Trends in hepatitis B virus screening in a large U.S. cancer center.

e19631 Background: In the past 5 years, national hepatitis B virus (HBV) screening recommendations differed with respect to populations that should be screened to prevent reactivation, which may occur in patients with hematologic or solid malignancies. Previous studies showed that up to 60% of oncologists are not screening. We sought to compare the HBV screening patterns over time in a large US cancer center in relationship to the 2010 ASCO Provisional Clinical Opinion (PCO) which includes recommendations to screen patients with hematologic malignancies prior to receipt of certain cancer therapies. Methods: Retrospective cohort study of patients with newly diagnosed cancer registered at MD Anderson (1/04 - 4/11) who received chemotherapy. Screening was defined as testing for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before chemotherapy. We compared screening rates among patients with hematologic malignancies vs. solid tumors. Using Chi-square tests, we compared screening rates before and after the PCO. A generalized linear regression model was used to detect changes in the rates of HBV screening over time for patients based on cancer type. Results: During our study period, 141,877 patients were registered, and 13% (n=18,877) received chemotherapy. Of these, 18% (n=3475) had HBV screening: 1% (n=42) were HBsAg+/anti-HBc+, while 7% (n=242) were HBsAg-/anti-HBc+. The overall screening rate significantly increased from 18% before the PCO to 23% after the PCO (p<0.01). After the PCO, the screening rate among patients with hematologic malignancies increased from 69% to 79% (p<0.01), and among patients with solid tumors from 3.8% to 5% (p=0.05). Overall, the rate of increase of HBV screening among patients with hematologic malignancies was higher than for patients with solid tumors (p<0.01). Conclusions: Rates of HBV screening increased after the PCO, although the rate of increase was greater among patients with hematologic malignancies than solid tumors. Because reactivation is an important and preventable cause of morbidity and mortality in patients with either hematologic or solid malignancies, further efforts are needed to screen patients at risk by identifying predictors of reactivation of HBV infection.

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Effect of national recommendations on hepatitis B virus screening in a large U.S. cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.175 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 175-175

Author(s):

Jessica Hwang ◽

Michael Fisch ◽

Anna Lok ◽

Hong Zhang ◽

John Vierling ◽

...

Keyword(s):

Risk Factors ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Solid Tumors ◽

Cancer Center ◽

Hbv Reactivation ◽

Entire Study Period ◽

Entire Study ◽

B Virus ◽

Hbv Screening

175 Background: National organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened. We aimed to determine changes in screening rates at a cancer center after national recommendations were published between 2008 and 2010. Methods: We conducted a retrospective cohort study of HBV screening in cancer patients registered 1/2004 through 4/2011. Screening was defined as HBsAg and anti-HBc tests ordered around initial chemotherapy. We compared screening rates for 3 periods: before publication recommendations, during the period of publication of CDC, NCCN, AASLD, IOM, and ASCO recommendations, and after publication of recommendations. Logistic regression models were used to identify predictors of screening. Results: Of 139,981 new patients, 18,688 received chemotherapy, and 3,020 (16.2%) were screened. HBV screening rates increased over the 3 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 during the entire study period, and odds of screening nearly doubled after publication of recommendations (p<0.0001). Less than 4% of patients with solid tumors were screened during the entire study period despite 70% increase in odds of screening after recommendations (p=0.003). Other predictors of screening included younger age, planned rituximab therapy, and known risk factors for HBV infection. Conclusions: HBV screening increased after publication of national recommendations, yet most patients with solid tumors or HBV risk factors remained unscreened. Efforts are needed to increase awareness of the importance of HBV screening prior to chemotherapy and antiviral prophylaxis to prevent HBV reactivation.

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Impact of the timing of hepatitis B virus (HBV) identification and anti-HBV therapy initiation on the risk of adverse liver outcomes in patients receiving cancer therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6503 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6503-6503

Author(s):

Jessica Hwang ◽

Maria E. Suarez-Almazor ◽

Scott B. Cantor ◽

Andrea G. Barbo ◽

Heather Y. Lin ◽

...

Keyword(s):

Hepatitis B Virus ◽

Cancer Therapy ◽

Hepatitis B ◽

Liver Failure ◽

Solid Tumors ◽

Hematologic Malignancies ◽

Patients With Cancer ◽

Therapy Initiation ◽

B Virus ◽

Chronic Hbv

6503 Background: Patients with cancer and hepatitis B virus (HBV) infection receiving cancer therapy are at risk for HBV reactivation. We aimed to determine the impact of early vs. late HBV identification and early vs. late/no anti-HBV therapy on adverse liver outcomes of patients with cancer with chronic (HBsAg+/anti-HBc+) or past (HBsAg-/anti-HBc+) HBV infection. Methods: We retrospectively studied adult patients with solid or hematologic malignancies who received chemotherapy during 2004-2011. Adverse liver-related events included hepatitis flares, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariable hazard models to determine predictors of outcomes. Early was defined as at the initiation of cancer therapy and late as after therapy initiation. Results: There were 18,688 study patients (80.4% had solid tumors). Among patients with hematologic malignancies, 89.6% had HBV testing of which 90.4% was early. Among patients with solid tumors, 10.8% had HBV testing of which 46.4% was early. Prevalence of chronic HBV was 1.1% (52/4905) and past HBV was 7.1% (350/4905). Among patients with chronic HBV with hematologic or solid malignancy, those identified late had 2.95 times (1.45-6.01) higher risk of liver failure than those identified early. Among chronic HBV patients, 59% (23/39) with early testing had early initiation of anti-HBV therapy, while all of those tested late had late/no initiation of anti-HBV therapy. Predictors of liver failure were male sex, chronic HBV, and late HBV identification for patients with solid tumors, and allogeneic SCT for patients with hematologic malignancies. Conclusions: Early HBV identification correlated with early anti-HBV therapy initiation and reduced risk of liver failure after chemotherapy in chronic HBV patients with solid tumors or hematologic malignancies as well as patients with past HBV and solid tumors.

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Screening for hepatitis B virus prior to chemotherapy: A quality improvement project.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.158 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 158-158

Author(s):

Lisa K. Hicks ◽

Patricia Leung ◽

Jennifer Cape

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Process Control ◽

Screening Rate ◽

Post Intervention ◽

Process Improvements ◽

Control Charting ◽

Testing Rate ◽

B Virus ◽

Hbv Screening

158 Background: Hepatitis B virus (HBV) reactivation is a well-recognized and serious complication of chemotherapy which can be prevented with prophylactic antiviral therapy. St. Michael’s Hospital (SMH) is an academic hospital in Toronto, Canada, serving an inner city population. The prevalence of chronic HBV in populations such as ours is estimated to be > 8%, compared to 2% of all Canadians. In this context, surveillance for HBV prior to chemotherapy is very important. Aim: To increase the HBV screening rate among patients starting IV chemotherapy at SMH to greater than 90% by December 2013. Methods: Repeated plan-do-study-act (PDSA) cycles targeting HBV screening in our chemotherapy unit were initiated in January 2013 and are on-going. Appropriate HBV screening was defined as at least one HBsAg test up to 3 months prior to, or 3 weeks after starting chemotherapy. Interventions included education sessions, posters, standardized HBV lab order sets, and pharmacist review of lab data prior to first chemotherapy with reminders to physicians when HBV testing was absent. Pre and post-intervention HBV screening rates were compared using process control charting. Results: Between January 1, 2012, and June 15, 2013, 407 unique patients started IV chemotherapy at SMH. Prior to our interventions a stable HBV screening rate of approximately 30% was observed. Sequential process improvements were introduced in January and April 2013. Process control charting demonstrated the presence of special cause variation subsequent to our interventions with a significant improvement in the HBV testing rate (post-intervention rate of 70%). The HBV testing rate began to improve in January 2013 and met criteria for special cause variation by February 2013. Conclusions: It is possible to dramatically increase the rate of HBV testing prior to chemotherapy through relatively simple, low tech process improvements. Further improvements are necessary to reach our goal of a 90% HBV screening rate prior to IV chemotherapy. Additional planned interventions include individualized physician report cards on HBV screening rates using achievable benchmark criteria and an education campaign directed at empowering patients to ask about HBV testing.

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An electronic prompt to improve hepatitis B virus screening prior to cancer treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.169 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 169-169

Author(s):

Lisa K. Hicks ◽

Jordan J. Feld ◽

Joshua Juan ◽

Judy Truong ◽

Urszula Zurawska ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Control Charts ◽

Hbv Reactivation ◽

Screening Rate ◽

Control Center ◽

Process Control Charts ◽

B Virus ◽

Hbv Screening ◽

Study Center

169 Background: Hepatitis B virus (HBV) reactivation is a potentially fatal complication of cancer therapy that is almost entirely preventable. Despite this, HBV screening rates remain low at many centers. We evaluated the effectiveness of an electronic prompt on HBV screening rates and compared this strategy with education alone. Methods: An education session on HBV reactivation was delivered to all oncology staff at two large, academic oncology centers in the fall of 2010. At one center (study center) an electronic prompt was also introduced. The electronic prompt reminded physicians to screen for HBV when booking a new patient’s first chemotherapy and automatically trigged an electronic order for HBsAg if the physician assented. The prompt was not implemented at the second (control) center. The primary endpoint was the rate of HBV screening. Actual HBV screening rates were determined in both centers for 10 months prior to and for 12 months following the interventions. HBV screening rates were assessed and compared with process control charts (p-charts); 3-sigma limits were employed to define special cause variation. Results: 6,116 new patients received their first chemotherapy during the study period (2,095 study center; 4,021 control center). In the pre-prompt period, the screening rate was stable at 16% at the study center and 25% in the control center. In the prompt period, the screening rate increased to 62% at the study center and was unchanged at 25% in the control center. Special cause variation suggesting a non-random improvement in HBV screening rate was detected at the Study Center two months after the introduction of the electronic prompt. Conclusions: An electronic prompt increased the rate of HBV screening, however screening rates remained relatively low. Education sessions did not appear to improve the HBV screening rate.

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Hepatitis B Virus Screening Before Cancer Chemotherapy in Taiwan: A Nationwide Population-Based Study

Frontiers in Medicine ◽

10.3389/fmed.2021.657109 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wei-Chih Sun ◽

Pei-Ling Tang ◽

Wen-Chi Chen ◽

Feng-Woei Tsay ◽

Huay-Min Wang ◽

...

Keyword(s):

Health Insurance ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Cancer Chemotherapy ◽

National Health Insurance ◽

Screening Rate ◽

Hematological Cancer ◽

B Virus ◽

Prophylactic Antiviral Therapy ◽

Hbv Screening

Background: Reactivation of the hepatitis B virus (HBV) during cancer chemotherapy is a severe and sometimes fatal complication. In 2009, the National Health Insurance (NHI) in Taiwan recommended and reimbursed screening for HBV infection and prophylactic antiviral therapy before cancer chemotherapy. In this study, we determined the HBV screening rate in patients with cancer undergoing chemotherapy in Taiwan.Methods: We retrospectively collected data from the National Health Insurance Research Database on patients who received systemic chemotherapy for solid or hematologic cancers from January 2000 through December 2012. We defined HBV screening based on testing for serum HBsAg within 2 years of the first chemotherapy commencement. We calculated overall and annual HBV screening rates in all patients and subgroups of age, gender, cancer type, hospital level, physician's department, and implementation of NHI reimbursement for HBV screening before cancer chemotherapy.Results: We enrolled 379,639 patients. The overall HBV screening rate was 45.9%. The screening rates were higher in males, those with hematological cancer, those at non-medical centers and medical departments. The HBV screening rates before (2000–2008) and after the implementation of NHI reimbursement (2009–2012) were 38.1 and 57.5%, respectively (p < 0.0001). The most common practice pattern of HBV screening was only HBsAg (64.6%) followed by HBsAg/HBsAb (22.1%), and HBsAg/HBcAb/HBsAb (0.7%) (p < 0.0001). The annual HBV screening rate increased from 31.5 to 66.3% (p < 0.0001). The screening rates of solid and hematological cancers significantly increased by year; however, the trend was greater in solid cancer than in hematological cancer (35.9 and 26.2%, p < 0.0001).Conclusions: The HBV screening rate before cancer chemotherapy was fair but increased over time. These figures improved after implementing a government-based strategy; however, a mandatory hospital-based strategy might improve awareness of HBV screening and starting prophylactic antiviral therapy before cancer chemotherapy.

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Hepatitis B virus (HBV) screening strategy to ensure the safety of blood for transfusion through a combination of immunological testing and nucleic acid amplification testing — Japanese experience

Journal of Clinical Virology ◽

10.1016/s1386-6532(06)80010-7 ◽

2006 ◽

Vol 36 ◽

pp. S56-S64 ◽

Cited By ~ 24

Author(s):

Hisao Yugi ◽

Masaaki Mizui ◽

Junko Tanaka ◽

Hiroshi Yoshizawa

Keyword(s):

Hepatitis B Virus ◽

Nucleic Acid ◽

Hepatitis B ◽

Screening Strategy ◽

Nucleic Acid Amplification ◽

Japanese Experience ◽

Nucleic Acid Amplification Testing ◽

B Virus ◽

Hbv Screening

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Screening for hepatitis B virus prior to initiating tocilizumab and tofacitinib in patients with rheumatologic diseases: a cross-sectional study

The Journal of Rheumatology ◽

10.3899/jrheum.210257 ◽

2021 ◽

pp. jrheum.210257

Author(s):

Amir M. Mohareb ◽

Naomi J. Patel ◽

Xiaoqing Fu ◽

Arthur Y. Kim ◽

Zachary S. Wallace ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Positive Hbsag ◽

Rheumatologic Diseases ◽

American College Of Rheumatology ◽

B Virus ◽

Hbv Screening

Objective Hepatitis B virus (HBV) can reactivate among rheumatology patients initiating tocilizumab or tofacitinib. HBV screening is recommended by the Centers for Disease Control and Prevention (CDC), the American Association for the Study of Liver Diseases (AASLD), and the Canadian Rheumatology Association but is not explicitly recommended by the American College of Rheumatology. Methods We conducted a cross-sectional study to characterize HBV screening practices for adult rheumatology patients initiating tocilizumab or tofacitinib before December 31, 2018, in the Greater Boston area. We classified appropriate HBV screening patterns prior to tocilizumab or tofacitinib (i.e., HBV surface antigen [HBsAg], total core antibody [anti- HBcAb], and surface antibody [HBsAb]) as: complete (all 3 tested), partial (any 1 or 2 tests), or none. We determined the frequency of inappropriate HBV testing (HBeAg, anti-HBcAb IgM, or HBV DNA without a positive HBsAg or total anti-HBcAb) and used multivariable regression to assess factors associated with complete HBV screening. Results Among 678 subjects initiating tocilizumab, 194 (29%) completed appropriate HBV screening, 307 (45%) had partial screening, and 177 (26%) had none. Among 391 subjects initiating tofacitinib, 94 (24%) completed appropriate HBV screening, 195 (50%) had partial screening, and 102 (26%) had none. Inappropriate testing was performed in 22% of subjects. Race was associated with complete HBV screening (white versus non-white, OR 0.74; 95%CI: 0.57-0.95) while prior immunosuppression was not (csDMARDs, OR 1.05, 95%CI: 0.72-1.55; bDMARDs, OR 0.73, 95%CI: 0.48- 1.12). Conclusion Patients initiating tocilizumab or tofacitinib are infrequently screened for HBV despite recommendations from AASLD and CDC.

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