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Latent infection screening and prevalence in cancer patients born outside of Australia: a universal versus risk-based approach?

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Abstract

Purpose

Contention surrounds how best to screen patients for latent and undiagnosed infection prior to cancer treatment. Early treatment and prophylaxis against reactivation may improve infection-associated morbidity. This study sought to examine rates of screening and prevalence of latent infection in overseas-born patients receiving cancer therapies.

Methods

A single-centre retrospective audit of 952 overseas-born patients receiving chemotherapy, targeted agents and immunotherapy between January 1 and December 31 2019 was undertaken at Peter MacCallum Cancer Centre. Pre-treatment screening for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), latent tuberculosis (LTBI), toxoplasmosis and strongyloidiasis was audited.

Results

Approximately half of our overseas-born patients were screened for HBV (58.9%) and HCV (50.7%). Fewer patients were screened for HIV (30.5%), LTBI (18.3%), strongyloidiasis (8.6%) or toxoplasmosis (8.1%). Although 59.7% of our patients were born in countries with high epidemiological risk for latent infection, according to World Health Organization data, 35% were not screened for any infection prior to commencement of therapy.

Conclusion

The prevalence of latent infections amongst overseas-born patients with cancer, and complexities associated with risk-based screening, likely supports universal latent infection screening amongst this higher-risk cohort.

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Data availability

Deidentified data is provided as part of the replication package and has been uploaded into file submissions for the Journal of Supportive Care in Cancer.

Code availability

Code for data cleaning and analysis is provided in the excel spreadsheet uploaded into file submissions for the Journal of Supportive Care in Cancer.

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Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia

    Gemma Reynolds, Gabrielle Haeusler, Monica A. Slavin, Benjamin Teh & Karin Thursky

  2. Department of Infectious Diseases, Royal Children’s Hospital, Melbourne, Victoria, Australia

    Gabrielle Haeusler

  3. National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Gabrielle Haeusler, Monica A. Slavin, Benjamin Teh & Karin Thursky

  4. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia

    Gabrielle Haeusler, Monica A. Slavin, Benjamin Teh & Karin Thursky

  5. Murdoch Children’s Research Institute, Parkville, Victoria, Australia

    Gabrielle Haeusler

Authors
  1. Gemma Reynolds
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  2. Gabrielle Haeusler
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  3. Monica A. Slavin
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  4. Benjamin Teh
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Contributions

G.R, M.A.S and K.T conceived of the project. G.R. collected the data and performed the data analysis. G.R, G.H, B.W.T, M.A.S and K.T assisted with drafting and critically revising the manuscript.

Corresponding author

Correspondence to Gemma Reynolds.

Ethics declarations

Ethics approval

This work was approved by Ethics Department, Peter MacCallum Cancer Centre (QA/64870/PMCC-2020).

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Conflict of interest

B.W.T is supported by the Australian Government National Health and Medical Research Council Early Career Fellowship, Medical Research Future Fund Emerging Leader Fellowship and Peter MacCallum Foundation Discovery Partner Fellowship. B.W.T has received research funding from Merck Sharp and Dohme, Gilead Sciences and Sanofi-Pasteur and on the advisory board for CSL-Behring. M.A.S. is supported by National Health and Medical Research Council grants 1116876 and 1173791. M.A.S. has received research funding from Merck, F2G, and Gilead, and personal fees from Pfizer and Gilead.

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Reynolds, G., Haeusler, G., Slavin, M.A. et al. Latent infection screening and prevalence in cancer patients born outside of Australia: a universal versus risk-based approach?. Support Care Cancer 29, 6193–6200 (2021). https://doi.org/10.1007/s00520-021-06116-w

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  • DOI: https://doi.org/10.1007/s00520-021-06116-w

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