Hepatitis c virus infection risk tool for patients with cancer.

Abstract

e18694 Background: Hepatitis C virus (HCV) infection can cause adverse hepatic and oncologic outcomes in cancer patients. In the general population, HCV screening is recommended using risk-factor-based and 1945-1965 birth-cohort-based strategies; however, in cancer patients the optimal screening strategies have yet to be established. Methods: We prospectively enrolled 2122 patients at MD Anderson Cancer Center prior to first anticancer therapy during 7/2013-12/2014 and surveyed HCV risk factors, including birth year, injection drug use, blood transfusion or organ transplant before 1992, clotting factor concentrate before 1987, chronic liver disease, and HIV. We estimated HCV prevalence by positive HCV antibody (anti-HCV) and examined associations of demographic, clinical, and behavioral factors with HCV status using Fisher’s exact test or Student’s t-test. False negative rates (FNR) are given for 3 screening strategies: risk-based cohort (positive for ≥1 risk factor), birth-year risk cohort, or both cohorts combined. Results: Prevalence of anti-HCV was 1.93% (41 patients; 95% CI 1.39-2.61%) and highest among blacks (5.0%; 95% CI 2.2-9.6%), followed by whites (1.9%; 95% CI 1.3-2.6%). Participant race/ethnicity was white (76%), Hispanic (11%), black (8%), or Asian (4%). Median age was 59 years (range 18-91), and 54% were female. Primary cancer diagnosis was non-hepatocellular carcinoma (HCC) solid cancers (79%), hematologic cancers (20%), or HCC (1%). Education less than a bachelor’s degree, birth-year cohort, injection drug use, blood transfusion or organ transplant, and chronic liver disease were each significantly associated with detectable anti-HCV. Sixty-two percent (n = 1,315) of participants, including 39 of 41 with anti-HCV, reported ≥1 risk factor. FNR for the 3 screening strategies was 32% (95% CI 18−48%) for the risk-based cohort, 20% (95% CI 9−35%) for birth-year cohort, and 5% (95% CI 1−17%) for the combined strategy. Conclusions: Combined birth-year and risk-based screening was superior to either screening strategy alone; however, this approach increases the burden placed upon the medical teams and yet still miss 5% of infected patients. Thus, universal HCV testing may be more efficient in patients with cancer.