Shingles Protection Is Critical for Cancer Patients

Dale Shepard, MD

Cancer patients have long been known to be at higher risk of developing shingles and its related complications. Now they can protect themselves from the opportunistic virus by simply rolling up their sleeve and getting two doses of the Shingrix vaccine. One medical oncologist says it’s an important step that pharmacists and primary care physicians should promote among their patients.

A recent study published in the British Journal of Cancer reports that cancer patients may experience cell-mediated immunosuppression resulting from chemotherapy, psychological stress, or the physical trauma of surgery or radiation therapy. A weakened immune system puts them at greater risk of developing herpes zoster.

The researchers concluded that these patients may benefit from the rapid initiation of antiviral therapy to reduce acute pain and complications. “To obtain maximum benefit, vaccination as soon as possible after cancer diagnosis may be needed, prior to immunosuppressive therapies being initiated,” they recommend.

Oncologist Dale Shepard, MD, PhD, of the Cleveland Clinic concurs with that advice, especially now that the non-live recombinant Shingrix vaccine is available in the United States. He notes that the only other option Zostavax, is made from a live attenuated virus and is specifically contraindicated in immunocompromised people. He calls Shingrix a breakthrough for the treatment of cancer patients.

“There have been some studies that have shown that patients with cancer have a 10% to 50% increase in the incidence of shingles. It’s a population at increased risk,” Shepard tells Drug Topics. “Now, in addition to trying to treat their cancer, we can try to prevent them from getting shingles.” By preventing herpes zoster, Shingrix also reduces the overall incidence of postherpetic neuralgia and other complications.

While shingles does not necessarily make cancer worse or prevent its treatment, Shepard says that it can make patients’ lives more complicated at a time when they’re already facing tremendous challenges. He adds that he has had patients who developed shingles and thought they had a recurrence of their tumor.

Shepard downplays the vaccine’s reactogenicity, saying it’s not a major issue for the patients he treats. “Certainly, there are some issues of flu-like symptoms, but that’s kind of par for the course for most vaccines and along the lines of what we tell everyone for most of the chemotherapy and immunotherapies that we’re giving,” he says. “It’s not going to make the symptoms they’re getting from their treatment worse.”

In addition to advising his patients in that age population to get the vaccine, Shepard also recommends immunization against pneumonia and influenza as laid out in the CDC’s Adult Immunization Schedule.

Pharmacists can make a difference when it comes to protecting against shingles and other health maintenance issues. “Sometimes, once people have cancer, even if they’re not actively being treated, there’s a little hesitancy to do something. And the shingles vaccine may be on that list because historically they couldn’t get it,” Shepard concludes. “Reaching out [to pharmacists] and making sure they’re comfortable with the fact that they can now give it is important.”