December 18, 2018
3 min read

Patients with cancer have 40% higher risk for shingles

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Patients diagnosed with cancer of any kind have an approximately 40% higher risk for developing shingles than patients without cancer, researchers found.

The risk for herpes zoster was three-fold higher in patients with hematological cancers compared with patients without cancer, and it was 30% higher in patients with solid tumors, according to Jiahui Qian, MPH, a postgraduate student at the University of New South Wales in Sydney, Australia, and colleagues.

“Previous studies have reported zoster among cancer patients following chemotherapy. However, there are few studies that attempt to separate the risk associated with the cancer itself from the receipt of cancer treatment, particularly chemotherapy,” Qian and colleagues wrote in The Journal of Infectious Diseases.

“Clinical guidelines recommend antivirals for zoster prevention in patients with hematological cancer receiving specific chemotherapies; however, they are less clear for solid organ cancer patients receiving conventional chemotherapy. Given that a new non–live subunit zoster vaccine has been shown to be safe and immunogenic in immunocompromised patients, better defining the factors that contribute to the increased risk of zoster in cancer patients could inform strategies for targeted prevention.”

Qian and colleagues conducted a prospective study using information collected from The Sax Institute’s 45 and Up Study — a population-based prospective cohort study that recruited more than 267,000 Australians aged 45 years or older in New South Wales between January 2006 and December 2009. Datasets were also procured from the New South Wales Admitted Patient Data Collection and Registry of Births, Deaths and Marriages from 2006 to 2015. Participants with a record of a specific zoster antiviral medication or a hospitalization record with and ICD-10-AM code B02 in the primary or secondary diagnosis field qualified as a zoster case.

According to study findings, 20,286 new cancer diagnoses and 16,350 zoster events occurred over 1,760,481 person-years — or over 8 years — of follow-up and 241,497 patients were included in the study. Qian and colleagues observed higher relative risks for zoster among participants with hematological (adjusted HR = 3.74; 95% CI, 3.11–4.51) and solid cancer (aHR = 1.3; 95% CI, 1.21–1.40) compared with those without cancer.

Moreover, the researchers also reported observing an elevated zoster risk 1 to 2 years before a diagnosis of hematological cancer when compared with those without cancer (aHR = 2.01; 95% CI, 1.31–3.09), though the same risk was not seen among patients with solid organ cancers (aHR = 0.90; 95% CI, .75–1.07). There was a higher observed zoster risk associated with chemotherapy in sold cancer patients (aHR = 1.83; 95% CI, 1.60–2.09) compared with those who did not receive chemotherapy (aHR = 1.16; 95% CI, 1.06-1.26).

"We found that among those with hematological cancer, the risk of zoster was elevated in the 2 years prior to their diagnosis (albeit not as high as after the diagnosis), presumably before they received treatment,” the researchers wrote. “This finding suggests that the immune dysfunction from the hematological cancer itself can lead to zoster activation, although we also observed a substantial rise in risk after diagnosis, supporting a major role for subsequent treatment in further increasing the risk.”

In a related editorial, Kosuke Kawai, ScD, from Boston Children’s Hospital, and Barbara P. Yawn, MD, MSc, of the University of Minnesota, said the findings reported by Qian and colleagues “have important implications in view of recent advances in development of zoster vaccines.”

“The live attenuated zoster vaccine is currently contraindicated in immunocompromised individuals. However, an inactivated [varicella zoster virus] vaccine was recently shown to be safe with vaccine efficacy of 64% in a randomized trial of 560 recipients of autologous hematopoietic stem cell transplant,” they wrote. “The safety and efficacy of the inactivated [varicella zoster virus] vaccine is currently being evaluated in patients with solid tumors and hematologic malignancies.” – by Marley Ghizzone

Disclosures: Yawn reports receiving consulting fees from Merck and GlaxoSmithKline. Kawai and Qian report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.