289. Importance of Universal Screening for Hepatitis B in Cancer Patients: Quality Improvement Project in Japan

Abstract

BackgroundHepatitis B virus (HBV) reactivation after immunosuppressive therapy in cancer patients is associated with significant morbidity and mortality. In the United States (US), infection rate of previous HBV infection and chronic HBV infection in cancer patients is 6.5% and 0.6%,, respectively. Universal screening of HBV including surface antigen (HBsAg) and core antibody (HBcAb) in cancer patients has not been recommended in the United States, but it may be warranted to prevent viral reactivation and adverse clinical outcomes in endemic countries such as Japan.MethodsWe conducted a retrospective chart review at a tertiary care hospital in Tokyo, Japan from July 2003 through March 2019 and collected the data of HBV screening tests in patients with cancer and without cancer. (1) We compared the positive results of HBsAg and HBcAb between patients with cancer and without cancer during the study period. (2) We started a quality improvement (QI) project in 2012 to raise the rate of HBV screening tests in cancer patients and analyzed the rate of HBV screening tests by comparing pre vs. post QI intervention.ResultsOverall, the positivity rate of HBsAg and HBcAb was 1.18% (10,979/929,024) and 20.2% (3,538/17,537), respectively. When we compared positive results of cancer patients with non-cancer patients, HBsAg was significantly higher (1.85% [424/22,934] vs. 1.16% [10,555/906,090], P < 0.001) (Figure 1), and HBcAb showed lower tendency (14.1% [701/4,981] vs. 22.6% [2,837/12,556], P = 0.086) (Figure 2). Annual trend of screening tests in cancer patients are shown at Figures 3 and 4. Through our QI project, the rate of both HBsAg and HBcAb tests significantly increased from 91.2% (5,064/5,551) to 99.4% (7,748/7,798) (P < 0.001) and from 3.9% (215/5,469) to 81.2% (6.304/7,767) (P < 0.001), respectively, from 2011 to 2018.ConclusionPrevalence of HBV is much higher in Japan than the United States. Universal screening tests of HBV in cancer patients is warranted especially in endemic countries to prevent reactivation and adverse clinical outcomes. The rate of screening tests dramatically increased through our QI project. Disclosures All authors: No reported disclosures.