title: The epidemiology of herpes zoster in patients with newly diagnosed cancer.
abstract: BACKGROUND
  Given the limited literature, we conducted a study to examine the epidemiology of herpes zoster (HZ) among newly diagnosed cancer patients.
  
  
  METHODS
  We identified adult health plan members of Kaiser Permanente Northern California diagnosed with invasive cancer from 2001 to 2005. Electronic health records with inpatient and outpatient diagnoses, laboratory tests, and antiviral medications were used to identify HZ diagnoses from 2001 to 2006. HZ diagnoses and associated complications were confirmed by medical chart review. Treatment with chemotherapy and corticosteroids was used to classify patients by immunosuppression level.
  
  
  RESULTS
  Among 14,670 cancer patients, 424 were diagnosed with HZ during follow-up (median 22 months). The incidence of HZ was 31/1,000 person-year (PY) in patients with hematologic malignancies and 12/1,000 PY in patients with solid tumors. The corresponding 2-year cumulative incidence of HZ was approximately 6% and 2%, respectively. Compared with incidence rates of HZ reported in a general US population, the age- and sex-standardized rates of HZ were 4.8 times higher [95% confidence interval (CI), 4.0-5.6] in patients with hematologic malignancies and 1.9 times higher (95% CI, 1.7-2.1) in those with solid tumors. HZ risk increased with increasing level of immunosuppression. Among HZ cases, 19% with hematologic malignancies and 14% with solid tumors had HZ-associated pain for at least 30 days. The corresponding numbers for nonpain-related complications were 30% and 18%, respectively.
  
  
  CONCLUSIONS
  Cancer patients are at substantially increased risk of HZ and among those with HZ, complications are relatively common.
  
  
  CONCLUSIONS
  Better HZ prevention and treatment options for cancer patients are needed.
authors.affiliation: Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA. laurel.habel@kp.org
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
authors.forename: Gary Thomas
authors.initials: GT
authors.lastname: Ray
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.forename: Adrienne L
authors.initials: AL
authors.lastname: Castillo
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Patricia
authors.initials: P
authors.lastname: Sadier
authors.forename: Trung N
authors.initials: TN
authors.lastname: Tran
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006562:Herpes Zoster / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D014645:Herpesvirus 3, Human / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D055815:Young Adult