The rate of hepatitis B virus screening before systemic anticancer therapy among patients in Japan

Abstract

Background: Patients with chronic or resolved hepatitis B virus (HBV) infection have a risk of reactivation after chemotherapy. Japanese guidelines recommend that all patients on chemotherapy should be screened for HBV infection. Although Asian peoples are considered to be a high risk population of HBV infection, little is known about the screening rate in Japan. Methods: We analyzed health insurance claims data linked with hospital-based cancer registry. Patients diagnosed with cancer in 2014, 20 years and older, who received at least one dose of systemic anticancer therapy in 2014-15 entered the analyses. We assessed the HBV screening rates by HBsAg or anti-HBc test ordered around initial treatment, HBV-DNA test and entecavir prescription. A multiple logistic regression model was used to identify factors related to the receipt of screening. Results: Of 177636 patients (mean [SD] age, 65.6 [12.2] years), 82.6%, 12.9%, 4.5% patients had solid tumor other than hepatocellular carcinoma (HCC), hematologic malignancy and HCC, respectively. Among them, 88.5%, 8.8%, 2.6% patients received cytotoxic chemotherapy, targeted therapy and anti-CD20 antibody, respectively. Overall, 70.6% of patients were screened but 34.5% were tested HBsAg only. The positive predictors of the HBV screening were hematologic malignancy (OR 2.45; 95%CI, 2.35-2.55) and negative predictors were age 85 (OR 0.75 compared to age <65, 95%CI, 0.71-0.80), age 75-84 (OR 0.77; 95%CI, 0.75-0.79), targeted therapy (OR 0.79; 95%CI, 0.76-0.82). Among the screened patients, 13.2% were tested HBV-DNA and 1.49% were prescribed prophylactic entecavir. Conclusions: This is the largest study to evaluate the HBV screening rate before systemic anticancer therapy in Japan. Although the screening rate is higher than previous reports from other countries (13-19%), half of the screened patients were tested HBsAg only. The elderly patients and patients who received targeted therapy were less screened. Background: In the management of febrile neutropenia (FN) several models were developed to yield an objective and reproducible prediction of complications and outcomes. The most widely used predictive model is the Multinational Association for Supportive Care in Cancer (MASCC) model which has several limitations. To overcome some of these limitations a new prognostic score known as the Clinical Index of Stable Febrile Neutropenia (CISNE) score was developed. We have attempted to compare MASCC model and CISNE model in predicting the risk of serious complications in clinically stable febrile neutropenia patients. Methods: A prospective study was conducted from January 2016 to December 2017 at Kidwai Cancer Institute. Clinical data regarding the covariates of both CISNE and MASCC models were obtained. The outcome measure was the appearance of major complications associated with FN episodes. The discriminatory ability of the scales on the basis of their areas under the receiver operating characteristic curves (ROC), using the Hanley method was analyzed. Results: Two hundred apparently clinically stable febrile neutropenia patients were evaluated. Thirty-one patients had serious complications of which 4 patients died. The MASCC score 20 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of 41.94%, 85.8%, 35.1%, and 89.0% respectively for detecting complications. The CISNE score cutoff > 2 had a sensitivity, specificity, PPV, NPV of 80.6%, 72.8%, 35.2%, and 95.3% respectively for detecting complications. Areas under ROC curves were 0.686 (C.I. 0.581 to 0.792) for MASCC, and 0.846 (C.I. 0.781-0.911) for CISNE score. The area difference between the CISNE ROC and MASCC ROC was 0.16 and this difference was statistically significant (p ¼ 0.0003).