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Hepatitis B Virus Screening and Management for Patients Receiving Systemic Treatment

Hepatitis B reactivation (HBVr) is a recognized complication of cancer therapy. If left untreated, HBVr can lead to cancer treatment delays/discontinuation, permanent liver damage, liver cancer, and death. Variation in the screening and management of HBV was identified as a quality and safety gap by Ontario clinicians. Several professional organizations have published guidelines for screening and management of HBVr; however, due to limited evidence, there has been a lack of agreement on the optimal approach.

To help bridge the quality and safety gap we developed an HBV Care Map for Ontario patients undergoing systemic treatment for hematological and solid tumor malignancies with a focus on preventing HBVr.

Recommendations on when to test for HBV, which tests to order, how to interpret, manage, and follow positive test results, when to refer to an HBV Specialist, and when and how to prescribe anti-viral therapy were produced in collaboration with an expert panel.

Implementing the care map in oncology settings, can help improve care through:

  • standardization of practice
  • recognition of HBV prior to systemic treatment
  • monitoring for viral proliferation during systemic treatment
  • early detection of HBVr
  • streamlining care for patients experiencing HBVr
  • decreased incidence of HBVr, decreased interruption of systemic treatment, and decreased mortality resulting in better patient outcomes.