Trends in hepatitis B virus screening in a large U.S. cancer center.

Abstract

e19631 Background: In the past 5 years, national hepatitis B virus (HBV) screening recommendations differed with respect to populations that should be screened to prevent reactivation, which may occur in patients with hematologic or solid malignancies. Previous studies showed that up to 60% of oncologists are not screening. We sought to compare the HBV screening patterns over time in a large US cancer center in relationship to the 2010 ASCO Provisional Clinical Opinion (PCO) which includes recommendations to screen patients with hematologic malignancies prior to receipt of certain cancer therapies. Methods: Retrospective cohort study of patients with newly diagnosed cancer registered at MD Anderson (1/04 - 4/11) who received chemotherapy. Screening was defined as testing for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before chemotherapy. We compared screening rates among patients with hematologic malignancies vs. solid tumors. Using Chi-square tests, we compared screening rates before and after the PCO. A generalized linear regression model was used to detect changes in the rates of HBV screening over time for patients based on cancer type. Results: During our study period, 141,877 patients were registered, and 13% (n=18,877) received chemotherapy. Of these, 18% (n=3475) had HBV screening: 1% (n=42) were HBsAg+/anti-HBc+, while 7% (n=242) were HBsAg-/anti-HBc+. The overall screening rate significantly increased from 18% before the PCO to 23% after the PCO (p<0.01). After the PCO, the screening rate among patients with hematologic malignancies increased from 69% to 79% (p<0.01), and among patients with solid tumors from 3.8% to 5% (p=0.05). Overall, the rate of increase of HBV screening among patients with hematologic malignancies was higher than for patients with solid tumors (p<0.01). Conclusions: Rates of HBV screening increased after the PCO, although the rate of increase was greater among patients with hematologic malignancies than solid tumors. Because reactivation is an important and preventable cause of morbidity and mortality in patients with either hematologic or solid malignancies, further efforts are needed to screen patients at risk by identifying predictors of reactivation of HBV infection.