A Duke professor is helping to create new guidelines for improved treatment for cancer patients with HIV. 

The National Comprehensive Care Network is an alliance of 27 cancer centers that has created a guide of best practices for treating cancer. Its aim is to synthesize the evidence and practices available to make sure that all patients receive the best possible preventive, diagnostic, treatment and supportive services. 

Recently, Gita Suneja, associate professor of radiation oncology and global health at Duke, co-chaired the NCCN panel that produced a new set of guidelines for treating cancer in patients living with HIV.

“In the research that led up to this, we saw patients who have both cancer and HIV are a lot less likely to get cancer treatment compared to people who don’t have HIV,” she said. “We found that surprising and concerning because many of these cancers are treatable.” 

Research illuminating this disparity in treatment was published in 2014. A year later, Suneja led an effort to survey U.S. oncologists about how they treat patients with cancer and HIV. The results indicated that doctors who were more concerned with toxicity—the degree to which a drug can harm patients—and efficacy—the ability of a drug to produce a beneficial outcome—were less likely to administer standard cancer treatments when caring for patients who had HIV and cancer.

A majority of respondents agreed that the guidelines available for cancer management in patients with HIV were insufficient, suggesting that better standards would increase the number of HIV patients receiving standard cancer care.

Instead of focusing on one cancer subtype, the guidelines that Suneja and the panel produced will be useful for oncologists treating a variety of cancers in a specific population that is currently more at risk for HIV than cancer patients in general. 

The guidelines discuss some specific cancer types—including cervical cancer and Hodgkin's lymphoma—and include a general summary of principles unique to people with HIV, including HIV management during cancer treatment, drug-drug interactions, radiation therapy, surgery, imaging and supportive care.

“Those are things that the average oncologist may not be aware of,” Suneja said. “We tried to really synthesize the data out there into a format that’s really easy to use for clinicians treating those patients.” 

Now that the new guidelines have been distributed, Suneja explained that the goal is to start getting treatment to people who need it, especially people who are at risk of not receiving such treatment. As people are increasingly living longer with HIV, the number of patients developing cancers related to both HIV infection and typical aging is increasing. This makes cancer a leading cause of death for this population, Suneja said.

“It’s disappointing that people who have survived HIV and now have a life expectancy almost as long as people without HIV are less likely to get cancer treatment and have worse outcomes,” she said. “[This work is] about making cancer treatment more accessible and available to people, even those with chronic medical conditions.”