982. Oncologist Compliance with Recommendations for Hepatitis B Serostatus Testing: Experience from an academic hospital

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982. Oncologist Compliance with Recommendations for Hepatitis B Serostatus

Testing: Experience from an academic hospital.

R. Lee; K. Vu; H. Shah; C. Bell; L. K. Hicks

Reactivation of hepatitis B (HBV) is a recognized complication of chemotherapy

associated with substantial morbidity and mortality. Prophylaxis with lamivudine

in chronic HBV carriers prior to chemotherapy can reduce the incidence and

severity of reactivation hepatitis. Published guidelines recommend screening all

patients receiving chemotherapy for HBV prior to initiation. There is currently

no such policy at St. ’s Hospital in Toronto, Canada. St. ’s

Hospital is a large teritiary referral centre with a high local prevalence of

HBV infection.

Aim:

The objectives of this study are to 1) determine the frequency with which HBsAg

is tested prior to intravenous (IV) chemotherapy at St. ’s Hospital, and

2) to compare the incidence of HBsAg testing pre-chemotherapy, with the

incidence of cardiac function testing prior to potentially cardiotoxic

chemotherapy.

Patients who were started on IV chemotherapy at St. ’s Hospital between

March 2006 to March 2007 were retrospectively identified using existing pharmacy

records. The frequency of HBsAg and LV function testing within 1 year prior to

starting chemotherapy were determined via electronic chart review. Standard

descriptive statistical modeling was used. Between March 2006 and March 2007,

208 patients were started on IV chemotherapy at St. ’s Hospital. 28

patients (13.5%) had HBsAg testing within 1 year prior to chemotherapy

commencement. None of these patients were found to be HBsAg positive. In

comparison, 138 patients were administered potentially cardiotoxic chemotherapy

during the same time interval. All 138 (100%) patients had either a MUGA scan or

an echocardiogram prior to chemotherapy; less than 1% had abnormal left

ventricular function. There were no reports of HBV reactivation in any of the

patients.

Results:

Despite the recognized importance of HBV testing prior to chemotherapy, the

proportion of patients being tested for HBV status prior to chemotherapy at our

academic institution is low. In contrast, cardiac function is routinely

determined prior to cardiotoxic chemotherapy. The high rate of testing for

cardiac function indicates that programs aimed at predicting and preventing side

effects to chemotherapy can have a high compliance. Barriers to universal HBV

testing likely include oncologists’ perception of the importance of testing as

low and lack of a systematic requirement to test prior to chemotherapy. A

quality assurance intervention will be performed in response to this data to

determine whether the frequency of HBsAg testing can be increased to 90% or more

at our academic institution.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a982

982. Oncologist Compliance with Recommendations for Hepatitis B Serostatus

Testing: Experience from an academic hospital.

R. Lee; K. Vu; H. Shah; C. Bell; L. K. Hicks

Reactivation of hepatitis B (HBV) is a recognized complication of chemotherapy

associated with substantial morbidity and mortality. Prophylaxis with lamivudine

in chronic HBV carriers prior to chemotherapy can reduce the incidence and

severity of reactivation hepatitis. Published guidelines recommend screening all

patients receiving chemotherapy for HBV prior to initiation. There is currently

no such policy at St. ’s Hospital in Toronto, Canada. St. ’s

Hospital is a large teritiary referral centre with a high local prevalence of

HBV infection.

Aim:

The objectives of this study are to 1) determine the frequency with which HBsAg

is tested prior to intravenous (IV) chemotherapy at St. ’s Hospital, and

2) to compare the incidence of HBsAg testing pre-chemotherapy, with the

incidence of cardiac function testing prior to potentially cardiotoxic

chemotherapy.

Patients who were started on IV chemotherapy at St. ’s Hospital between

March 2006 to March 2007 were retrospectively identified using existing pharmacy

records. The frequency of HBsAg and LV function testing within 1 year prior to

starting chemotherapy were determined via electronic chart review. Standard

descriptive statistical modeling was used. Between March 2006 and March 2007,

208 patients were started on IV chemotherapy at St. ’s Hospital. 28

patients (13.5%) had HBsAg testing within 1 year prior to chemotherapy

commencement. None of these patients were found to be HBsAg positive. In

comparison, 138 patients were administered potentially cardiotoxic chemotherapy

during the same time interval. All 138 (100%) patients had either a MUGA scan or

an echocardiogram prior to chemotherapy; less than 1% had abnormal left

ventricular function. There were no reports of HBV reactivation in any of the

patients.

Results:

Despite the recognized importance of HBV testing prior to chemotherapy, the

proportion of patients being tested for HBV status prior to chemotherapy at our

academic institution is low. In contrast, cardiac function is routinely

determined prior to cardiotoxic chemotherapy. The high rate of testing for

cardiac function indicates that programs aimed at predicting and preventing side

effects to chemotherapy can have a high compliance. Barriers to universal HBV

testing likely include oncologists’ perception of the importance of testing as

low and lack of a systematic requirement to test prior to chemotherapy. A

quality assurance intervention will be performed in response to this data to

determine whether the frequency of HBsAg testing can be increased to 90% or more

at our academic institution.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a982

982. Oncologist Compliance with Recommendations for Hepatitis B Serostatus

Testing: Experience from an academic hospital.

R. Lee; K. Vu; H. Shah; C. Bell; L. K. Hicks

Reactivation of hepatitis B (HBV) is a recognized complication of chemotherapy

associated with substantial morbidity and mortality. Prophylaxis with lamivudine

in chronic HBV carriers prior to chemotherapy can reduce the incidence and

severity of reactivation hepatitis. Published guidelines recommend screening all

patients receiving chemotherapy for HBV prior to initiation. There is currently

no such policy at St. ’s Hospital in Toronto, Canada. St. ’s

Hospital is a large teritiary referral centre with a high local prevalence of

HBV infection.

Aim:

The objectives of this study are to 1) determine the frequency with which HBsAg

is tested prior to intravenous (IV) chemotherapy at St. ’s Hospital, and

2) to compare the incidence of HBsAg testing pre-chemotherapy, with the

incidence of cardiac function testing prior to potentially cardiotoxic

chemotherapy.

Patients who were started on IV chemotherapy at St. ’s Hospital between

March 2006 to March 2007 were retrospectively identified using existing pharmacy

records. The frequency of HBsAg and LV function testing within 1 year prior to

starting chemotherapy were determined via electronic chart review. Standard

descriptive statistical modeling was used. Between March 2006 and March 2007,

208 patients were started on IV chemotherapy at St. ’s Hospital. 28

patients (13.5%) had HBsAg testing within 1 year prior to chemotherapy

commencement. None of these patients were found to be HBsAg positive. In

comparison, 138 patients were administered potentially cardiotoxic chemotherapy

during the same time interval. All 138 (100%) patients had either a MUGA scan or

an echocardiogram prior to chemotherapy; less than 1% had abnormal left

ventricular function. There were no reports of HBV reactivation in any of the

patients.

Results:

Despite the recognized importance of HBV testing prior to chemotherapy, the

proportion of patients being tested for HBV status prior to chemotherapy at our

academic institution is low. In contrast, cardiac function is routinely

determined prior to cardiotoxic chemotherapy. The high rate of testing for

cardiac function indicates that programs aimed at predicting and preventing side

effects to chemotherapy can have a high compliance. Barriers to universal HBV

testing likely include oncologists’ perception of the importance of testing as

low and lack of a systematic requirement to test prior to chemotherapy. A

quality assurance intervention will be performed in response to this data to

determine whether the frequency of HBsAg testing can be increased to 90% or more

at our academic institution.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a982

982. Oncologist Compliance with Recommendations for Hepatitis B Serostatus

Testing: Experience from an academic hospital.

R. Lee; K. Vu; H. Shah; C. Bell; L. K. Hicks

Reactivation of hepatitis B (HBV) is a recognized complication of chemotherapy

associated with substantial morbidity and mortality. Prophylaxis with lamivudine

in chronic HBV carriers prior to chemotherapy can reduce the incidence and

severity of reactivation hepatitis. Published guidelines recommend screening all

patients receiving chemotherapy for HBV prior to initiation. There is currently

no such policy at St. ’s Hospital in Toronto, Canada. St. ’s

Hospital is a large teritiary referral centre with a high local prevalence of

HBV infection.

Aim:

The objectives of this study are to 1) determine the frequency with which HBsAg

is tested prior to intravenous (IV) chemotherapy at St. ’s Hospital, and

2) to compare the incidence of HBsAg testing pre-chemotherapy, with the

incidence of cardiac function testing prior to potentially cardiotoxic

chemotherapy.

Patients who were started on IV chemotherapy at St. ’s Hospital between

March 2006 to March 2007 were retrospectively identified using existing pharmacy

records. The frequency of HBsAg and LV function testing within 1 year prior to

starting chemotherapy were determined via electronic chart review. Standard

descriptive statistical modeling was used. Between March 2006 and March 2007,

208 patients were started on IV chemotherapy at St. ’s Hospital. 28

patients (13.5%) had HBsAg testing within 1 year prior to chemotherapy

commencement. None of these patients were found to be HBsAg positive. In

comparison, 138 patients were administered potentially cardiotoxic chemotherapy

during the same time interval. All 138 (100%) patients had either a MUGA scan or

an echocardiogram prior to chemotherapy; less than 1% had abnormal left

ventricular function. There were no reports of HBV reactivation in any of the

patients.

Results:

Despite the recognized importance of HBV testing prior to chemotherapy, the

proportion of patients being tested for HBV status prior to chemotherapy at our

academic institution is low. In contrast, cardiac function is routinely

determined prior to cardiotoxic chemotherapy. The high rate of testing for

cardiac function indicates that programs aimed at predicting and preventing side

effects to chemotherapy can have a high compliance. Barriers to universal HBV

testing likely include oncologists’ perception of the importance of testing as

low and lack of a systematic requirement to test prior to chemotherapy. A

quality assurance intervention will be performed in response to this data to

determine whether the frequency of HBsAg testing can be increased to 90% or more

at our academic institution.