HBV reactivation among cancer patients receiving chemotherapy

描述（由申请人提供）：本次K07奖将为Jessica Hwang博士提供经验和指导，以实现她的长期目标，即成为一名独立的研究者，在内科问题和癌症治疗患者的支持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方面。近期的职业目标包括扩大HBV感染再激活方面的专业知识；发展分析技能，包括决策分析和成本效益研究的技能；并在HBV血清学情况的解释和再激活风险患者的临床管理方面获得专业知识。目前，美国的肿瘤学家仅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。本应用程序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HBV筛查和治疗对临床结果的影响。本应用程序的具体目的是：1)确定在m.d.安德森癌症中心接受化疗的癌症患者中HBV血清学筛查的比率和决定因素；2)确定在现行护理标准下接受化疗的m.d. Anderson患者急性HBV感染的发生率和预测因素；3)与历史队列比较，评估接受化疗的癌症患者系统HBV筛查对急性HBV感染率和相关临床结局的影响；4)建立决策分析模型，以检查预防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和目标2将通过对合并的行政和临床数据库的回顾性分析以及选定的图表审查来实现；目的3通过前瞻性临床队列；和目标4通过决策分析和成本效益分析。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，使她非常适合主持这个项目。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，使她成为她所在领域的独立研究员。

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.