Risk of Herpes Zoster Prior to and Following Cancer Diagnosis and Treatment: A Population-Based Prospective Cohort Study

Abstract

Background. Information on the risks of herpes zoster (zoster) preceding a cancer diagnosis and the role of cancer treatment on risk is limited. Methods. This was a prospective cohort of 241497 adults, with mean age 62.0 years at recruitment (2006-2009), linked to health datasets from 2006 to 2015. The relation between cancer diagnosis, treatment, and zoster risk was analyzed using time-varying proportional hazards models. Results. Over 1760 481 person-years of follow-up, 20 286 new cancer diagnoses and 16 350 zoster events occurred. Participants with hematological and solid cancer had higher relative risks of zoster than those without cancer (adjusted hazard ratio [aHR], 3.74 [95% confidence interval {CI}, 3.11-4.51] and 1.30 [95% CI, 1.21-1.40], respectively). Compared to those without cancer, zoster risk was also elevated prior to a hematological cancer diagnosis (aHR for 1-2 years prior, 2.01 [95% CI, 1.31-3.09]), but this was not the case for solid cancers (aHR for 1-2 years prior, 0.90 [95% CI, .75-1.07]). Compared to those without cancer, zoster risk among participants with solid cancers receiving chemotherapy was greater than in those without a chemotherapy record (aHR, 1.83 [95% CI, 1.60-2.09] and 1.16 [95% CI, 1.06-1.26], respectively). Conclusions. For hematological cancer, increases in zoster risk are apparent in the 2 years preceding diagnosis and treatment; for solid organ cancers, the increased risk appears to be largely associated with receipt of chemotherapy.

Risk of herpes zoster in the Japanese population with immunocompromising and chronic disease conditions: Results from a claims database cohort study, from 2005 to 2014

“…Previously, for this same study population we found that IRs for HZ were higher in females compared with males and increased with greater age, and were highest in patients with IC conditions (and in particular those undergoing HSCT, subjects with HM and those with SLE), and somewhat lower in subjects with chronic medical conditions . Those findings are consistent with those from other epidemiological studies which report an increasing incidence of HZ with older age, and also a higher incidence in patients with malignancy, and other IC conditions such as SLE . In the further data we present here, we show that the influence of age and sex is also apparent in patients with different IC and chronic medical conditions.…”

“…In our regression analyses, while we adjusted for important covariates, we did not account for the effects of exposure to specific immunosuppressive or immunomodulatory agents (including corticosteroids, chemotherapy, immunosuppressants such as methotrexate and biologic therapies). As it is recognized that these agents are associated with increased risk of HZ, they might have had an impact on the HRs reported in this study.…”

“…Nevertheless, our general findings that the risk of HZ is greater in subjects with IC conditions are consistent with those reported in previous studies. 8,12,14,[33][34][35][36] While our findings should be interpreted in light of such limitations, the main strength of this study was the use of a large insurance claims database which allowed for the analysis of a large and broadly representative portion of the Japanese population. Figure 3 presents a plain-language summary of the context, outcomes and potential impact of this study for health-care providers.…”

“…Declining VZV‐specific cell‐mediated immunity, which predisposes an individual to VZV reactivation and clinical HZ, occurs as a result of age‐related “immunosenescence”, which may explain the greater risk and higher incidence of HZ in individuals aged 50 years or more . Incidence and risk is greater in women, in individuals with immunocompromised (IC) medical conditions (e.g., patients with hematological or solid tumors or those receiving immunosuppressive therapies) and also in individuals with certain chronic medical conditions . Older adults and those with IC conditions (where complications may be more severe) and with chronic medical conditions are also at greater risk of HZ‐associated complications, most commonly postherpetic neuralgia (PHN), but also other neurological complications, ocular complications, and disseminated HZ …”

“…2,6,7 Incidence and risk is greater in women, 2,6 in individuals with immunocompromised (IC) medical conditions (e.g., patients with hematological or solid tumors or those receiving immunosuppressive therapies) and also in individuals with certain chronic medical conditions. 6,[8][9][10][11][12][13][14] Older adults and those with IC conditions (where complications may be more severe) and with chronic medical conditions are also at greater risk of HZ-associated complications, most commonly postherpetic neuralgia (PHN), but also other neurological complications, ocular complications, and disseminated HZ. 2,8,13,15 Previously, we reported on the HZ disease burden in the general adult Japanese population and in those patients with IC and chronic medical conditions, using data derived from the Japan Medical Data Center claims database (JMDC-CDB).…”