Vaccinations While Under Oncology Treatments

Patients with cancer have increased risks for several preventable infections due to underlying disease and toxicities of treatment. Compared with other chronic diseases, infections in immune-compromised patients with cancer may lead to more serious complications.

Vaccination is an effective approach for prevention of infectious diseases and related morbidity and mortality. Although the efficacy of influenza and pneumococcus vaccines in immune-compromised hosts has been well documented, the vaccination coverage rate (VCR) in patients with cancer and their relatives is still low. Clinicians’ concerns about vaccination and its consequences are important obstacles to immunization in oncology practice. Another important reason for low VCR is that not all providers suggest vaccination to the patients with cancer.

Dr. Ali Alkan and colleagues evaluated the attitudes of medical oncologists towards vaccination in cancer patients and details of daily practice.  The survey study with medical oncologists actively working in Turkey tried to evaluate the attitudes of medical oncologists towards vaccination and to identify predictors of intention to recommend vaccination in patients with cancer.

Influenza, pneumococcus and hepatitis B are the most common vaccines recommended (Table). Medical oncologists recommend vaccination especially to elderly patients and specific cancer types (lung cancer, lymphoma, and breast cancer). Chronic Obstructive pulmonary disease and diabetes mellitus are the most common comorbidities in which vaccination recommended. Although the efficacy of vaccination under therapy has been shown, 90.5% of medical oncologists recommend vaccination either before starting or finishing therapy. In addition, 35.9% of them recommended vaccination to the relatives of cancer patients.

Unfortunately, only 23.4% of medical oncologists think that their recommendations on vaccination are efficient and satisfying. Lack of time during an outpatient clinic visit and lack of knowledge or experience about vaccination are the most common limitations while recommending vaccination. Medical oncologists with more experience in the field, higher academic degrees, low workload during daily practice and experience with autologous or allogeneic bone marrow transplant patients evaluate patients and recommend vaccination. The study pointed out an inverse correlation between the number of patients were seen per day and recommending vaccination.

The efficacy of vaccination in cancer patients is clear. Vaccination coverage rate is an important issue that should be handled. Medical oncologists’ positive attitudes and knowledge about vaccination are the essential components that can increase VCR.

Vaccination recommended/ prescribed
    Hepatitis B183(67.0)
    Human Papilloma Virus63(23.0)
¬†¬†¬† Hemophilus ńįnfluenza B32(11.7)
    Varicella Zoster11(4.0)
Diagnoses which have priority during vaccination
    Lung cancer94(68.1)
    Breast Cancer34(24.6)
    Colorectal Cancer23(16.6)
    Prostate Cancer12(8.6)
Group of patients who are evaluated for vaccination 
    In remission/follow up187(68.4)
    Before beginning  therapy175(64.1)
    After last chemotherapy123(45.0)
    Patients actively under therapy37(13.5)
Comorbidities in which vaccination is recommended
    Chronic Obstructive Pulmonary Disease149(94.3)
    Diabetes Mellitus131(82.9)
    Coronary Artery Disease50(31.6)
Timing of vaccination during active therapy
    Before starting therapy143(52.4)
    After finishing therapy104(38.1)
    Between therapy cycles9(3.3)
    Independent of timing of therapy17(6.2)
Limitations/ problems during recommending vaccination
    Lack of time during outpatient clinic visit173(63.3)
    Lack of knowledge and experience about vaccination in patients with cancer161(58.9)
    Unconvinced about efficacy of vaccination136(49.8)
    Conflicting recommendations in guidelines74(27.1)
    Fear of side/adverse effects74(27.1)
¬†¬†¬† Patients’ or patients’ relatives negative thoughts about vaccination64(23.4)
    Conflicting results of clinical trials49(17.9)
    Unavailability of vaccine through health insurance45(16.4)

Table: Characteristics of medical oncologists’preferences during recommendation of vaccination

These findings are described in the article entitled Vaccination in oncology practice and predictors, published in the journal Supportive Care in Cancer. This work was led by Ali Alkan from Ankara University School of Medicine.

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