Document Type
Article
Abstract
American Society of Clinical Oncology guidelines recommend screening all patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) before initiation of cancer therapy. Cancer patients receiving cancer therapy represent a vulnerable population, and reactivation of undetected hepatitis virus can lead to devastating consequences. At MD Anderson Cancer Center, rates of hepatitis screening for all cancer patients have been historically low. The overall aim of this quality improvement (QI) study was to increase rates of HBV and HCV screening to at least 50% in early-stage breast cancer patients before cancer therapy in the Breast Medical Oncology clinic at MD Anderson. The present study reports current progress after the first QI cycle. QI measures were implemented by 1) creation of an order panel in the electronic medical record (EMR) that contains all tests needed for comprehensive HBV and HCV screening and 2) an educational session to providers in the Breast Medical Oncology clinics. Data were collected for patients seen at MD Anderson initiating cancer therapy (start of cycle 1) from April 1, 2023, through September 30, 2023, which was immediately after the QI initiatives were implemented. Inclusion criteria were early-stage breast cancer (stage I-III) and receiving chemotherapy at MD Anderson. Of 340 patients screened, 220 met the inclusion criteria for data extraction. In total, 105 patients (48%) received comprehensive HBV screening (measuring HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and antibody to HBV surface antigen [anti-HBs]), and 137 (63%) received at least 1 HBV test. A total of 122 (56%) patients were screened for HCV. Eighty-eight patients (40%) received both comprehensive HBV and HCV screening. The EMR order panel was used in 51 (23%) of patients. Anti-HBc was positive in 8 of those tested, and HBsAg was positive in 1 patient. No patients tested positive for HCV. Screening rates for HBV and HCV individually were near or exceeded our goal; however, rates of combined HBV and HCV screening were lower. Going forward, additional education to providers as well as increased use of the available order panel will be needed to ensure we are comprehensively screening for both HBV and HCV in our patients.
Grants and Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Creative Commons License
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Recommended Citation
Klein K, Hwang J, Valero V, Ramirez D, Kaushik J. Viral Hepatitis Screening in Early Breast Cancer Patients Receiving Cancer Therapy: A Quality Improvement Initiative. Advances in Cancer Education and Quality Improvement. 2026; 2(1).