Impact of provider education on hepatitis B screening practices prior to patients receiving cancer treatment.

Authors

Michael Adashek

Michael Adashek

St. Joseph Mercy Hospital IHA Hematology Oncology, Ypsilanti, MI

Michael Adashek , Jacob Culver , Carolyn Anne Carrera

Organizations

St. Joseph Mercy Hospital IHA Hematology Oncology, Ypsilanti, MI, Methods Consultants of Ann Arbor, Ann Arbor, MI, St. Joseph Mercy Hospital IHA Hematology Oncology Associates, Ypsilanti, MI

Research Funding

No funding received

Background: Hepatitis B virus (HBV) reactivation is a known side effect of CD20 targeted therapies with complications ranging from transient hepatitis to fulminant hepatic failure and death. In 2020 the American Society of Clinical Oncology (ASCO) expanded its provisional clinical opinion (PCO) to recommend HBV screening for all patients prior to receiving non-hormonal systemic anti-cancer therapies and if positive, offer viral prophylaxis or treatment. We assessed in a single-institution prospective study if a provider-led educational session on the 2020 ASCO PCO was effective in increasing HBV screening among patients receiving systemic non-hormonal anti-cancer therapies. Methods: An educational session for 30 minutes on the benefits outlined in the ASCO 2020 PCO discussing hepatitis B screening was held at a community-based hematology/oncology practice in Michigan. HBV screening panel was added to pre-chemotherapy lab order sets. Provider compliance with HBV screening recommendations was assessed monthly. Patients with positive HBV serology were identified and referred to Hepatology for monitoring and anti-viral treatment/prophylaxis as indicated. Data from 1,984 patient encounters for cancer treatment utilizing either chemotherapy or rituximab among 12 providers from March of 2020 to December 2021. Multivariate and logistic regression analysis was performed. Results: The educational intervention on the best practices of screening for Hepatitis B was effective in raising screening. Prior to intervention, 79.3% of all patients receiving rituximab (N = 140) and 15.7% of all patients receiving chemotherapy (N = 1277) had documentation for Hepatitis B before cancer treatment. Post-intervention hepatitis B testing increased both among patients receiving rituximab to 95.8% (N = 48) and chemotherapy to 29.9% (N = 519). In summary, prior to intervention, just 22.0% of 1,417 patient encounters had documentation for Hepatitis B screening before undergoing a treatment regimen. Post-intervention this level was raised to 35.45% (= 37.41,). In this study, 3 cases (0.5%) of acute and 12 cases (2.0%) of chronic HBV were identified from the 603 tested patients. A mixed effects logistic regression model controlling for treatment type and provider found patient encounters occurring post-intervention were 2.30 times more likely to be screened (OR = 2.30, 95% CI = [1.81, 2.93], p < 0.001). Conclusions: Our single educational session discussing the 2020 ASCO PCO and testing techniques for HBV was effective at increasing the odds of screening 2.3 times among patients receiving non-hormonal systemic anticancer therapies adjusting for therapy and provider. This may serve as a model for other implementations of PCOs. Further research will assess long-term oncologic outcomes of those identified with HBV and effects of anti-viral interventions.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 1539)

DOI

10.1200/JCO.2022.40.16_suppl.1539

Abstract #

1539

Poster Bd #

132

Abstract Disclosures