Original articlePancreas, biliary tract, and liverLow Level of Hepatitis B Virus Screening Among Patients Receiving Chemotherapy
Section snippets
Data Sources
After approval was obtained from the Institutional Review Board of the Mayo Clinic, an electronic pharmacy database was queried to identify a cohort of patients who underwent cytotoxic chemotherapy as an outpatient for the first time at the Mayo Clinic (Rochester, MN) between January 1, 2006, and September 30, 2011. Pharmaceutical agents or antibodies that may suppress the immune system such as high-dose steroids were included, whereas antibodies that do not affect immune function such as
Results
During the study period, 8005 patients initiated chemotherapy, 23% (n = 1805) of whom had hematologic malignancies. The median age was 61 years (interquartile range [IQR], 51.4–70.0 y) and men accounted for 50.8% (n = 4064). In Table 1, screening for HBV before chemotherapy occurred in 1279 (16%) patients, including 668 (37%) with hematologic malignancies. The median interval between HBV testing and initiation of chemotherapy was approximately 6 months (0.46 y; IQR, 0.06–4.10). In addition, 523
Discussion
In this study, we analyzed a cohort of patients undergoing chemotherapy and assessed screening for HBV infection and the resultant outcome. The main findings included the following: (1) the overall frequency of testing, be it for screening or diagnostic purposes, was low with fewer than a quarter of the patients ever being tested for HBV before or after initiation of chemotherapy; although screening did increase over time, mostly among patients with hematologic malignancies; (2) in addition to
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Cited by (25)
Cost-Effectiveness Analysis of Screening for Hepatitis B Virus Infection in Patients With Solid Tumors Before Initiating Chemotherapy
2020, Clinical Gastroenterology and HepatologyCitation Excerpt :Our analyses remained robust to these assumptions. Importantly, we modeled a 10% rate of HBV screening in high-risk patients, which is consistent with population-based estimates.9,10 Even at rates of HBV screening more than twice this value, a screen all strategy was preferred.
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2017, Digestive and Liver DiseaseCitation Excerpt :The magnitude of risk for clinically significant hepatitis B virus reactivation with chemotherapy for non-hematological tumors is not fully clear. Indeed, chemotherapy for solid tumors is carried out with drugs that have a minor documented effect on immune system, if compared to drugs used in hematologic malignancies [9–15,20–22]. The rate of HBV reactivation is higher in patients with breast cancer (41–56%) [23–26], and appears to be lower in those treated for other solid tumors (14–21%) [27–29].
Is the Risk of Death Enhanced in Immunosuppressed Hepatitis B Virus–infected Patients Who Develop Acute Liver Failure?
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This article has an accompanying continuing medical education activity on page e51. Learning Objective–Upon completion of this activity, successful learners will be able to identify factors associated with screening for HBV in patients receiving chemotherapy.
Conflicts of interest The authors disclose no conflicts.