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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

Proportions of patients developing herpes zoster after cancer diagnosis. The proportions of patients developing HZ by time since index date are plotted. Cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis. The proportion of patients being diagnosed with HZ was plotted for the overall, hematologic, solid tumor, and non-cancer cohorts. Dashed lines indicate the percentage of each cohort with HZ at 1 year since the index date. Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively.
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Fig2: Proportions of patients developing herpes zoster after cancer diagnosis. The proportions of patients developing HZ by time since index date are plotted. Cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis. The proportion of patients being diagnosed with HZ was plotted for the overall, hematologic, solid tumor, and non-cancer cohorts. Dashed lines indicate the percentage of each cohort with HZ at 1 year since the index date. Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively.

Mentions: The proportions of patients developing HZ by time since index date are plotted in Figure 2 (cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis). Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively. Overall, 9.2% of hematologic and 6.3% of solid cancer patients were diagnosed with HZ during follow-up. Among patients who developed HZ, the median time of HZ onset following cancer diagnosis was 34.0 months (24.8 and 35.4 months for hematologic and solid tumor patients, respectively).Figure 2


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)

Proportions of patients developing herpes zoster after cancer diagnosis. The proportions of patients developing HZ by time since index date are plotted. Cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis. The proportion of patients being diagnosed with HZ was plotted for the overall, hematologic, solid tumor, and non-cancer cohorts. Dashed lines indicate the percentage of each cohort with HZ at 1 year since the index date. Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Proportions of patients developing herpes zoster after cancer diagnosis. The proportions of patients developing HZ by time since index date are plotted. Cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis. The proportion of patients being diagnosed with HZ was plotted for the overall, hematologic, solid tumor, and non-cancer cohorts. Dashed lines indicate the percentage of each cohort with HZ at 1 year since the index date. Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively.
Mentions: The proportions of patients developing HZ by time since index date are plotted in Figure 2 (cancer patients in this analysis were required to have survived for at least 2 years after cancer diagnosis). Approximately 3.75% and 1.50% of patients in the hematologic and solid cancer cohorts developed HZ within 1 year of cancer diagnosis, compared with 1.10% of non-cancer patients. The proportions of hematologic and solid cancer patients who developed HZ within 2 years of cancer diagnosis were 6.6% and 3.0%, respectively. Overall, 9.2% of hematologic and 6.3% of solid cancer patients were diagnosed with HZ during follow-up. Among patients who developed HZ, the median time of HZ onset following cancer diagnosis was 34.0 months (24.8 and 35.4 months for hematologic and solid tumor patients, respectively).Figure 2

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