Hepatitis B virus screening in patients receiving intravenous chemotherapy.

Abstract

205 Background: Patients with chronic hepatitis B (HBV) who undergo chemotherapy without antiviral prophylaxis may develop HBV reactivation, hepatitis, liver injury, and even death. The University of Illinois Cancer Center (UICC) lacks a standardized guideline for screening patients for HBV prior to chemotherapy initiation. A retrospective chart review was conducted on chemotherapy orders submitted to UICC pharmacy over 4 weeks for both hematological and solid tumor malignancies. Of 63 new orders for intravenous chemotherapy, only 14 patients (22%) underwent HBV screening prior to chemotherapy initiation. We aimed to increase HBV screening from 22% to 50% over 2 months. Methods: A multidisciplinary taskforce comprised of hematology/oncology and hepatology physicians, clinical pharmacy, and nursing was created. An ideal process map was created identifying a clear management schema for HBV screening including differences in screening tests for various populations and management recommendations for positive test results. Two Plan-Do-Study-Act (PDSA) cycles were tested with post intervention data collected over eight weeks. Results: Of 192 chemotherapy orders submitted to outpatient pharmacy over 8 weeks, 62 patients (32%) were determined to be appropriate for HBV screening prior to initiation of chemotherapy. Of these, 36 patients (58%) were screened appropriately for HBV. Additionally, a subset analysis revealed 100% of patients successfully screened for HBV prior to initiation of anti-CD20 therapies. Conclusions: At UICC, a multidisciplinary team created and successfully piloted the implementation of a HBV screening policy in both hematological and solid tumor malignancies. Our initial aim was reached after 8 weeks of implementation, and ongoing efforts are being conducted to further improve HBV screening rates to 90%.