TY - JOUR
T1 - Models to predict hepatitis B virus infection among patients with cancer undergoing systemic anticancer therapy
T2 - A prospective cohort study
AU - Hwang, Jessica P.
AU - Lok, Anna S.
AU - Fisch, Michael J.
AU - Cantor, Scott B.
AU - Barbo, Andrea
AU - Lin, Heather Y.
AU - Foreman, Jessica T.
AU - Vierling, John M.
AU - Torres, Harrys A.
AU - Granwehr, Bruno P.
AU - Miller, Ethan
AU - Eng, Cathy
AU - Simon, George R.
AU - Ahmed, Sairah
AU - Ferrajoli, Alessandra
AU - Romaguera, Jorge
AU - Suarez-Almazor, Maria E.
N1 - Publisher Copyright:
© 2018 by American Society of Clinical Oncology.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Purpose Most patients with cancer are not screened for hepatitis B virus (HBV) infection before undergoing anticancer therapy, and optimal screening strategies are unknown. We sought to develop selective HBV screening strategies for patients who require systemic anticancer therapy. Methods This prospective cohort study included adults age $ 18 years with solid or hematologic malignancies who received systemic anticancer therapy at a comprehensive cancer center during 2013 and 2014. Patients underwent hepatitis B surface antigen, hepatitis B core antibody, and hepatitis B surface antibody testing, and completed a 19-question modified Centers for Disease Control and Prevention (CDC) HBV survey. Multivariable models that predict chronic or past HBV infection were developed and validated using bootstrapping. Results A total of 2,124 patients (mean age, 58 6 13 years) completed the risk survey and HBV testing. Of these, 54% were women; 77% were non-Hispanic white, 11% Hispanic, 8% black, and 4% Asian; and 20% had a hematologic malignancy and 80% a solid tumor. Almost 12% were born outside the United States. The prevalence was 0.3% for chronic HBV infection and 6% for past HBV infection. Significant predictors of positive hepatitis B surface antigen or hepatitis B core antibody tests were as follows: men who had sex with men, black or Asian race, birthplace outside the United States, parent's birthplace outside the United States, household exposure to HBV, age $ 50 years, and history of injection drug use. The area under the receiver operating characteristic curve of the model on the basis of these seven predictors was 0.79 (95% CI, 0.73 to 0.82). The modified CDC survey and brief tools with fewer than seven questions yielded similar false-negative rates (0% and 0% to 0.7%, respectively). Conclusion An internally validated risk tool performed as well as the modified CDC survey; however, more than 90% of patients who completed the tool would still require HBV testing. Universal HBV testing is more efficient than risk-based screening.
AB - Purpose Most patients with cancer are not screened for hepatitis B virus (HBV) infection before undergoing anticancer therapy, and optimal screening strategies are unknown. We sought to develop selective HBV screening strategies for patients who require systemic anticancer therapy. Methods This prospective cohort study included adults age $ 18 years with solid or hematologic malignancies who received systemic anticancer therapy at a comprehensive cancer center during 2013 and 2014. Patients underwent hepatitis B surface antigen, hepatitis B core antibody, and hepatitis B surface antibody testing, and completed a 19-question modified Centers for Disease Control and Prevention (CDC) HBV survey. Multivariable models that predict chronic or past HBV infection were developed and validated using bootstrapping. Results A total of 2,124 patients (mean age, 58 6 13 years) completed the risk survey and HBV testing. Of these, 54% were women; 77% were non-Hispanic white, 11% Hispanic, 8% black, and 4% Asian; and 20% had a hematologic malignancy and 80% a solid tumor. Almost 12% were born outside the United States. The prevalence was 0.3% for chronic HBV infection and 6% for past HBV infection. Significant predictors of positive hepatitis B surface antigen or hepatitis B core antibody tests were as follows: men who had sex with men, black or Asian race, birthplace outside the United States, parent's birthplace outside the United States, household exposure to HBV, age $ 50 years, and history of injection drug use. The area under the receiver operating characteristic curve of the model on the basis of these seven predictors was 0.79 (95% CI, 0.73 to 0.82). The modified CDC survey and brief tools with fewer than seven questions yielded similar false-negative rates (0% and 0% to 0.7%, respectively). Conclusion An internally validated risk tool performed as well as the modified CDC survey; however, more than 90% of patients who completed the tool would still require HBV testing. Universal HBV testing is more efficient than risk-based screening.
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U2 - 10.1200/JCO.2017.75.6387
DO - 10.1200/JCO.2017.75.6387
M3 - Article
C2 - 29447061
AN - SCOPUS:85045007133
SN - 0732-183X
VL - 36
SP - 959
EP - 967
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 10
ER -