{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:23:04Z","timestamp":1787725384474,"version":"build-2784847793"},"reference-count":26,"publisher":"Harborside Press, LLC","issue":"2D","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The prevalence of chronic hepatitis C virus (HCV) infection in the United States is \u22641%. Universal HCV screening is recommended nationwide. Here we describe our experience implementing universal HCV screening at a cancer center.<jats:bold> Methods:<\/jats:bold> 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\u2019s Reporting Workbench Business Intelligence tools were used. Statistical significance was defined as <jats:italic>P<\/jats:italic>&lt;.05 on chi-square analysis. <jats:bold>Results:<\/jats:bold> 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 (<jats:italic>P<\/jats:italic>&lt;.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 (<jats:italic>P<\/jats:italic>=.0002). <jats:bold>Conclusions:<\/jats:bold> 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.<\/jats:p>","DOI":"10.6004\/jnccn.2023.7332","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T13:47:32Z","timestamp":1715348852000},"source":"Crossref","is-referenced-by-count":5,"title":["Implementation of Universal Hepatitis C Virus Screening in a Tertiary Cancer Center"],"prefix":"10.6004","volume":"22","author":[{"given":"Harrys A.","family":"Torres","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX"},{"name":"Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalis","family":"Mustafayev","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruston P.","family":"Juneau","sequence":"additional","affiliation":[{"name":"Information Services\u2013Liaison Program, Epic Boost, Epic, Verona, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica P.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan Sun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Angelidakis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Hawk","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno P.","family":"Granwehr","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Yepez Guevara","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita K.","family":"Ying","sequence":"additional","affiliation":[{"name":"Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"Lancet Gastroenterol Hepatol","first-page":"161","article-title":"Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study","volume":"2","author":"Blach S","year":"2017","unstructured":"Blach S, Zeuzem S, Manns M,  Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study.  Lancet Gastroenterol Hepatol 2017;2:161\u2013176."},{"key":"B2","series-title":"Hepatology","first-page":"1020","article-title":"Estimating prevalence of hepatitis C virus infection in the United States, 2013\u20132016","volume":"69","author":"Hofmeister MG","year":"2019","unstructured":"Hofmeister MG, Rosenthal EM, Barker LK,  Estimating prevalence of hepatitis C virus infection in the United States, 2013\u20132016. Hepatology 2019;69:1020\u20131031."},{"key":"B3","series-title":"Lancet Gastroenterol Hepatol","first-page":"396","article-title":"Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study","volume":"7","author":"Blach S","year":"2022","unstructured":"Blach S, Terrault NA, Tacke F,  Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol 2022;7:396\u2013415."},{"key":"B4","author":"Centers for Disease Control and Prevention","unstructured":"Centers for Disease Control and Prevention. Hepatitis C: by the numbers. Accessed August 8, 2023. Available at: https:\/\/www.cdc.gov\/nchhstp\/newsroom\/docs\/factsheets\/Hepatitis-c-by-the-numbers.pdf"},{"key":"B5","author":"World Health Organization","unstructured":"World Health Organization. Global health sector strategy on viral hepatitis 2016\u20132021: toward ending viral hepatitis. Accessed August 8, 2023. Available at: https:\/\/www.afro.who.int\/sites\/default\/files\/2017-06\/WHO-HIV-2016.06-eng.pdf"},{"key":"B6","series-title":"Gastroenterol Clin North Am","first-page":"253","article-title":"Progress toward hepatitis C virus elimination: therapy and implementation","volume":"49","author":"Martinello M","year":"2020","unstructured":"Martinello M, Bajis S, Dore GJ. Progress toward hepatitis C virus elimination: therapy and implementation. Gastroenterol Clin North Am 2020;49:253\u2013277."},{"key":"B7","series-title":"JAMA","first-page":"1251","article-title":"A national hepatitis C elimination program in the United States: a historic opportunity","volume":"329","author":"Fleurence RL","year":"2023","unstructured":"Fleurence RL, Collins FS. A national hepatitis C elimination program in the United States: a historic opportunity. JAMA 2023;329:1251\u20131252."},{"key":"B8","series-title":"Hepatology","first-page":"371","article-title":"The national hepatitis C elimination program\u2014AASLD\u2019s coalition and call to action","volume":"78","author":"Terrault NA","year":"2023","unstructured":"Terrault NA, Torres H, Price J,  The national hepatitis C elimination program\u2014AASLD\u2019s coalition and call to action. Hepatology 2023;78:371\u2013374."},{"key":"B9","series-title":"Hepatology","first-page":"686","article-title":"Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases\u2013Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection","volume":"71","author":"Ghany MG","year":"2020","unstructured":"Ghany MG, Morgan TR, Marks KM,  Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases\u2013Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology 2020;71:686\u2013721."},{"key":"B10","series-title":"J Oncol Pract","first-page":"629","article-title":"Oncologic implications of chronic hepatitis C virus infection","volume":"15","author":"Hwang JP","year":"2019","unstructured":"Hwang JP, LoConte NK, Rice JP,  Oncologic implications of chronic hepatitis C virus infection. J Oncol Pract 2019;15:629\u2013637."},{"key":"B11","series-title":"Gastroenterology","first-page":"909","article-title":"Hepatitis C virus infection in patients with cancer: impact on clinical trial enrollment, selection of therapy, and prognosis","volume":"157","author":"Torres HA","year":"2019","unstructured":"Torres HA, Pundhir P, Mallet V. Hepatitis C virus infection in patients with cancer: impact on clinical trial enrollment, selection of therapy, and prognosis. Gastroenterology 2019;157:909\u2013916."},{"key":"B12","series-title":"JAMA Oncol","first-page":"497","article-title":"Prevalence of hepatitis B virus, hepatitis C virus, and HIV infection among patients with newly diagnosed cancer from academic and community oncology practices","volume":"5","author":"Ramsey SD","year":"2019","unstructured":"Ramsey SD, Unger JM, Baker LH,  Prevalence of hepatitis B virus, hepatitis C virus, and HIV infection among patients with newly diagnosed cancer from academic and community oncology practices. JAMA Oncol 2019;5:497\u2013505."},{"key":"B13","series-title":"CA Cancer J Clin","first-page":"411","article-title":"The oncologic burden of hepatitis C virus infection: a clinical perspective","volume":"67","author":"Torres HA","year":"2017","unstructured":"Torres HA, Shigle TL, Hammoudi N,  The oncologic burden of hepatitis C virus infection: a clinical perspective. CA Cancer J Clin 2017;67:411\u2013431."},{"key":"B14","series-title":"J Hepatocell Carcinoma","first-page":"81","article-title":"Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer","volume":"5","author":"Dandachi D","year":"2018","unstructured":"Dandachi D, Hassan M, Kaseb A,  Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer. J Hepatocell Carcinoma 2018;5:81\u201386."},{"key":"B15","series-title":"Dig Liver Dis","first-page":"348","article-title":"Hepatocellular carcinoma as a second primary cancer in patients with chronic hepatitis C virus infection","volume":"47","author":"Mahale P","year":"2015","unstructured":"Mahale P, Kaseb AO, Hassan MM,  Hepatocellular carcinoma as a second primary cancer in patients with chronic hepatitis C virus infection. Dig Liver Dis 2015;47:348\u2013349."},{"key":"B16","series-title":"JAMA","first-page":"970","article-title":"Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement","volume":"323","author":"Owens DK","year":"2020","unstructured":"Owens DK, Davidson KW, Krist AH,  Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA 2020;323:970\u2013975."},{"key":"B17","series-title":"Clin Infect Dis","first-page":"740","article-title":"Hepatitis C clinic operated by infectious disease specialists at a comprehensive cancer center: help is on the way","volume":"54","author":"Torres HA","year":"2012","unstructured":"Torres HA, Adachi JA, Roach LR,  Hepatitis C clinic operated by infectious disease specialists at a comprehensive cancer center: help is on the way. Clin Infect Dis 2012;54:740\u2013742."},{"key":"B18","series-title":"J Natl Compr Canc Netw","first-page":"1185","article-title":"Transdisciplinary approach to managing hepatitis C virus infection in patients at a tertiary care cancer center","volume":"14","author":"Torres HA","year":"2016","unstructured":"Torres HA, Roach LR, Mahale P,  Transdisciplinary approach to managing hepatitis C virus infection in patients at a tertiary care cancer center. J Natl Compr Canc Netw 2016;14:1185\u20131188."},{"key":"B19","series-title":"Am J Gastroenterol","first-page":"250","article-title":"Sofosbuvir-based therapy in hepatitis C virus-infected cancer patients: a prospective observational study","volume":"114","author":"Torres HA","year":"2019","unstructured":"Torres HA, Economides MP, Angelidakis G,  Sofosbuvir-based therapy in hepatitis C virus-infected cancer patients: a prospective observational study. Am J Gastroenterol 2019;114:250\u2013257."},{"key":"B20","series-title":"J Hepatol","first-page":"822","article-title":"Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006\u20132010","volume":"63","author":"Allison RD","year":"2015","unstructured":"Allison RD, Tong X, Moorman AC,  Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006\u20132010. J Hepatol 2015;63:822\u2013828."},{"key":"B21","series-title":"Clin Infect Dis","first-page":"1540","article-title":"Continuum of care for hepatitis C virus among patients diagnosed in the emergency department setting","volume":"64","author":"Anderson ES","year":"2017","unstructured":"Anderson ES, Galbraith JW, Deering LJ,  Continuum of care for hepatitis C virus among patients diagnosed in the emergency department setting. Clin Infect Dis 2017;64:1540\u20131546."},{"key":"B22","series-title":"J Viral Hepat","first-page":"129","article-title":"Evaluation of a pilot emergency department linkage to care program for patients previously diagnosed with hepatitis C","volume":"30","author":"Hyde Z","year":"2023","unstructured":"Hyde Z, Roura R, Signer D,  Evaluation of a pilot emergency department linkage to care program for patients previously diagnosed with hepatitis C. J Viral Hepat 2023;30:129\u2013137."},{"key":"B23","series-title":"PLoS One","first-page":"e101554","article-title":"The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis","volume":"9","author":"Yehia BR","year":"2014","unstructured":"Yehia BR, Schranz AJ, Umscheid CA,  The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis. PLoS One 2014;9:e101554."},{"key":"B24","unstructured":"Centers for Disease Control and Prevention. Breakthrough cures for hepatitis C still fail to reach the vast majority of Americans who need them. Accessed September 15, 2023. Available at: https:\/\/www.cdc.gov\/media\/releases\/2023\/p0629-hepatitis-c.html"},{"key":"B25","series-title":"Clin Infect Dis","first-page":"549","article-title":"Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United States","volume":"67","author":"Barocas JA","year":"2018","unstructured":"Barocas JA, Tasillo A, Eftekhari Yazdi G,  Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United States. Clin Infect Dis 2018;67:549\u2013556."},{"key":"B26","series-title":"Clin Infect Dis","first-page":"376","article-title":"Cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings","volume":"66","author":"Assoumou SA","year":"2018","unstructured":"Assoumou SA, Tasillo A, Leff JA,  Cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings. Clin Infect Dis 2018;66:376\u2013384."}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/22\/2D\/article-e237332.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/22\/2D\/article-e237332.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/22\/2D\/article-e237332.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T19:49:27Z","timestamp":1718135367000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/22\/2D\/article-e237332.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":26,"journal-issue":{"issue":"2D"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2023.7332","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}