title: The epidemiology of herpes zoster and its complications in Medicare cancer patients.
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.
authors.affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. Mihran.Yenikomshian@analysisgroup.com.
authors.forename: Mihran A
authors.initials: MA
authors.lastname: Yenikomshian
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium. adrienne.x.guignard@gsk.com.
authors.forename: Adrienne P
authors.initials: AP
authors.lastname: Guignard
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium. francois.f.haguinet@gsk.com.
authors.forename: François
authors.initials: F
authors.lastname: Haguinet
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA. Ann_LaCasce@dfci.harvard.edu.
authors.forename: Ann S
authors.initials: AS
authors.lastname: LaCasce
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA. Arthur_Skarin@dfci.harvard.edu.
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Skarin
authors.affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. alex.trahey@gmail.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Trahey
authors.affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. Paul.Karner@analysisgroup.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Karner
authors.affiliation: Analysis Group, Inc., 111 Huntington Ave., Tenth Floor, Boston, MA, 02199, USA. Mei.Duh@analysisgroup.com.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006562:Herpes Zoster / Q000150:complications* / Q000191:economics / Q000453:epidemiology*; D014645:Herpesvirus 3, Human; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000150:complications* / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology