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

Yenikomshian MA, Guignard AP, Haguinet F, LaCasce AS, Skarin AT, Trahey A, Karner P, Duh MS - BMC Infect. Dis. (2015)

Bottom Line: 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 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.

View Article: PubMed Central - PubMed

Affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. Mihran.Yenikomshian@analysisgroup.com.

ABSTRACT

Background: Literature 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.

Methods: Patients ≥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.

Results: The 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.

Conclusions: Elderly 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.

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Related in: MedlinePlus

Study population disposition. The flow chart depicts how the selection criteria affect the number of patients remaining in the study sample. Each box represents the number of patients remaining in the sample at each step. From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients.
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Fig1: Study population disposition. The flow chart depicts how the selection criteria affect the number of patients remaining in the study sample. Each box represents the number of patients remaining in the sample at each step. From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients.

Mentions: From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients (see Figure 1). Patient baseline characteristics are presented in Table 1. Significant differences existed between cancer and non-cancer patients in all characteristics considered. Due to the large sample size, not all statistically significant differences were meaningful. The average age at the index date was approximately 75–78 years across the cohorts. Compared with non-cancer patients, hematologic and solid cancer patients were slightly older on average (mean ages 77.5 and 76.1 vs. 74.7 years, p-values <0.0001). Most (62.7%) non-cancer patients were female, while hematologic cancer patients were roughly evenly divided across genders (51.0% female) and solid cancer patients tended to be male (55.1%). Most (84-89%) patients were White in race. Compared with non-cancer patients, larger proportions of hematologic and solid cancer patients were White (89.3% and 86.4%, respectively, vs. 84.1%), while smaller proportions were Asian/Pacific Islanders (2.2-2.3% vs. 3.2%) and North American Native/Alaska Native (0.2% vs. 0.4%). A smaller proportion of hematologic cancer patients were Black (4.7%) compared with solid cancer (7.9%) and non-cancer (7.6%) patients. Average follow-up times for hematologic and solid cancer patients were 37.8 and 52.1 months, respectively, and were significantly shorter compared to non-cancer patients (mean 85.3 months, p-values <0.0001).Figure 1


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

Yenikomshian MA, Guignard AP, Haguinet F, LaCasce AS, Skarin AT, Trahey A, Karner P, Duh MS - BMC Infect. Dis. (2015)

Study population disposition. The flow chart depicts how the selection criteria affect the number of patients remaining in the study sample. Each box represents the number of patients remaining in the sample at each step. From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352235&req=5

Fig1: Study population disposition. The flow chart depicts how the selection criteria affect the number of patients remaining in the study sample. Each box represents the number of patients remaining in the sample at each step. From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients.
Mentions: From an initial sample of 2,110,735 cancer and 676,712 non-cancer patients, the final sample included 82,832 hematologic, 944,777 solid, and 246,308 non-cancer patients (see Figure 1). Patient baseline characteristics are presented in Table 1. Significant differences existed between cancer and non-cancer patients in all characteristics considered. Due to the large sample size, not all statistically significant differences were meaningful. The average age at the index date was approximately 75–78 years across the cohorts. Compared with non-cancer patients, hematologic and solid cancer patients were slightly older on average (mean ages 77.5 and 76.1 vs. 74.7 years, p-values <0.0001). Most (62.7%) non-cancer patients were female, while hematologic cancer patients were roughly evenly divided across genders (51.0% female) and solid cancer patients tended to be male (55.1%). Most (84-89%) patients were White in race. Compared with non-cancer patients, larger proportions of hematologic and solid cancer patients were White (89.3% and 86.4%, respectively, vs. 84.1%), while smaller proportions were Asian/Pacific Islanders (2.2-2.3% vs. 3.2%) and North American Native/Alaska Native (0.2% vs. 0.4%). A smaller proportion of hematologic cancer patients were Black (4.7%) compared with solid cancer (7.9%) and non-cancer (7.6%) patients. Average follow-up times for hematologic and solid cancer patients were 37.8 and 52.1 months, respectively, and were significantly shorter compared to non-cancer patients (mean 85.3 months, p-values <0.0001).Figure 1

Bottom Line: 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 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.

View Article: PubMed Central - PubMed

Affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. Mihran.Yenikomshian@analysisgroup.com.

ABSTRACT

Background: Literature 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.

Methods: Patients ≥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.

Results: The 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.

Conclusions: Elderly 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.

Show MeSH
Related in: MedlinePlus