Patients Remain Unscreened for HBV Prior to Chemotherapy, Despite National Recommendations

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(ChemotherapyAdvisor) – Most patients with solid tumors or risk factors for the hepatitis B virus (HBV) remain unscreened prior to chemotherapy, despite an increase in such screening after publication of national recommendations; findings were noted in a study presented during ASCO's inaugural Quality Care Symposium in San Diego, CA.

“Efforts are needed to increase awareness of the importance of HBV screening prior to chemotherapy and antiviral prophylaxis to prevent HBV reactivation,” noted Jessica P. Hwang, MD, MPH, of the University of Texas MD Anderson Cancer Center, Houston, TX.

Dr. Hwang and colleagues conducted a retrospective cohort study of HBV screening in cancer patients registered at their institution from January 2004 through April 2011.

“Screening was defined as HBsAg and anti-HBc tests ordered around initial chemotherapy,” she noted.

Screening rates for three periods were compared: 1) before publication recommendations; 2) during publication of Centers for Disease Control and Prevention, National Comprehensive Cancer Network, American Association for the Study of Liver Diseases, Institute of Medicine, and ASCO recommendations; and 3) after publication of recommendations. The screening recommendations differ regarding which patients should be screened.

Of 139,981 new patients, 18,688 received chemotherapy, and 3,020 (16.2%) were screened, Dr. Hwang reported.

HBV screening rates increased significantly from 14.8% to 18.2% to 19.9% over the three periods (P<0.0001); however, less than 19% of patients with HBV risk factors were screened.

During the entire study period, more than 66% of patients with hematologic malignancies were screened; odds of screening nearly doubled after publication of recommendations (P<0.0001). Less than 4% of patients with solid tumors were screened, despite a 70% increase in odds of screening after recommendations (P=0.003).

Other predictors of screening included younger age, planned rituximab therapy, and known risk factors for HBV infection, Dr. Hwang concluded.


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