Incidence and time trends of herpes zoster among patients with head and neck cancer who did and did not undergo radiotherapy: A population-based cohort study

Abstract

Purpose This study aimed to determine the risk and time trends of herpes zoster among patients with head and neck cancer, with or without radiotherapy. Methods A total of 2160 patients with head and neck cancer were enrolled. The radiotherapy and non- radiotherapy cohorts were frequency-matched at a 1:1 ratio according to sex, age, and index date. Moreover, 1080 matched non-cancer individuals were considered normal controls. Data were obtained from the National Health Insurance Research Database and Cancer Registry. The primary end point was the incidence of herpes zoster, and the adjusted confounding factors were age, sex, comorbidities, oncological surgery, and chemotherapy. Results The incidence of herpes zoster was higher in cancer patients than in non-cancer individuals but did not significantly differ (13.67 vs. 8.06 per 1,000 person-years, p = 0.18). The risk of herpes zoster was significantly higher in the radiotherapy cohort than in the non-radiotherapy cohort (18.55 vs. 9.06 per 1,000 person-years, p = 0.03). The 5-year incidence rates in the radiotherapy and non-radiotherapy cohorts were 8.9% and 5%, respectively (p < 0.0001). Survival analysis indicated there was no immortal time bias. The time trends in the radiotherapy cohort persistently showed a high risk within the first 2 years, which decreased thereafter. Only patients with comorbid rheumatoid arthritis showed a significantly high risk of herpes zoster (p = 0.02). Oncological surgery and chemotherapy had no impact on the development of herpes zoster. Conclusions This nationwide population-based study showed that patients with head and neck cancer receiving radiotherapy are at an increased risk of herpes zoster. Health care professionals should pay more attention to this vulnerable group to improve their quality of life.

Radiotherapy Increases the Incidence of Herpes Zoster in Oral Cavity Cancer Patients – a National Population-based Cohort Study

“…To the best of our knowledge, this is the first populationbased study to investigate the relationship between radiotherapy and the incidence of herpes zoster in oral cavity cancer patients. In 2020 and 2021, there were two articles that investigated the relationship between head and neck cancer and herpes zoster (11,12); however, these studies did not perform a subgroup analysis for oral cavity cancer. The clinical behavior is different in each type of head and neck cancer.…”

Late Cutaneous Manifestation of Herpes Zoster After Occurrence of Pelvic Pain and Tenesmus in Metastatic Bladder Cancer, a Case Report

“…Therefore, vaccination with RZV should be considered/highly recommendedin cancer patients to avoid serious complications while on therapy or cancer-treatment delays. [1,8].…”

Vaccination for herpes zoster in patients with solid tumors: a position paper on the behalf of the Associazione Italiana di Oncologia Medica (AIOM)

“…65 This increased risk of HZ has also been confirmed in patients with head/neck cancer (18.55 versus 9.06 per 1000 person-years, P ¼ 0.03) and persisted within the first 2 years and then diminished. 66…”