This K07 award will provide Dr. Jessica Hwang with the experience and mentoring to reach her long-term goal of developing into an independent investigator conducting clinical epidemiology and health services research in internal medicine issues and supportive care of patients undergoing treatment for cancer, particularly in viral reactivation during chemotherapy. Immediate career goals include expanding expertise on reactivation of HBV infection;developing analytic skills, including skills in decision-analysis and cost-effectiveness studies;and gaining expertise in the interpretation of HBV serologic scenarios and the clinical management of patients at risk for reactivation. At present, oncologists in the U.S. perform prechemotherapy screening in only a small percentage of patients at risk for HBV reactivation during chemotherapy. The objective of this application is to determine the impact of systematic prechemotherapy screening for and treatment of HBV among cancer patients undergoing chemotherapy affects clinical outcomes.
The specific aims of this application are to: 1) identify the rates and determinants of serologic screening for HBV among cancer patients receiving chemotherapy at M. D. Anderson Cancer Center;2) determine the rates and predictors of acute HBV infection among M. D. Anderson patients receiving chemotherapy under the current standard of care;3) assess the impact of systematic HBV screening of cancer patients undergoing chemotherapy on the rates of acute HBV infection and related clinical outcomes as compared with a historical cohort;4) develop a decision-analysis model to examine the costs and benefits of preventing reactivation of HBV infection. This study will be the first to systematically examine the impact of HBV screening on outcomes in patients undergoing chemotherapy.
Aims 1 and 2 will be achieved through a retrospective analysis of merged administrative and clinical databases as well as selected chart review;
Aim 3 through a prospective clinical cohort;
and Aim 4 through decision analysis and cost-effectiveness analysis. The combination of Dr. Hwang's unique background in internal medicine and public health and the collective and impressive expertise of her mentoring team make her well suited for conducting this project. The proposed career development activities in cancer control, statistics, decision analysis, and cost-effectiveness analysis will provide Dr. Hwang with the skills necessary to establish herself as an independent researcher in her field.
Nearly 17 million people in the United States have evidence of HBV infection, and they are at high risk for reactivation of HBV infection if they receive immunosuppressive therapy such as chemotherapy. Recent guidelines recommend widespread HBV screening prior to immunosuppression but lack data-driven evidence. This K07 will compare the effectiveness of wide spread vs. targeted HBV screening, and the end result will produce evidence to support HBV screening recommendations for oncologists. These recommendations will inform policy changes and future educational efforts.
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