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Practice Patterns in Hepatitis B Virus Screening Before Cancer Chemotherapy in a Major US Hospital Network.
- Source :
-
Digestive diseases and sciences [Dig Dis Sci] 2018 Jan; Vol. 63 (1), pp. 61-71. Date of Electronic Publication: 2017 Nov 24. - Publication Year :
- 2018
-
Abstract
- Background: Cancer patients receiving chemotherapy face an increased risk of reactivation of chronic hepatitis B virus infection.<br />Aim: To determine the HBV screening rate in patients receiving cancer chemotherapy in various clinical settings.<br />Method: We identified 11,959 adult cancer patients (age ≥ 18 years) receiving parenteral chemotherapy between 2012 and 2015 within a major US hospital network, including a large university hospital, community teaching hospitals, and community oncology clinics.<br />Result: Two thousand and forty-five patients (17.1%) were screened for either HBV surface antigen (HBsAg) or HBV core antibody (HBcAb) before chemotherapy, and 1850 patients (15.5%) had both HBsAg and HBcAb tested before chemotherapy. 8.4% were exposed to HBV, and 0.9% had chronic HBV infection (both HBsAg/HBcAb positive). Patients with hematologic tumor were more often screened than with solid tumor (55.6 vs. 8.3%, p < 0.001). Patients receiving chemotherapy with higher HBV reactivation risk had higher yet suboptimal HBV screening rate (41.1% B-depleting agents, 21.5% anthracycline, 14.9% steroid, 64.7% anti-TNF alpha and 18.6% other chemotherapy, p < 0.001). Patients with age ≥ 50 years (old 16.2% vs. young 23.9%, p < 0.001) and Asian ethnicity (Asian 13.6 vs. Caucasian 16.6%, p < 0.001) were screened less for HBV despite higher prevalence of HBV exposure (old 9.3% vs. young 4.3%, p < 0.001 and Asian 27.8% vs. Caucasian 6.4%, p < 0.001). Patients receiving chemotherapy in community oncology clinics were less screened versus community teaching hospitals or university hospital (12.7 vs. 19.1 vs. 19.7%, p < 0.001), despite similar prevalence of HBV infection. On multivariate analysis, receiving chemotherapy at a community oncology clinic [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.45-0.72, p < 0.001] was independently associated with less HBV screening compared to receiving chemotherapy at a university or community teaching hospital.<br />Conclusion: HBV screening among patients undergoing cancer chemotherapy was suboptimal and less commonly performed in community oncology clinics compared to teaching hospitals.
- Subjects :
- Adult
Aging
Ethnicity
Female
Humans
Male
Mass Screening
Middle Aged
Multivariate Analysis
Neoplasms classification
Odds Ratio
Practice Patterns, Physicians'
Risk Factors
Sex Factors
United States
Antineoplastic Agents administration & dosage
Antineoplastic Agents therapeutic use
Hepatitis B diagnosis
Hepatitis B virus isolation & purification
Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2568
- Volume :
- 63
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Digestive diseases and sciences
- Publication Type :
- Academic Journal
- Accession number :
- 29177849
- Full Text :
- https://doi.org/10.1007/s10620-017-4850-1