The epidemiology of herpes zoster and its complications in Medicare cancer patients

Abstract

BackgroundLiterature on the epidemiology of herpes zoster (HZ) in cancer patients is sparse and does not include the elderly. The objectives of this study were to determine the incidence of HZ and related complications in elderly cancer patients and assess risk factors associated with HZ.MethodsPatients ≥65 years diagnosed with cancer in 1991–2007 were identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registry-Medicare linked database in this retrospective, longitudinal, open cohort study. The observation period spanned from first cancer diagnosis until the end of data availability. A random group of non-cancer Medicare patients served as the comparison group. Cases of HZ and related complications were ascertained from medical claims. Incidence rates (IR) and adjusted IR ratios were reported.ResultsThe study population consisted of 82,832 hematologic (HEM) and 944,777 solid cancer patients (SOLID). During follow-up, 9.2% of HEM and 6.3% of SOLID were diagnosed with HZ. The IR of HZ was significantly higher in HEM than SOLID (31.0 vs. 14.9 per 1,000 patient-years, p <0.01). The adjusted IR ratio vs. non-cancer elderly patients was 2.4 in HEM and 1.2 in SOLID. The proportion of patients with complications was higher in HEM than SOLID (17.8% vs. 15.8%, p <0.01). Age, gender, race, certain cancer therapies, and immunosuppression were HZ risk factors.ConclusionsElderly cancer patients run a 1.2-2.4 times higher risk of developing HZ than those without cancer. The rates of HZ and HZ-related complications are significantly higher for hematologic than solid cancer patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0810-6) contains supplementary material, which is available to authorized users.

Healthcare utilization and costs among patients with herpes zoster and solid tumor malignancy on chemotherapy

“…The adjusted incidence of HZ in this study was 13.8/1000 PY, similar to the rate found in previous studies of patients with solid tumors [ 4 , 5 ] and approximately 3 times the rate of 3/1000 to 5/1000 PY estimated for the general population. [ 3 ] Consistent with the literature, HZ incidence increased with age and comorbidity burden, [ 20 – 23 ] was greater among women than among men, [ 20 , 21 , 24 ] and was highest among patients with lung or bronchus cancer, [ 4 ] which may reflect differences in the patient population (e.g., age and advanced cancer stage at diagnosis) or immunosuppression level of chemotherapy used for lung/bronchus cancers compared with other cancer types.…”

“…[ 1 ] Herpes zoster (HZ), the reactivation of latent varicella-zoster virus in sensory ganglia, is a known complication of immunosuppressive chemotherapy. [ 1 , 2 ] Estimates of HZ incidence in the general population range from 3 to 5 per 1000 person-years (PY) [ 3 ] but are substantially higher among immunosuppressed patients with STM, [ 4 – 6 ] ranging from 6/1000 to 40/1000 PY depending on the site and tumor type. [ 5 ]…”

Incidence of herpes zoster amongst adults varies by severity of immunosuppression

“…However, the observed trend of an increasing HZ incidence with a decreasing immune status dovetails with studies examining HZ in patients with different IC conditions. They report, for example, increased risks of developing HZ for patients suffering from inflammatory bowel disease 26 , peptic ulcer 27 , systemic lupus erythematosus 28 , or chronic kidney disease 16 , and highly increased risks for patients with HIV 15,16,29 , malignant neoplasms 5,16,30,31 , or organ transplantation 32,33 .…”

Surgical results of herpes zoster and lung cancer association in preoperative period

“…Only a few studies have examined the interactions with age and time after the diagnosis of malignancy [14]. As a conclusion, the relationship between herpes zoster and malignancies should be kept in mind.…”