HBV reactivation among cancer patients receiving chemotherapy

描述(申请人提供)：K07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研究员，在内科问题和癌症治疗患者的支持性护理方面进行临床流行病学和医疗服务研究，特别是在化疗期间病毒重新激活的情况下。近期的职业目标包括扩大有关乙肝病毒感染重新激活的专业知识；发展分析技能，包括决策分析和成本效益研究方面的技能；以及在解释乙肝病毒血清学情景和有再次激活风险的患者的临床管理方面获得专业知识。目前，美国的肿瘤学家只对化疗期间有乙肝病毒重新激活风险的一小部分患者进行化疗前筛查。这项应用的目的是确定在接受化疗的癌症患者中进行系统的化疗前筛查和治疗对临床结果的影响。这项应用的具体目的是：1)确定在M.D.Anderson癌症中心接受化疗的癌症患者中进行乙肝病毒血清学筛查的比率和决定因素；2)确定在当前护理标准下接受化疗的M.D.Anderson患者中急性乙肝病毒感染的比率和预测因素；3)评估与历史队列相比，对接受化疗的癌症患者进行系统的乙肝病毒筛查对急性乙肝感染率和相关临床结果的影响；4)开发一个决策分析模型，以检验防止乙肝病毒感染重新激活的成本和效益。这项研究将首次系统地研究乙肝病毒筛查对接受化疗的患者结局的影响。目标1和目标2将通过对合并的行政和临床数据库的回顾分析以及选定的图表审查来实现；目标3通过前瞻性临床队列来实现；目标4通过决策分析和成本效益分析来实现。黄博士在内科医学和公共卫生方面的独特背景与她的指导团队令人印象深刻的集体专业知识相结合，使她非常适合进行这一项目。拟议的癌症控制、统计、决策分析和成本效益分析方面的职业发展活动将为黄博士提供必要的技能，使她成为所在领域的独立研究人员。

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.