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Lorene View Drop Down
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    Posted: Jun 19 2013 at 6:48pm
Could anyone help me on this?  One of the reasons given for not getting a Shingles vaccine is a weakened immune system.  I assume the WBC's (white blood counts) is an indication of that, and mine have been lower than the recommended range since I finished chemo 11 yrs ago.  I need to get a vaccine but can't get any explanation on this from the Medical establishment.  I'm in a quandry.  Thank you for any information.
 
Lorene
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Jun 30 2013 at 12:23am
Hi Lorene,

Do not have a complete answer for you.

Did find a reference that MAY be available at a cancer resource center/? public libary.......or maybe others
    can access it.
On   http://www.ascopost.com/issues/may-15,-2013/nccn-clinical-practice-guidelines-in-oncology-2013-updates.aspx
NCCN Clinical Practice Guidelines in Oncology: 2013 Updates    ( May 13, 2013)
'To better address the issues faced by cancer survivors and their families and to offer practical recommendations for clinical use, the NCCN Guidelines Panel for Survivorship Care created its inaugural practice guidelines, said Crystal S. Denlinger, MD, of Fox Chase Cancer Center, Philadelphia. Subtopics covered in the initial version of the guidelines are anxiety and depression, cognitive function, exercise, immunizations/infections, fatigue, pain, sexual function, and sleep disorders."
It goes on to say "Principles for herpes zoster (shingles) vaccination in cancer or transplant survivors are provided.".....but this article does not provide these principles.

From:HIGHLIGHTS OF PRESCRIBING INFORMATION     (Revised 4/2013)
http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf
These highlights do not include all the information needed to use ZOSTAVAX safely and effectively.
See full prescribing information for ZOSTAVAX.
ZOSTAVAX® (Zoster Vaccine Live) Suspension for subcutaneous injection Initial U.S. Approval: 2006
4.2 Immunosuppression
ZOSTAVAX is a live, attenuated varicella-zoster vaccine and administration may result in disseminated
disease in individuals who are immunosuppressed or immunodeficient. Do not administer ZOSTAVAX to
immunosuppressed or immunodeficient individuals including those with a history of primary or acquired
immunodeficiency states, leukemia, lymphoma or other malignant neoplasms affecting the bone marrow
or lymphatic system, AIDS or other clinical manifestations of infection with human immunodeficiency
viruses, and those on immunosuppressive therapy.
***Thus, one would want to ask oncologist:
          Would having any positive lymph node(s) with breast cancer be considered a malignant neoplasm
               affecting the lymphatic system?
Note from the Highlights of prescribing information:
    Table 4: Efficacy of ZOSTAVAX on HZ Incidence Compared with Placebo in the ZOSTAVAX
    Efficacy and Safety Trial*    (See link for full chart)
               Age group (yrs.)                      Vaccine Efficacy (95% CI)
                     50-59                                       69.8% (54.1%, 80.6%)
* The analysis was performed on the intent-to-treat (ITT) population that included all subjects randomized in the ZEST study.

Table 5: Efficacy of ZOSTAVAX on HZ Incidence Compared with Placebo in the Shingles
Prevention Study*
Age group in years                      Vaccine Efficacy 95% CI
     Overall                                           51% (44%, 58%)
     60-69                                             64% (56%, 71%)
     70-79                                             41% (28%, 52%)
     ≥80                                                18% (-29%, 48%)
* The analysis was performed on the Modified Intent-To-Treat (MITT) population that included all
subjects randomized in the study who were followed for at least 30 days postvaccination and did
not develop an evaluable case of HZ within the first 30 days postvaccination.
† Age strata at randomization were 60-69 and ≥70 years of age.

Also from HIGHLIGHTS:
5.4 Limitations of Vaccine Effectiveness
Vaccination with ZOSTAVAX does not result in protection of all vaccine recipients.
The duration of protection beyond 4 years after vaccination with ZOSTAVAX is unknown. The need for
revaccination has not been defined.



In the past, I have called the University of Michigan ( a NCCN Cancer Center)
               Cancer Answer line: 1-800-865-1125
Some times they were able to research a question and call back.
Since they are at University of Michigan Cancer Center, they could find out what the practices were at
   their NCCN Center about Shingles Vaccine post breast cancer chemo/surgery/rads treatment.
***NOTE: One would still need to review any info received at these answer lines with one's oncologist.
http://www.cancer.med.umich.edu/about/cancer_answerline.shtml

The above information is from a Web search.   
If any one knows/believes anything above is incorrect, please post and correct.
If any one has additional info on this matter, also please post.

Lorene, would be interested to learn what else you find out about this.


With caring and positive thoughts,
Grateful for today...........Judy

Edited by Grateful for today - Jul 01 2013 at 12:14pm
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Lorene View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lorene Quote  Post ReplyReply Direct Link To This Post Posted: Jun 30 2013 at 6:23pm
Judy,
 
So Very thoughtful of you to research this in such depth as you have!  And for questions to consider in making a decision.  I'm no longer under my Oncologist's care, only my Surgeon and Primary Care Dr., but will think toward how to go about this.    I will look at these websites, and contact the Univ of Mich as a start.  Thank you So much and I will let you know anything I learn.
 
In appreciation,
Lorene
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 30 2013 at 10:12pm
Hi Lorene,

I got the vaccine last fall after my primary dr recommended it.  Absolutely no side effects.  I asked my onc and they had no problem with it either.  Since chemo, my wbc is always at the low end of normal (or just below).  I'm so glad I got the vaccine as I watched my mother suffer her second episode with shingles in November and my SIL also had shingles a few months ago.  Talk to your doctor.  I think when they talk about a weakened immune system, its more for people actively going through chemo/radiation, or have an immune condition.

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Oh, thanks so much, Donna!
 
Lorene
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Post Options Post Options   Thanks (0) Thanks(0)   Quote bookish Quote  Post ReplyReply Direct Link To This Post Posted: Jul 01 2013 at 7:44pm
On the shingles vaccine, how about sending email to the maker of the vaccine and asking about its safety and efficacy for cancer survivors with low WBC counts that seem to be a consequence of chemo (eg, not related to other conditions).

I had two corneal transplants a few years ago and was worried about getting the vaccine post-transplant as I take a steroid drop daily to control rejection....but the opthalmologist urged me to get the vaccine feeling that shingles was worse than any risk from the vaccine.  And I had no side effects that I could notice.  That was before this year's chemo and my WBC count was normal.

I have a friend who had shingles about a year ago and it is STILL bothering her, like a band of fire around her rib cage on one side.  Not as bad as it was during the initial attack, but always present in some amount.  She could not get the vaccine b/c of taking Humira (which lowers immune system), but really regrets not having had the shot before she went on Humira.

Ann
IDC TNBC dx 9/2012 at age 66, Stage 1, Grade 3, 1.5 cm. Lumpectomy 9/2012, T+C 4 rounds, 33 sessions of radiation ending 3/2013. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 14 2013 at 11:18pm
Hi ladies,

I went to my doctor today regarding a stye and sinus infection and decided to question the Shingles Vaccine, my doctor says it is a good idea for us out here that have had Cancer.
As usual with any vaccines, it is an ongoing controversy for our friends and loved ones when we speak of getting any.
I come from a place of really really wanting to avoid this one all together I guess mostly due to the residual side effect of cronic painful nuralgia.
Just got done poking around on the internet at my usual research stops ie. Mayo clinic ( no contrary detail), WebMD ( not very reputable but again no contrary detail). 
I did come accross this one that I will share with you. It spoke of the small clinical trial not to be very compelling for us to get this vaccine. If you look at the comments they are a bit scarey. Yes yes yes, of course only the people that might have had a reaction from the vaccine would post, doesn't speak for the masses that didn't have a reaction. But how do I interpret this? have to be honest here, I am starting to second guess my choice. I know, I have to make up my own mind and feel good about my choice.


Then you have a small article (from 2006) from Dr. Weil, that he really doesn't share too much , but being the type of doctor that has a vision of Western and Eastern medicine to compliment eachother he also does not descriminate on this issue.


I do not want the side effects that the first article speaks of but I don't want  the shingles either.
Only 50% chance of NOT getting the Shingles?? Really?

I have to figure this one out to feel good about it and grounded in my choice now. On to more research.
All thoughts welcome. Thank you for any input.

I love this place to come for support in our dilemmas, scares, laughs, and just so supportive.
Seize the Day,
Natalie




Edited by Natalie - Oct 15 2013 at 12:09am
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Annie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 8:16am


   Hi Natalie, Well right now my 93 year old Mother has been in the hospital for a kidney infection??? tests reveal something to that diagnosis.   However she is in a great great deal of pain. I went in early the other day to make sure I saw her Dr. I was trying to determine if something else could be the cause of this persistent pain. Spoke to the Dr. about her having had shingles a few times in the past and that the medication that she took for it did a better job that was she is currently on...So the Dr. immediately checked her abdomen and chest which I did previously...no rash...the Dr. to my surprise said Shingles CAN occur WITHOUT a Rash...So now they added this possibility to the diagnosis along with the meds she took then...which are now providing much better relief.


                  Last year I took a pamphlet when I was at my Dr. office re: the shingles vaccine for myself. I was deterred in getting it because of the possible side effects which were even much more numerous and serious than the ones in the articles you gave us. I wish I had it but must have thrown it out. I have not seen it around the hospital but will pick one up someday. I just learned it costs $200 here in Canada.   Due to the alarming information I read I decided not to get it this year when I turned 60. To see my Mother in this much pain and for so long, over two weeks now is really hard although the pain is being better managed now. She is 93 and it has taken a great toll. She is even on Oxygen.
                   

                  I would like to find this pamphlet again and revisit the information on it. My Mother did not get it and I doubt if it would be advisable at her age. I will post when I find it but as I mentioned the possible side effects were serious enough for me not to consider it.

                  Thanks for bringing this topic up...take care, Love, Annie




Edited by Annie - Oct 15 2013 at 8:19am
Annie TNBC Stage IIA Gr 3 1cm lesion 2/5 lymph nodes+ lumpectomy,FEC & D 30Rads finished(08/2009) BRCA- Chronic Cellulitis due to Radiation-- L.Mastectomy Jan 2012
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lorene Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 8:46am
Natalie and Annie,
 
I debated this for over a year and it finally dawned on me I'd like to get my Oncologist's thoughts, as I no longer see him.  I stopped by and spoke with his Head Nurse/Physician Assistant.  She told me he never advises any of his former patients to get this vaccine because of the possibility it might activate the virus because of our weakened immune system.  I wouldn't say I'm immune-compromised exactly, but even after 11+ yrs since my treatment ended, my counts are still somewhat low.  So, that made the decision for me.  I'm not getting it.  Thanks for this discussion.
 
Lorene
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Grateful for Today - Judy,
 
  You provided us with so much factual information on the Shingles vaccine.  Did you get the vaccine yourself and/or were you advised one way or another? 
 
Hope you are doing well, and thanks again for all your input.
 
Lorene
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 11:55am
The shingles vaccine is now available to anyone age 50 and older.

Here's some info you may want to consider:

When can a patient previously on immunosuppressive chemotherapy receive zoster vaccine?
If the patient was on anticancer therapy, wait 3 months. If they were on high-dose steroids, isoantibodies, immune-mediators, immunomodulators, wait 1 month. Lastly, if they were on low doses of methotrexate, azathioprine, or 6-mercaptopurine, waiting is not indicated as these are not considered immunosuppressive. See the ACIP recommendations for zoster atwww.cdc.gov/mmwr/pdf/rr/rr5705.pdf for details.

Can we give zoster vaccine to elderly patients who have cancer or an immunosuppressed condition?
No. Zoster vaccine is contraindicated in persons with primary or acquired immunodeficiency.

I understand that in March 2011, FDA expanded the age indication for Zostavax (shingles vaccine; ZOS; Merck) to include the vaccine's use in people age 50 through 59 years (while retaining the age indication for use in people age 60 years and older). Can you tell me what ACIP recommends about this?
At its June 2011 meeting, the ACIP reviewed the current status of ZOS licensure and the burden of herpes zoster (HZ) disease. ACIP declined to vote to expand the recommendations for the use of ZOS to include people age 50 through 59 years for the following reasons: (1) vaccines that contain varicella virus (i.e., varicella, ZOS, and MMRV vaccines) are in recurrent short supply in the U.S., (2) though the burden of HZ disease increases after age 50, disease rates are lower in this age group than they are in the 60-years-and-older age group, (3) currently, ZOS vaccination rates are less than 10 percent, and (4) a recommendation to vaccinate people age 50–59 years could result in more zoster disease if the limited supply of vaccine were to be given to people whose risk of disease is lower than that of older, more vulnerable adults.
http://www.immunize.org/askexperts/experts_zos.asp

Some people should not get shingles vaccine or should wait.

A person should not get shingles vaccine who:

  • has ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.
  • has a weakened immune system because of current:
    • AIDS or another disease that affects the immune system,
    • treatment with drugs that affect the immune system, such as prolonged use of high-dose steroids,
    • cancer treatment such as radiation or chemotherapy,
    • cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • is pregnant, or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccines.

Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3° F or higher.

This information was taken directly from the Shingles VIS

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 12:56pm
Donna,

Thanks for posting the info.

Here is the link to the "Vaccine recommendations of the ACIP"
http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/shingles.html

You can download pdfs of the recommendations (from 2008) and the specific update on whether people aged 50-59 should be vaccinated (from 2011).

The concerns are related to the fact that the shingles (zoster) vaccine uses a live virus which undergoes replication.

On the left hand side is a list of other vaccine recommendations including pneumovax and influenza. Both use attenuated/inactivated viruses.  With these vaccines, the main concern has to do with whether an immunocompromised host can mount an effective immune response.

There are no specific recommendations or contradictions for patients with solid tumors who have completed treatment some time ago.  I guess, if there is evidence of diminished cell-mediated immunity, then it is better to forgo the shingles vaccine.  I don't know if there are specific tests for cell-mediated immunity -- maybe total lymphocyte counts to begin with and then evaluation of T cell subsets?

For those considering the shingles vaccine, I would think that talking to your oncologist first would be a wise thing to do and to ask specifically if there is any evidence of defective cell mediated immunity.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 1:53pm
Ladies,

Great information coming up here, much better then I did. 
Son Carl actually has appointment with my hematologist/ Oncologist today so I am putting these questions to him on this. I really want to get to a place of know one way or the other what is best for me. Should I shouldn't I? Tough stuff.
I will share what he speaks of.
Thanks again,
Natalie
TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 2:20pm
Hi Natalie,

Glad you are asking your questions.  I asked both my primary and oncologist and for me, they said it was a good decision.  I had absolutely no reaction to the vaccine, not even soreness in the muscle like you get from some shots.  It's always best to go by what your doctor recommends.

Donna


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lorene Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 8:48pm
I'm glad you did well with it, Donna.  Thanks for all your information.
 
Lorene
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 9:26pm
Ladies,

My primary care doctor said she highly recommended the Shingles vaccine a couple of weeks ago. She brought this up to all her Cancer patients, according to her.

My Oncologist today said pretty much the same thing. If I had been only a few months out from treatment he would not say yes. He also tells all of his patients to get the vaccine, he steadfastly said that the benefit outweighs any risks. He claims not one of his patients have had any reactions to the vaccine.
He also stated that my chemo as many of you had the same AC/T is NOT immune suppresent drugs.  Hmmm I was under the impression they were, I mean, I was told to stay away from people that were sick and also to discourage anyone from coming around if they were ill or had sighns of anything at all. Of course I thought of this arguement after leaving his office. Also that my tumor was solid, what this has to do with anything I do not know. Doc said people with different knidsw of Cancer are more at risk then us, Lymphoma for instance.
So I have to be honest I think I am going for it, I do not want the Shingles and if I can avoid that virus then I will.
One experience I must share with you ladies is this. Many of you know of my son Carl and that he is injured and I am his Primary caregiver (Traumatic Brain Injury due to drunk driver, Carl was a pedestrian crossing strreet when 13 he is now 18).
 Upon leaving the office when I was loading Carl into the van (he is in a wheelchair) a very sweet Hatian woman came over to me ( I saw her in the office with her Mom) and proceeded to ask me if Carl had nursing as she has a friend that is desperately looking for work. having to let her know that Carl only gets 20 hours a week (rediculous considering he needs help with all activities of daily living) I had to let her know we weren't looking for any more nurses that I have 2 nurses for that whopping 20 hours a week.

Anyways, she was asking about Carl and I. I gave her a quick synopsis of the both of us. She proceeded to tell me about her Mom and other loved ones that has been helped to cure Cancer and Asthma to name two illnesses or conditions. She told me to drink 1 litre of water with 1 Tblsp baking soda & 3 limes every day, NO SUGAR (hard one for me, my father ran a cake & bread route so leftovers on that truck were one of our main staples for breakfast lunch and dinner growing up LOL ) I'm an addict and I have the power to admit it hahaha.. and no red meat. She said they let Mom have 1 cup of coffee 1 time every 2 weeks and she can have 1 tsp precious sugar in that only. I know what this was doing to her considering I have some very dear friends that have tried to educate me on the fact that Cancer CAN NOT grow in an Alkeline enviroment, our bodies are acidic which this is the enviroment that all illness love especially Cancer.

She says Mom was diagnosed with Lung Cancer last December, 3 lesions the largest being 7CM. Mom refused Chemo and her daughters went to work to turn her body alkeline among giving her other Hatian remedies. Her latest PET scan showed the 2 smaller lesions to be gone completely and the 7CM one is down to 1 CM. Her doctor is amazed at this and is looking to educate and explore more into what they are doing for there mother so she might share in some way to those patients that refuse chemo.
 Pretty compelling stuff that keeps coming up for me. She also spoke of an herb called Pau d' Arco 500 mg to take also. I have to admitt I could have listened to her all night for her accent alone and coupled with her passion for what she feels OMG!!! I love to hear wisdom from other cultures, I think I was born to the wrong time and place sometimes.

Chemo brained me didn't ask this woman for her number, bugging the heck out of me now. So I might call my Oncs office tomorrow and try to get a message to this woman wanting to thank her for sharing her knowledge with me and see where it may lead. Nothing ventured nothing gained right?

She told me to pray, and she even ventured to say that my son will walk again. Was she saying this out of compassion for seeing my pain when speaking of Carl? I don't know, or could it be that this beautiful Hatian woman is intuitive in some way? I'm attracted to people that feel those things too.

So thats the story, sorry for the long entry, but I felt to share this warm experience with you all because simply put  " That is what we do".

Natalie


Edited by Natalie - Oct 15 2013 at 9:30pm
TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 10:42pm
Thank you Donna & Lee for your researches also, thank you all for being an active part to all of our issues in this community of ours.
TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lizziealberta Quote  Post ReplyReply Direct Link To This Post Posted: Apr 23 2014 at 1:43am
I am 53 and can't get my insurance provider to pay for the shingles vaccine, even though I had shingles after my first bout of cancer. Oncologist even wrote them a letter and still no-go. Any suggestions on what to say to convince health insurer to approve? Thanks!!
ER+ misdiagnosed 09, was ER+/TNBC,lumpectomy, C/T, rads, AI. TNBC in node 4/14, in neoadjuvant A/C then carbo/gemzar, complete path response. double mastectomy.
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