDs. Patients diagnosed with head and neck cancer were stratified by HIV status. Kaplan-Meier survival curves and Cox regression models were used to analyze all-cause and HNC-specific mortality as secondary outcomes. Total healthcare costs, as well as setting-specific costs (inpatient, outpatient, and private practice), were the primary outcomes. Results will be adjusted for demographic and clinical characteristics, including age, race/ethnicity, cancer stage, comorbidities, and treatment modalities (surgery, radiation, chemotherapy).
Main Outcomes and Results: The cohort included 148,504 head and neck cancer (HNC) patients, with a mean age of 69.8 years, of whom 71.5% were male. Among the cohort, 1,335 patients (0.9%) were HIV-positive. HIV-positive patients exhibited higher mortality rates compared to HIV-negative patients (Hazard Ratio = 1.099, p = 0.018). Additionally, HIV-positive patients incurred significantly higher setting-specific and total healthcare costs than HIV-negative patients. A t-test revealed a mean total healthcare cost of $308,518.70 for HIV-negative patients and $588,894 for HIV-positive patients (p < 0.01). Subsequent multivariable regression which will be conducted prior to the meeting will control for the year of diagnosis, comorbidities, and stage of diagnosis.
Conclusions and relevance: HIV patients in the era of HAART typically have normal life expectancy when utilizing these medications, and as such the incidence of HNC in this population expected to increase with time. This population-based study assessed the association between HIV infection and healthcare costs and outcomes in Medicare enrollees with head and neck cancer. Despite representing a small percentage of those with HNC, HIV-positive patients exhibited higher mortality rates compared to HIV-negative patients and incurred significantly higher setting-specific and total healthcare costs than HIV-negative patients. Providers should be aware of this potential trend, particularly in HIV endemic areas.