Nearly 350 million people have chronic hepatitis B virus (HBV) infection worldwide. Reactivation of HBV has been reported in 20-50% of HBV carriers undergoing chemotherapy for cancer treatment and may lead to flare-up of hepatitis, hepatic failure and death. Administering oral anti-HBV agents is an effective means of reducing HBV reactivation during chemotherapy. Despite all international guidelines recommend that HBV screening is indicated for patients receiving chemotherapy, pre-chemotherapy HBV testing rates are extremely low in most hospitals (e.g., 17% in the MD Anderson Cancer Center of the United States). The low pre-chemotherapy HBV testing rate is mainly owing to that chemotherapy is conducted by physicians from various hospital departments whose perceptions with respect to the importance of pre-chemotherapy HBV screening and prophylaxis widely vary.
To prevent HBV flare-up during chemotherapy, we organized the chart, laboratory, chemotherapy agent and antiviral drug databases in our hospital and developed a computerized order entry-based alert system (e-REMINDER) in September 2011. The computer system reminded doctors to check HBsAg whenever they prescribed chemotherapy agents. This system increased pre-chemotheray HBV screening rate from 40.2% to 93.5% whereas the prophylactic rate for HBV carriers was only 39.2%. In August 2012, we developed a computerized order entry-based testing and therapeutic control system (e-CONTROL) to ensure the patient safety during chemotherapy. No chemotherapy was permitted for HBV carriers if anti-HBV medications were not prescribed. This system increased HBV screening rate and HBV prophylactic rate to 99.3% and 95.8% respectively. Additionally, it decreased HBV flare-up related mortality during chemotherapy from 1.2% to 0%.
The successful experiences of HBV prophylaxis during chemotherapy in Taiwan have been published in several important international journals and followed by many medical centers and local hospitals. The official journal of the American Association of Study in Liver Disease (AASLD), Hepatology, has praised the world-leading safety control system during chemotherapy as an electronic control of HBV.
2016 Symbol of National Quality