Latent hepatitis B virus (HBV) infection can be reactivated upon receipt of immunosuppressive therapy. The Centers for Disease Control and Prevention recommends widespread HBV screening prior to immunosuppression;however, the American Society of Clinical Oncology recommends that only select cancer patients be screened prior to chemotherapy. This controversy has hindered dissemination of screening strategies, and oncologists now face a gap in knowledge about best HBV screening practices. This has led to inconsistent screening and deleterious yet preventable clinical outcomes.
We aim to study current rates of HBV screening and the comparative effect of the potential implementation of two distinct screening strategies in one of the largest Comprehensive Cancer Centers in the US. Our overall goal is to help guide oncology medical providers to achieve a higher level of clinical excellence in HBV-related patient care. The objective of this application s to determine whether widespread or selective screening is more effective in preventing reactivation of HBV infection. The central hypothesis is that widespread HBV screening is more effective than selective screening to decrease the rates of reactivation and subsequently reduce unnecessary morbidity and mortality in cancer patients. Our study will provide an evidence-based HBV screening strategy that will change the standard of HBV care for cancer patients prior to chemotherapy.
Three specific aims have been designed to test the central hypothesis and accomplish the objective of this application:
Aim 1 : Compare patterns of HBV screening before and after the release of recommendations from the Centers for Disease Control and Prevention and from the American Society of Clinical Oncology.
Aim 2 : Assess the impact of widespread vs. selective screening of cancer patients undergoing chemotherapy on the ability to detect prevalence of HBV infection, incidence of reactivation, and delays in cancer therapy.
Aim 3 : Develop a decision-analysis model to compare the predictive ability and cost-effectiveness of implementing widespread vs. selective HBV screening. This R21 application will establish the current status of HBV screening and infection, and burden of reactivation;the adherence to national screening guidelines;and the potential implementation of two distinct screening strategies. Through a decision-making processes, we will determine whether widespread or selective HBV screening is the most effective screening strategy for cancer patients. This application possesses the potential to shift the standard of care for cancer patients with HBV prior to chemotherapy.

Public Health Relevance

Nearly 17 million people in the US have evidence of hepatitis B virus (HBV) infection and are at risk for reactivation if they receive chemotherapy. Recent national guidelines are controversial about whether all patients or only select patients should be screened prior to chemotherapy and thus have not been systematically implemented. This R21 will focus on the implementation of national HBV screening recommendations and will compare the effectiveness of widespread versus selective HBV screening;study results will produce evidence to guide oncologists to effective HBV screening strategies, inform policy changes, and identify future dissemination needs.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Doriarose, Vincent P
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University of Texas MD Anderson Cancer Center
Internal Medicine/Medicine
Other Domestic Higher Education
United States
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Lu, Huifang; Lok, Anna S; Warneke, Carla L et al. (2018) Passive transfer of anti-HBc after intravenous immunoglobulin administration in patients with cancer: a retrospective chart review. Lancet Haematol 5:e474-e478
Hwang, J P; Barbo, A G; Perrillo, R P (2015) Hepatitis B reactivation during cancer chemotherapy: an international survey of the membership of the American Association for the Study of Liver Diseases. J Viral Hepat 22:346-52
Hwang, Jessica P; Suarez-Almazor, Maria E; Torres, Harrys A et al. (2014) Hepatitis C virus screening in patients with cancer receiving chemotherapy. J Oncol Pract 10:e167-74
Hwang, Jessica P; Lok, Anna S-F (2014) Management of patients with hepatitis B who require immunosuppressive therapy. Nat Rev Gastroenterol Hepatol 11:209-19
Guo, Ying; Jones, Desiree; Palmer, J Lynn et al. (2014) Oral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial. Support Care Cancer 22:1223-31
Hwang, Jessica P; Fisch, Michael J; Lok, Anna S-F et al. (2013) Trends in hepatitis B virus screening at the onset of chemotherapy in a large US cancer center. BMC Cancer 13:534