TY - JOUR
T1 - Trends in hepatitis B virus screening at the onset of chemotherapy in a large US cancer center
AU - Hwang, Jessica P.
AU - Fisch, Michael J.
AU - Lok, Anna S.F.
AU - Zhang, Hong
AU - Vierling, John M.
AU - Suarez-Almazor, Maria E.
N1 - Funding Information:
Supported by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant, CA016672. Dr. Hwang is a recipient of National Cancer Institute grants K07 CA132955 and R21 CA167202. Dr. Suarez-Almazor has a Midcareer Investigator Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24 AR053593). We are grateful to the following individuals for their assistance with institutional databases: Mark Routbort (Laboratory Informatics); Sarah Taylor (Tumor Registry); Chun Feng (Pharmacy Informatics); Weiming Shi (Patient Accounts). We would also like to acknowledge Susan Lackey, MPH, and Angelic Castillo, General Internal Medicine, for administrative support; Shana Palla, MS, and Andrea Barbo, MS, Department of Biostatistics, for manuscript review; Laurissa Gann, MSLS, Research Medical Library, for assistance with literature review; and Stephanie Deming, BA, Department of Scientific Publications, for editing the manuscript.
PY - 2013/11/9
Y1 - 2013/11/9
N2 - Background: National organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened. We aimed to determine contemporary screening rates at a cancer center and the possible influence on these rates of publication of national recommendations.Methods: We conducted a retrospective cohort study of HBV screening in cancer patients registered during the period from January 2004 through April 2011. Screening was defined as HBsAg and anti-HBc tests ordered around the time of initial chemotherapy. We compared screening rates for 3 periods: January 1, 2004, through December 18, 2008 (Food and Drug Administration and American Association for the Study of Liver Diseases 2007 recommendations); December 19, 2008, through September 30, 2010 (Centers for Disease Control and Prevention, National Comprehensive Cancer Network, American Association for the Study of Liver Diseases 2009, Institute of Medicine, and American Society of Clinical Oncology recommendations); and October 1, 2010, through April 30, 2011. Logistic regression models were used to identify predictors of screening.Results: Of 141,877 new patients, 18,688 received chemotherapy, and 3020 (16.2%) were screened. HBV screening rates increased over the 3 time periods (14.8%, 18.2%, 19.9%; P < 0.0001), but <19% of patients with HBV risk factors were screened. Among patients with hematologic malignancies, over 66% were screened, and odds of screening nearly doubled after publication of the recommendations (P < 0.0001). Less than 4% of patients with solid tumors were screened, although odds of screening increased 70% after publication of the recommendations (P = 0.003). Other predictors of screening included younger age, planned rituximab therapy, and known risk factors for HBV infection.Conclusions: Most patients with solid tumors or HBV risk factors remained unscreened, although screening rates increased after publication of national recommendations. Efforts are needed to increase awareness of the importance of HBV screening before chemotherapy to identify patients who should start antiviral prophylaxis.
AB - Background: National organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened. We aimed to determine contemporary screening rates at a cancer center and the possible influence on these rates of publication of national recommendations.Methods: We conducted a retrospective cohort study of HBV screening in cancer patients registered during the period from January 2004 through April 2011. Screening was defined as HBsAg and anti-HBc tests ordered around the time of initial chemotherapy. We compared screening rates for 3 periods: January 1, 2004, through December 18, 2008 (Food and Drug Administration and American Association for the Study of Liver Diseases 2007 recommendations); December 19, 2008, through September 30, 2010 (Centers for Disease Control and Prevention, National Comprehensive Cancer Network, American Association for the Study of Liver Diseases 2009, Institute of Medicine, and American Society of Clinical Oncology recommendations); and October 1, 2010, through April 30, 2011. Logistic regression models were used to identify predictors of screening.Results: Of 141,877 new patients, 18,688 received chemotherapy, and 3020 (16.2%) were screened. HBV screening rates increased over the 3 time periods (14.8%, 18.2%, 19.9%; P < 0.0001), but <19% of patients with HBV risk factors were screened. Among patients with hematologic malignancies, over 66% were screened, and odds of screening nearly doubled after publication of the recommendations (P < 0.0001). Less than 4% of patients with solid tumors were screened, although odds of screening increased 70% after publication of the recommendations (P = 0.003). Other predictors of screening included younger age, planned rituximab therapy, and known risk factors for HBV infection.Conclusions: Most patients with solid tumors or HBV risk factors remained unscreened, although screening rates increased after publication of national recommendations. Efforts are needed to increase awareness of the importance of HBV screening before chemotherapy to identify patients who should start antiviral prophylaxis.
KW - Chemotherapy
KW - Hepatitis B virus
KW - Hepatitis B virus screening
KW - Reactivation
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U2 - 10.1186/1471-2407-13-534
DO - 10.1186/1471-2407-13-534
M3 - Article
C2 - 24209764
AN - SCOPUS:84887057653
SN - 1471-2407
VL - 13
JO - BMC cancer
JF - BMC cancer
M1 - 534
ER -