Trends in hepatitis B virus screening at the onset of chemotherapy in a large US cancer center

Michael J Fisch,Maria E Suarez-Almazor,Anna S-F Lok,Jessica P Hwang,Hong Zhang,John M Vierling

doi:10.1186/1471-2407-13-534

Abstract

BackgroundNational organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened. We aimed to determine contemporary screening rates at a cancer center and the possible influence on these rates of publication of national recommendations.MethodsWe conducted a retrospective cohort study of HBV screening in cancer patients registered during the period from January 2004 through April 2011. Screening was defined as HBsAg and anti-HBc tests ordered around the time of initial chemotherapy. We compared screening rates for 3 periods: January 1, 2004, through December 18, 2008 (Food and Drug Administration and American Association for the Study of Liver Diseases 2007 recommendations); December 19, 2008, through September 30, 2010 (Centers for Disease Control and Prevention, National Comprehensive Cancer Network, American Association for the Study of Liver Diseases 2009, Institute of Medicine, and American Society of Clinical Oncology recommendations); and October 1, 2010, through April 30, 2011. Logistic regression models were used to identify predictors of screening.ResultsOf 141,877 new patients, 18,688 received chemotherapy, and 3020 (16.2%) were screened. HBV screening rates increased over the 3 time 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, and odds of screening nearly doubled after publication of the recommendations (P < 0.0001). Less than 4% of patients with solid tumors were screened, although odds of screening increased 70% after publication of the recommendations (P = 0.003). Other predictors of screening included younger age, planned rituximab therapy, and known risk factors for HBV infection.ConclusionsMost patients with solid tumors or HBV risk factors remained unscreened, although screening rates increased after publication of national recommendations. Efforts are needed to increase awareness of the importance of HBV screening before chemotherapy to identify patients who should start antiviral prophylaxis.

Highlights

National organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened
We previously found that only 17% of patients treated at a US cancer center from 2004 through 2007 were screened for HBV infection before chemotherapy [14]
During the study period, 141,877 new patients were registered at MD Anderson (Figure 1), of whom 18,688 (13.2%) received chemotherapy at MD Anderson

Summary

Introduction

National organizations recommend screening for hepatitis B virus (HBV) before chemotherapy but differ regarding which patients should be screened. National [1,2,3,4,5,6,7] and international [8,9] recommendations for hepatitis B virus (HBV) screening before chemotherapy emphasize the need to identify patients with HBV infection so that antiviral prophylaxis can be initiated to prevent reactivation of HBV infection. The rates of HBV screening before immunosuppressive therapy in the US are unknown because of the lack of large-scale studies, rates have been estimated through physician surveys, which have shown rates ranging from 38-80% [11,12,13]. Monitor carriers of HBV for clinical and laboratory signs of active HBV infection and for signs of hepatitis during and for up to several months after rituximab therapy.

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