Widespread vs Selective Screening for Hepatitis B Infection Prior to Chemotherapy

描述（由申请人提供）：潜伏乙型肝炎病毒（HBV）感染可在接受免疫抑制治疗后重新激活。疾病控制和预防中心建议在免疫抑制前进行广泛的HBV筛查；然而，美国临床肿瘤学会建议，只有选定的癌症患者在化疗前进行筛查。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HBV筛查实践的知识差距。这导致了不一致的筛查和有害但可预防的临床结果。我们的目的是在美国最大的综合癌症中心之一研究目前的HBV筛查率和两种不同筛查策略的潜在实施的比较效果。我们的总体目标是帮助指导肿瘤医疗提供者在hbv相关患者护理方面达到更高水平的临床卓越。本应用的目的是确定广泛筛查还是选择性筛查在预防HBV感染再激活方面更有效。中心假设是，广泛的HBV筛查比选择性筛查更有效地降低癌症患者的再激活率，从而降低不必要的发病率和死亡率。我们的研究将提供一种基于证据的HBV筛查策略，这将改变癌症患者化疗前的HBV护理标准。目的1：比较美国疾病控制与预防中心和美国临床肿瘤学会发布建议前后的HBV筛查模式。目的2：评估接受化疗的癌症患者广泛筛查与选择性筛查对检测HBV感染流行率、再激活发生率和癌症治疗延迟能力的影响。目的3：建立一个决策分析模型，比较实施广泛和选择性HBV筛查的预测能力和成本效益。该R21申请将确定HBV筛查和感染的现状，以及再激活的负担；遵守国家筛查指南；以及两种不同筛查策略的潜在实施。通过决策过程，我们将确定广泛或选择性HBV筛查是癌症患者最有效的筛查策略。这一应用具有改变化疗前HBV癌症患者护理标准的潜力。

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.