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: 7787924
• 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/7787924
• 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 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; Simian B disease; Supportive care; Surface Antigens; Surveys; Testing; Therapeutic immunosuppression; United States; University of Texas M D Anderson Cancer Center; Viral; anti-hepatitis B; base; cancer therapy; career; career development; chemotherapy; clinical epidemiology; cohort; compare effectiveness; cost; cost effectiveness; design; experience; high risk; improved; mortality; preference; prevent; prophylactic; prospective; public health relevance; 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 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者，开展内科问题的临床流行病学和健康服务研究，以及接受癌症治疗的患者的支持性护理，特别是化疗期间的病毒再激活。近期职业目标包括扩大乙型肝炎病毒感染再激活方面的专业知识；培养分析技能，包括决策分析和成本效益研究的技能；并获得乙型肝炎病毒血清学情况的解释和有再激活风险的患者的临床管理方面的专业知识。目前，美国的肿瘤学家仅对一小部分化疗期间有乙肝病毒再激活风险的患者进行化疗前筛查。本申请的目的是确定接受化疗的癌症患者中系统性化疗前筛查和 HBV 治疗对临床结果的影响。本应用的具体目的是： 1) 确定在 M. D. Anderson 癌症中心接受化疗的癌症患者中进行 HBV 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 HBV 感染的发生率和预测因素； 3) 与历史队列相比，评估对接受化疗的癌症患者进行系统 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乙型肝炎病毒筛查对接受化疗的患者结果的影响的研究。目标 1 和 2 将通过对合并的管理和临床数据库进行回顾性分析以及选定的图表审查来实现；通过前瞻性临床队列实现目标 3；通过决策分析和成本效益分析实现目标 4。黄博士在内科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，使她非常适合开展该项目。拟议的癌症控制、统计学、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，让她成为该领域的独立研究员。公共卫生相关性：美国有近 1700 万人有 HBV 感染的证据，如果他们接受化疗等免疫抑制治疗，他们面临着 HBV 感染重新激活的高风险。最近的指南建议在免疫抑制之前进行广泛的乙型肝炎筛查，但缺乏数据驱动的证据。 K07 将比较广泛传播与针对性 HBV 筛查的有效性，最终结果将为肿瘤学家提供支持 HBV 筛查建议的证据。这些建议将为政策变化和未来的教育工作提供信息。