Stepwise Development of a Cancer Care Delivery Research Study to Evaluate the Prevalence of Virus Infections in Cancer Patients

Unger, Joseph M.; Hershman, Dawn L.; Arnold, Kathryn B.; Loomba, Rohit; Chugh, Rashmi; Hwang, Jessica P.; O’Rourke, Mark Allen; Bhadkamkar, Nishin A.; Wang, Lili X.; Siegel, Abby B.; Cooley, Timothy P.; Berenberg, Jeffrey L.; Bridges, Benjamin B.; Ramsey, Scott D.

doi:10.2217/fon-2015-0076

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…A run-in phase involving 7 selected sites and 312 patients was conducted to examine the feasibility of study procedures and acceptability to patients. The results of the run-in phase were previously reported . End point data for run-in participants are included in this report.…”

Section: Methodsmentioning

confidence: 98%

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Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

et al. 2019

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screening of patients with newly diagnosed cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV is not routine in oncology practice, and experts disagree about whether universal screening should be performed. OBJECTIVE To estimate the prevalence of HBV, HCV, and HIV infection among persons with newly diagnosed cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective cohort study of patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG (formerly the Southwest Oncology Group) Cancer Research Network, a member of the National Clinical Trials Network, with enrollment from August 29, 2013, through February 15, 2017. The data analysis was conducted using data available through August 17, 2017. MAIN OUTCOMES AND MEASURES The accrual goal was 3000 patients and the primary end point was the presence of HBV infection (previous or chronic), HCV infection, or HIV infection at enrollment. Patients with previous knowledge of infection as well as patients with unknown viral viral status were evaluated. RESULTS Of 3092 registered patients, 3051 were eligible and evaluable. Median (range) age was 60.6 (18.2-93.7) years, 1842 (60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic ethnicity. Screened patients had similar clinical and demographic characteristics compared with those registered. The observed infection rate for previous HBV infection was 6.5% (95% CI, 5.6%-7.4%; n = 197 of 3050 patients); chronic HBV, 0.6% (95% CI, 0.4%-1.0%; n = 19 of 3050 patients); HCV, 2.4% (95% CI, 1.9%-3.0%; n = 71 of 2990 patients); and HIV, 1.1% (95% CI, 0.8%-1.6%; n = 34 of 3045). Among those with viral infections, 8 patients with chronic HBV (42.1%; 95% CI, 20.3%-66.5%), 22 patients with HCV (31.0%; 95% CI, 20.5%-43.1%), and 2 patients with HIV (5.9%; 95% CI, 0.7%-19.7%) were newly diagnosed through the study. Among patients with infections, 4 patients with chronic HBV (21.1%; 95% CI, 6.1%-45.6%), 23 patients with HCV (32.4%; 95% CI, 21.8%-44.5%), and 7 patients with HIV (20.6%; 95% CI, 8.7%-37.9%) had no identifiable risk factors. CONCLUSIONS AND RELEVANCE Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.

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Section: Methodsmentioning

confidence: 98%

“…The results of the run-in phase were previously reported. 15 End point data for run-in participants are included in this report.…”

Section: Institutions and Patientsmentioning

confidence: 99%

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

et al. 2019

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“…Although cancer care delivery research has been proposed as an emerging research focus to address these gaps, 4 cancer care delivery research efforts to date seem insufficiently informed by implementation science theories and methods. 5,6 At the same time, quality improvement (QI) efforts are often local, may not be disseminated in a manner that allows the reader to critically appraise the generalizability of the findings, and are typically not designed to isolate the underlying mechanisms of practice change. 7 Significant challenges exist when introducing researchtested interventions into care delivery, and in many settings, practice change tends to be opportunistic, rather than systematically planned.…”

Section: Importance Of Implementation Science For Practice Transformamentioning

confidence: 99%

Leveraging Implementation Science to Improve Cancer Care Delivery and Patient Outcomes

Mitchell

Chambers

2017

JOP

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“…In the early phases of S1204, some providers expressed concern about payment for viral screening and the potential cost burden on patients from uncovered tests. In practice, no such issues were encountered ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Universal Viral Screening of Patients with Newly Diagnosed Cancer in the United States: A Cost-efficiency Evaluation

Vaidya,

Unger,

Loomba

et al. 2023

Cancer Research Communications

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Recommendations for universal screening of cancer patients for HBV, HCV, and HIV are inconsistent. A recent multi-site screening study (S1204) from the SWOG Cancer Research Network found that a substantial number of newly diagnosed cancer patients had previously unknown viral infections. The objective of this study was to determine the cost-efficiency of universal screening of newly diagnosed cancer patients. We estimated the cost-efficiency of universal screening of new cancer cases for HBV, HCV, or HIV, expressed as cost per virus detected, from the health care payer perspective. The prevalence of each virus among this cohort was derived from S1204. Direct medical expenditures included costs associated with laboratory screening tests. Costs per case detected were estimated for each screening strategy. Secondary analysis examined the cost efficiency of screening patients whose viral status at cancer diagnosis was unknown. Among the possible options for universal screening, screening for HBV alone ($581), HCV alone ($782), HBV and HCV ($631) and HBV, HCV, and HIV ($841) were most efficient in terms of cost per case detected. When screening was restricted to patients with unknown viral status, screening for HBV alone ($684), HBV and HCV ($872), HBV and HIV ($1,157), and all three viruses ($1,291) were most efficient in terms of cost per newly detected case. Efficient viral testing strategies represent a relatively modest addition to the overall cost of managing a cancer patient. Screening for HBV, HCV, and HIV infections may be reasonable from both a budget and clinical standpoint.

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Stepwise Development of a Cancer Care Delivery Research Study to Evaluate the Prevalence of Virus Infections in Cancer Patients

Cited by 3 publications

References 16 publications

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Leveraging Implementation Science to Improve Cancer Care Delivery and Patient Outcomes

Universal Viral Screening of Patients with Newly Diagnosed Cancer in the United States: A Cost-efficiency Evaluation

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