Implementation of Universal Hepatitis C Virus Screening in a Tertiary Cancer Center

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Harrys A. Torres Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX

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Khalis Mustafayev Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

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Ruston P. Juneau Information Services–Liaison Program, Epic Boost, Epic, Verona, WI

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Jessica P. Hwang Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

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Lan Sun Wang Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX

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Georgios Angelidakis Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

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Ernest Hawk Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX

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Bruno P. Granwehr Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

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Eduardo Yepez Guevara Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

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Anita K. Ying Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX

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Background: The prevalence of chronic hepatitis C virus (HCV) infection in the United States is ≤1%. Universal HCV screening is recommended nationwide. Here we describe our experience implementing universal HCV screening at a cancer center. Methods: In October 2016, universal HCV screening with HCV antibody (anti-HCV) was initiated for all new outpatients. Universal screening was promoted through widespread provider education, orders in the Epic electronic health records (EHRs), SmartSets, and automated EHR reminders. The effort focused on patients with solid tumors, because universal screening in patients with hematologic malignancies was already standard practice. Primary outcomes were the proportion of patients screened and the proportion of patients with reactive anti-HCV test results linked to HCV care. The secondary outcome was the incidence of HCV-associated hepatocellular carcinoma as a second primary malignancy (HCC-SPM) in patients with a history of other cancers before HCC diagnosis. Epic’s Reporting Workbench Business Intelligence tools were used. Statistical significance was defined as P<.05 on chi-square analysis. Results: From April 2016 through April 2023, 56,075 patients with solid tumors were screened for HCV, of whom 1,300 (2.3%) had reactive anti-HCV test results. The proportion of patients screened was 10.1% in the 6 months before study implementation and 34.4% in the last 6 months of the study (P<.001). HCV screening was ordered using SmartSets in 39,332 (45.8%) patients and in response to automated EHR reminders in 10,972 (12.8%) patients. Most patients with reactive anti-HCV test results were linked to care (765/1,300; 59%), most with proven HCV infection were treated (425/562; 76%), and most treated patients achieved sustained virologic response (414/425; 97%). The incidence of HCC-SPMs was 15% in historical controls treated from 2011 to 2017 and 5.7% following implementation of universal screening (P=.0002). Conclusions: Universal HCV screening can be successfully implemented in cancer hospitals using an EHR-based multipronged approach to eliminate HCV and prevent HCV-associated HCC-SPMs.

Submitted October 31, 2023; final revision received December 15, 2023; accepted for publication December 18, 2023. Published online May 10, 2024.

Previous presentation: A portion of this work was presented at The Liver Meeting 2023; November 10–14, 2023; Boston, Massachusetts.

Author contributions: Study concept and design: Torres. Investigation: Mustafayev. Formal analysis: Torres, Mustafayev, Juneau. Resources: Torres. Writing—original draft: All authors. Writing—review & editing: All authors.

Disclosures: Dr. Torres has disclosed receiving institutional grant/research support from Gilead Sciences and Merck & Co., Inc.; and serving as a scientific advisor for Dynavax Technologies, AbbVie, Gilead Sciences, Janssen Pharmaceuticals, Inc., and Merck & Co., Inc. Dr. Hawk has disclosed serving as a consultant for Exact Sciences. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA016672.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Harrys A. Torres, MD, Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030. Email: htorres@mdanderson.org
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