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Widespread vs Selective Screening for Hepatitis B Infection Prior to Chemotherapy

化疗前乙型肝炎感染的广泛筛查与选择性筛查

基本信息

批准号：
8603780
负责人：
Jessica Park Hwang
金额：
$ 20万
依托单位：
UNIVERSITY OF TX MD ANDERSON CAN CTR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-01-10 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8603780
关键词：
Address Adherence Alanine Transaminase American Society of Clinical Oncology Antibodies Antigens Antiviral Agents Biological Assay Cancer Patient Caring Centers for Disease Control and Prevention (U.S.)Chronic Hepatitis B Clinical Complication Comprehensive Cancer Center Country Decision Analysis Decision Making Diagnostic Face Flare Future Goals Guidelines Health Hepatic Hepatitis B Hepatitis B Prevalence Hepatitis B Virus Immunosuppression Incidence Individual Infection International Knowledge Lead Liver Medical Oncology Methods Modeling Morbidity - disease rate Oncologist Outcome Patient Care Patients Pattern Pharmaceutical Preparations Policies Process Provider Public Policy Recommendation Research Risk Screening for cancer Services Shapes Surface Antigens Testing Therapeutic immunosuppression Treatment Protocols Virus Diseases Withdrawal cancer care cancer therapy chemotherapy comparative compare effectiveness cost effectiveness design disorder prevention evidence base experience improved mortality oncology patient population prevent prophylactic public health relevance screening standard of care viral DNA virus core

项目摘要

DESCRIPTION (provided by applicant): Latent hepatitis B virus (HBV) infection can be reactivated upon receipt of immunosuppressive therapy. The Centers for Disease Control and Prevention recommends widespread HBV screening prior to immunosuppression; however, the American Society of Clinical Oncology recommends that only select cancer patients be screened prior to chemotherapy. This controversy has hindered dissemination of screening strategies, and oncologists now face a gap in knowledge about best HBV screening practices. This has led to inconsistent screening and deleterious yet preventable clinical outcomes. We aim to study current rates of HBV screening and the comparative effect of the potential implementation of two distinct screening strategies in one of the largest Comprehensive Cancer Centers in the US. Our overall goal is to help guide oncology medical providers to achieve a higher level of clinical excellence in HBV-related patient care. The objective of this application s to determine whether widespread or selective screening is more effective in preventing reactivation of HBV infection. The central hypothesis is that widespread HBV screening is more effective than selective screening to decrease the rates of reactivation and subsequently reduce unnecessary morbidity and mortality in cancer patients. Our study will provide an evidence-based HBV screening strategy that will change the standard of HBV care for cancer patients prior to chemotherapy. Three specific aims have been designed to test the central hypothesis and accomplish the objective of this application: Aim 1: Compare patterns of HBV screening before and after the release of recommendations from the Centers for Disease Control and Prevention and from the American Society of Clinical Oncology. Aim 2: Assess the impact of widespread vs. selective screening of cancer patients undergoing chemotherapy on the ability to detect prevalence of HBV infection, incidence of reactivation, and delays in cancer therapy. Aim 3: Develop a decision-analysis model to compare the predictive ability and cost-effectiveness of implementing widespread vs. selective HBV screening. This R21 application will establish the current status of HBV screening and infection, and burden of reactivation; the adherence to national screening guidelines; and the potential implementation of two distinct screening strategies. Through a decision-making processes, we will determine whether widespread or selective HBV screening is the most effective screening strategy for cancer patients. This application possesses the potential to shift the standard of care for cancer patients with HBV prior to chemotherapy.

描述(申请人提供)：接受免疫抑制治疗后，潜伏的乙肝病毒(乙肝)感染可以重新激活。疾病控制和预防中心建议在免疫抑制之前进行广泛的乙肝筛查；然而，美国临床肿瘤学会建议在化疗前只对选定的癌症患者进行筛查。这一争议阻碍了筛查策略的传播，肿瘤学家现在面临着关于最佳乙肝筛查实践的知识缺口。这导致了不一致的筛查和有害但可预防的临床结果。我们的目标是研究目前的乙肝筛查率以及在美国最大的综合性癌症中心之一实施两种不同的筛查策略的比较效果。我们的总体目标是帮助指导肿瘤医疗提供者在乙肝相关患者护理方面实现更高水平的临床卓越。S这一应用的目的是确定广泛筛查或选择性筛查在预防乙肝病毒感染再激活方面更有效。中心假设是，广泛的乙肝筛查比选择性筛查更有效地降低癌症患者的复发率，从而减少不必要的发病率和死亡率。我们的研究将提供一种循证的乙肝病毒筛查策略，将改变癌症患者化疗前的乙肝病毒护理标准。设计了三个特定的目标来检验中心假设并实现这一应用的目标：目标1：比较疾病控制和预防中心和美国临床肿瘤学会发布建议之前和之后的乙肝筛查模式。目的2：评估对接受化疗的癌症患者进行广泛筛查和选择性筛查对检测乙肝病毒感染流行率、复发率和癌症治疗延迟的影响。目的3：建立一个决策分析模型，比较实施广泛和选择性乙肝筛查的预测能力和成本效益。这一R21应用程序将确定乙肝病毒筛查和感染的现状，以及重新激活的负担；遵守国家筛查指南；以及可能实施两种不同的筛查战略。通过决策过程，我们将确定广泛筛查还是选择性筛查是癌症患者最有效的筛查策略。这一应用有可能改变化疗前对携带乙肝病毒的癌症患者的护理标准。