The clinical care of patients with these tumours requires a multidisciplinary approach drawing on the skills and experience of all healthcare professional groups. Moreover, optimal care can only be achieved by the close co-operation of oncologists, haematologists and HIV physicians, and unless all these clinicians are intimately involved in the care of patients it is likely that the outcome will be less favourable. Patients with HIV-associated malignancies should therefore only be managed in a centre dealing with large numbers of patients with these tumours. The minimum number of patients that an HIV

oncology service should manage SB431542 mw has not been defined. Several studies and a Cochrane review have shown that the more HIV patients treated by a centre, Galunisertib ic50 the better the outcomes [6–8]. Similarly, Improving outcomes

in haematological cancer published by NICE in 2003 included a systematic review of published evidence suggesting that higher patient volumes are associated with improved outcomes and that outcomes in specialist centres are better. They advocated that all patients with haematological cancer should be managed by a multidisciplinary haemato-oncology team serving a population of at least 500 000 [9]. An audit study in North London confirmed the better management of patients with AIDS-related lymphomas in HIV centres with cohorts of >500 patients [10]. An audit from Canada also showed that clinicians treating larger numbers of patients with AIDS-related lymphoma provided better care [11] and a recent cohort study in the US published in 2013 attributed poorer results in some centres to a lack of access to optimal intergrated cancer and HIV

care [12]. An additional benefit of centralization could be greater uptake of HIV testing amongst patients diagnosed with cancers including lymphomas as advocated in BHIVA testing guidelines [13] and in the US [14]. This remains a concern since UK lymphoma clinicians are often overly reluctant to adopt universal testing [15] and uptake remains low even for AIDS-defining malignancies [16]. In line Y-27632 2HCl with national cancer waiting times, all patients with suspected cancers must be referred urgently and seen within 2 weeks of referral. Moreover, the NHS Cancer Plan sets out the goal that no patient should wait longer than 1 month from an urgent referral with suspected cancer, to the start of treatment [17]. We recommend that all patients with HIV and malignancy should be referred to centres that have developed expertise in the management of these diseases (level of evidence 1B). The multidisciplinary team managing these patients must include HIV physicians, oncologists, haematologists and palliative care physicians along with clinical nurse specialists, specialist HIV pharmacists and specialist chemotherapy pharmacists.