Cancer patients with HVB, HCV and HIV receiving systemic therapy are at risk of reactivation. It is relevant to determine the serologic status of patients at high risk. The CDC has broad screening recommendations for HBV, HCV and HIV. ASCO recommends HBV screening in patients with risk factors, before starting anti-CD20 therapy or stem-cell transplantation. In this population-based study we determine the rates of screening in a large cohort of elderly patients with solid tumors.
Patients with solid tumors (>66 yo) diagnosed between 2007-2013 and treated with systemic anticancer therapy were identified in the SEER-Medicare database. HBV, HCV and HIV testing was identified using HCPCS codes, the screening period was defined as testing within the first year of cancer diagnosis and no later than 30 days after the first dose of systemic anticancer therapy. Descriptive statistics and logistic regression were used.
A total of 70,488 patients were included. The rates of HBV, HCV and HIV screening were 4.13%, 2.05% and 0.73%, respectively. The median time from cancer diagnosis to screening were 26, 24 and 22 days for HBV, HCV and HIV respectively. Screening rates varied according to cancer type. The highest HBV screening rates were in pancreas (18.9%), melanoma (4.7%) and prostate cancer (5.7%). For HCV, melanoma (7.6%), prostate (3.6%) and anal/penile/vagina/vulvar cancers (2.9%). For HIV, the highest rates were in patients with anal/penile/vagina/vulvar cancers (6.7%), melanoma (2.7%), cervix/endometrial cancers (1.5%). Screening rates increased over time, in addition, males, younger patients and those living in urban areas had higher screening rates (all p < 0.001). Asians had the highest screening rates of HBV and HCV while African Americans had the highest HIV screening rate.
HBV, HCV and HIV screening rates were very low among elderly cancer patients receiving systemic anticancer therapy. There was significant variability in the screening rates according to cancer site and patient characteristics. Guidance is needed to select patients that can benefit from screening in order to avoid potential complications.
Clinical trial identification
Legal entity responsible for the study
Mariana Chavez MacGregor.
All authors have declared no conflicts of interest.