Clinical and Economic Impact of Herpes Zoster in Cancer Patients

Clinical and Economic Impact of Herpes Zoster in Cancer Patients - A Retrospective Cohort Study in a Brazilian Cancer Center

Herpes zoster (HZ) is an important infectious complication among patients with cancer, particularly in the setting of treatment-related immunosuppression. This retrospective observational cohort study aimed to characterize the clinical profile of HZ episodes and estimate direct hospital costs associated with emergency department visits and hospitalizations in patients with active malignancy treated at a Brazilian tertiary cancer center. The study also explored associations between cancer characteristics, recent oncologic therapies, and clinical outcomes, including postherpetic neuralgia, recurrence, disease dissemination, and hospital costs. Findings are intended to support future budget impact and cost-effectiveness analyses of herpes zoster vaccination in oncology populations.

Study Overview

• Status: Completed
• Conditions: Herpes Zoster
• Intervention / Treatment: Other: Herpes Zoster episode

Detailed Description

Herpes zoster (HZ) is associated with substantial morbidity among patients with cancer because of disease-related and treatment-related immunosuppression. Beyond the acute infection, HZ may delay anticancer treatment, increase healthcare utilization, and lead to long-term complications such as postherpetic neuralgia. Despite its clinical relevance, real-world data describing the clinical burden and direct hospital costs of HZ in oncology patients in Brazil remain limited.

This retrospective observational cohort study included adult patients with active cancer diagnosed with herpes zoster between September 2019 and December 2024 at A.C. Camargo Cancer Center, São Paulo, Brazil. Patients were identified through electronic medical records and institutional infection control databases. Demographic characteristics, cancer type and stage, recent oncologic therapies, clinical presentation, complications, recurrence, and postherpetic neuralgia were evaluated. Direct hospital costs related to emergency department visits and hospitalizations were obtained from institutional administrative databases.

The study was designed to characterize the clinical and economic burden of herpes zoster in oncology patients and to explore associations between oncologic characteristics and clinical and economic outcomes, providing real-world evidence to support future health economic evaluations and vaccination strategies.

• Study Type: Observational
• Enrollment (Actual): 150

Contacts and Locations

Study Locations

• Brazil
  • São Paulo
    • São Paulo, São Paulo, Brazil, 01509-001
      • A.C.Camargo Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adults (≥18 years) with active solid or hematologic malignancies evaluated at A.C. Camargo Cancer Center (São Paulo, Brazil) who experienced a clinically confirmed episode of herpes zoster during the study period.

Description

Inclusion Criteria:

• Adults (≥18 years).
• Active solid or hematologic malignancy.
• Evaluation at A.C. Camargo Cancer Center (São Paulo, Brazil) between September 2019 and December 2024.
• Clinically confirmed episode of herpes zoster (initial episode or recurrence).
• Herpes zoster diagnosed based on a typical painful dermatomal rash with polymorphic lesions (macules, papules, vesicles, and crusts), either localized or disseminated.

Exclusion Criteria:

• Age <18 years.
• No evidence of active malignancy (complete remission or no oncologic treatment for at least one year).
• Patients in whom herpes zoster was not confirmed after medical record review.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with Herpes Zoster and Active Cancer; Adult patients with active solid or hematologic malignancies who presented with a clinically confirmed episode of herpes zoster between September 2019 and December 2024 at A.C. Camargo Cancer Center, São Paulo, Brazil.	Other: Herpes Zoster episode; Clinically confirmed herpes zoster episode (initial episode or recurrence) identified through electronic medical records.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical characteristics of herpes zoster episodes	Characterization of herpes zoster episodes in adult patients with active cancer, including clinical presentation, dissemination, postherpetic neuralgia, recurrence, cancer type and stage, and recent oncologic therapies.	September 2019 through December 2024
Direct hospital costs	Estimation of direct hospital costs associated with emergency department visits and hospitalizations related to herpes zoster in patients with active cancer.	September 2019 through December 2024

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postherpetic neuralgia	Occurrence of postherpetic neuralgia, defined as neuropathic pain persisting for at least 3 months after the onset of herpes zoster.	3 months after herpes zoster episode

Collaborators and Investigators

• Sponsor: AC Camargo Cancer Center

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2019
• Primary Completion (Actual): December 30, 2024
• Study Completion (Actual): December 30, 2024

Study Registration Dates

• First Submitted: January 5, 2024
• First Submitted That Met QC Criteria: January 5, 2024
• First Posted (Actual): January 17, 2024

Study Record Updates

• Last Update Posted (Actual): August 19, 2026
• Last Update Submitted That Met QC Criteria: August 18, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: cancer; costs; herpes zoster; postherpetic neuralgia
• Additional Relevant MeSH Terms: Varicella Zoster Virus Infection; Pain; Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Infections; Virus Diseases; Peripheral Nervous System Diseases; DNA Virus Infections; Herpesviridae Infections; Neuralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neoplasms; Herpes Zoster; Neuralgia, Postherpetic
• Other Study ID Numbers: 3527/23

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO