Cancer patients with high rate of undiagnosed acute and chronic hepatitis B and C
Results from the largest study of hepatitis B and C and HIV infection prevalence in cancer patients show an alarmingly high rate of undiagnosed acute and chronic hepatitis B and C.
Hepatitis B and C are serious but treatable viral infections that cancer patients should know they have - because these viruses can cause life-threatening complications when certain cancer treatments are used.
Researchers from SWOG Cancer Research Network, an international cancer clinical trials group funded by the National Cancer Institute ( NCI ), part of the National Institutes of Health, conducted the study.
The results are published in JAMA Oncology.
The SWOG team found that a substantial portion of newly diagnosed cancer patients with hepatitis B or C were unaware of their viral infection.
Many had no identifiable risk factors for these infections, such as injection drug use.
The findings suggest that universal screening for hepatitis B or C may be warranted in community cancer clinics.
This would allow physicians to help patients avoid liver failure, kidney disease, or other complications from hepatitis.
Universal testing would also help care teams make more informed choices about cancer treatments, including avoiding those that may cause hepatitis viruses to reactivate and spread, making cancer patients even sicker.
There is some evidence that anti-CD20 therapies, such as the drug Rituximab, as well as hematopoietic cell transplantation, both treatments for lymphomas and leukemias, can cause some infection-causing viruses to reactivate and multiply.
The SWOG study, known as S1204, is notable for its large size and its diverse patient sample.
Between 2013 and 2017, 3,051 eligible patients were enrolled and received a simple blood test checking for the presence of the HIV virus, as well as the presence of the hepatitis B virus and the hepatitis C virus.
Patients lived in both rural and urban areas and were treated at 18 different academic and community hospitals across the county, from Montana to Massachusetts ( Unites States ).
The median age was 60.6 years, and 60% of participants were female.
The most common types of cancer study participants were being treated for included breast, blood, bone marrow, colorectal, and lung.
Researchers found: 6.5% of patients had past hepatitis B, 0.6% had chronic hepatitis B, 2.4% had hepatitis C, and 1.1% had HIV; infection rates similar to those found in the general U.S. population.
Importantly, a substantial proportion of patients with past ( 87.3% ) and chronic ( 42.1% ) hepatitis B infections were undiagnosed prior to the study screening, as well as a large proportion of people with hepatitis C infections ( 31% ).
No evidence of large numbers of undiagnosed HIV infections, although 5.9% of people with HIV were newly diagnosed through the study.
Many patients had no risk factors for their viral infections ( 27.4% for past hepatitis B, 21.1% of patients with chronic hepatitis B, 32.4% with hepatitis C and 20.6% with HIV ).
Screening may be especially important with use of immunotherapies for cancer, treatments that may affect cancer patients' immune systems and alter the course of their viral infections.
Little is known about the impact of immunotherapies on patients with cancer and hepatitis and other viral infections.
The oncologists should know as much as possible about the overall health of the people they treat. ( Xagena )
Source: SWOG Cancer Research Network, 2019
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