HBV reactivation among cancer patients receiving chemotherapy

接受化疗的癌症患者中乙型肝炎病毒再激活

• 批准号: 8268500
• 负责人: Jessica Park Hwang
• 金额: $ 14.04万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8268500
• 关键词: Acute Hepatitis; Acute Liver Failure; Address; Affect; Alanine Transaminase; American; Antibodies; Antigens; Antiviral Agents; Antiviral Therapy; Award; Biological Assay; Cancer Center; Cancer Control; Cancer Patient; Chronic Hepatitis B; Clinical; Clinical Management; Cost Effectiveness Analysis; Costs and Benefits; Country; Data; Databases; Decision Analysis; Diagnostic; Flare; Future; Goals; Guidelines; Health; Health Services Research; Hepatic; Hepatitis B; Hepatitis B Virus; Immunocompromised Host; Immunosuppression; Individual; Internal Medicine; International; Lead; Liver; Liver diseases; Malignant Neoplasms; Medical; Mentors; Modeling; Morbidity - disease rate; Oncologist; Outcome; Patients; Pharmaceutical Preparations; Physicians; Policies; Prevalence; Public Health; Recommendation; Reporting; Research Personnel; Risk; Screening for cancer; Screening procedure; Serological; Supportive care; Surface Antigens; Surveys; Testing; Therapeutic immunosuppression; United States; University of Texas M D Anderson Cancer Center; Viral; Virus Diseases; anti-hepatitis B; base; cancer therapy; career; career development; chemotherapy; clinical epidemiology; cohort; compare effectiveness; cost effective; cost effectiveness; design; experience; high risk; improved; mortality; preference; prevent; prophylactic; prospective; skills; standard of care; statistics; viral DNA; virus core

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.

描述（由申请人提供）：该K 07奖项将为Jessica Hwang博士提供经验和指导，以实现她的长期目标，即发展成为一名独立的研究者，在内科问题和接受癌症治疗的患者的支持性护理方面进行临床流行病学和卫生服务研究，特别是在化疗期间的病毒再激活。近期的职业目标包括扩大HBV感染再激活的专业知识;发展分析技能，包括决策分析和成本效益研究的技能;并获得HBV血清学方案的解释和有再激活风险的患者的临床管理的专业知识。目前，美国的肿瘤学家只对一小部分化疗期间有HBV再激活风险的患者进行化疗前筛查。本申请的目的是确定化疗前系统性HBV筛查和治疗对接受化疗的癌症患者临床结局的影响。本申请的具体目的是：1）确定在M接受化疗的癌症患者中HBV血清学筛查的比率和决定因素。D.安德森癌症中心; 2）确定M. D.在现行护理标准下接受化疗的安德森患者; 3）与历史队列相比，评估接受化疗的癌症患者的系统性HBV筛查对急性HBV感染率和相关临床结果的影响; 4）开发决策分析模型来检查预防HBV感染再激活的成本和收益。这项研究将是第一个系统地研究HBV筛查对化疗患者预后的影响。目标1和2将通过对合并的管理和临床数据库以及选定的病历审查进行回顾性分析来实现;目标3将通过前瞻性临床队列来实现;目标4将通过决策分析和成本效益分析来实现。黄博士在内科和公共卫生方面的独特背景以及她的指导团队的集体和令人印象深刻的专业知识相结合，使她非常适合进行这个项目。在癌症控制，统计，决策分析和成本效益分析的职业发展活动将提供必要的技能，建立自己作为一个独立的研究人员在她的领域。公共卫生关系：在美国有近1700万人有HBV感染的证据，如果他们接受免疫抑制治疗如化疗，他们有很高的HBV感染再激活的风险。最近的指南建议在免疫抑制之前进行广泛的HBV筛查，但缺乏数据驱动的证据。本K 07将比较广泛传播与靶向HBV筛查的有效性，最终结果将为支持肿瘤学家的HBV筛查建议提供证据。这些建议将为政策变化和未来的教育工作提供信息。