Abstract
330 Background: Patients with a history of HBV exposure are at risk of reactivation when receiving treatments that affect the immune system, such as cancer-directed therapies. ASCO guidelines recommend universal HBV screening prior to initiation of cancer-directed therapies to prevent hepatic dysfunction and delays in cancer care. However, significant variation remains in clinical practice. Improving HBV screening is of special interest at our institution, given that we serve a large proportion of Asian immigrants at high risk of prior HBV exposure. With our institution’s transition to EPIC on Apr 1, 2022, the HBV serology order set was incorporated into the pre-treatment checklist of every cancer therapy plan. We studied the rates of HBV screening before and after implementing this change. Methods: We identified patients with cancer starting systemic cancer treatment at our institution between Oct 1, 2021 – Mar 31, 2022 (pre-EPIC period), and Oct 1, 2023 – Mar 31, 2023 (post-EPIC period). Patients who received only endocrine therapy, transferred care, or lost to follow-up prior to treatment initiation were excluded. To select a random sample from each time-period of interest, patients were assigned a random number, sorted based on this random number, and then reviewed in order. All data was collected retrospectively by manual chart review. Results: We randomly selected and reviewed 69 patients from pre-EPIC period, and 75 from post-EPIC period. Their demographic, disease, and treatment characteristics are summarized in the table. HBV screening rates were 42% and 80% in the pre-and post-EPIC periods, respectively (p<0.001). Twenty-one (14.6%) patients screened positive for HBV core antibody, among whom six (5.1%) had negative surface antibodies. Conclusions: The built-in HBV serology order set significantly improved rates of hepatitis B screening prior to starting systemic cancer-directed treatment. It is a low-cost and highly effective intervention. Our next steps are to determine how a higher adherence to HBV screening guidelines impacted the management of patients with prior HBV exposure. Pre-EPIC:Oct 1, 2021 - Mar 31, 2022 (N=69) Post-EPIC: Oct 1, 2022 – Mar 31, 2023 (N=75) P values Age at diagnosis (years), mean (SD) 62.1 (1.4) 65.2 (1.6) 0.15 Female (%) 40 (58.0) 35 (46.7) 0.18 Race (%): 0.051 White 51 (73.9) 49 (65.3) Asian 8 (11.6) 20 (26.7) Other 10 (14.5) 6 (8.0) Cancer type (%): 0.39 Hematological Malignancies 19 (27.5) 16 (21.3) Solid Tumor 50 (72.7) 59 (78.7) Metastatic Disease (%) 24 (34.8) 25 (33.3) 0.95 Treatment Type (%): 0.13 CD20 mAb+/- other 3 (4.4) 9 (12.0) Chemotherapy+/-other 52 (75.4) 57 (76.0) Other 14 (20.3) 9 (12.0) mAb: monoclonal antibody.
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