Cancer patients should receive the influenza and H1N1 (swine flu) vaccines
Monday, May 17, 2010 at 10:20PM 
The CDC endorses the practice of influenza vaccination for patients with malignancies,4 but many question whether patients receiving chemotherapy are able to mount a sufficient immunological response to benefit from vaccination, or whether patients with can- cer experience excess mortality during influenza epidemics that would necessitate routine vaccination.
In a review published in the May issues of the Journal of Clinical Oncology, physicians from the Stanford Cancer Center, Ca, emphasize that oncology patients should receive the influenza vaccines recommended for the general population.
Despite high levels of public awareness and an acces- sible and effective vaccine, influenza remains a significant source of morbidity and mortality in the United States. It is responsible for 36,000 deaths and 226,000 hospitalizations each year, with an annual economic burden of $87.1 billion.
The Centers for Disease Control and Prevention (CDC) recommends annual vaccination for high-risk popula- tions, including health care workers, the elderly, and patients who are immunosuppressed or have chronic medical conditions.
Patients with malignancies receiving chemotherapy are also at an increased risk of contracting influenza, and may have higher complication and mortality rates than the general population. Furthermore, influenza can indirectly result in suboptimal oncological out- comes by resulting in treatment delays.
Physicians at the Stanford Cancer Center conducted a critical analysis of studies evaluating the benefit of influenza vaccination in patients with cancer, and noted the following observations:
The majority of patients with malignancies who have not received treatment for greater than 30 days can mount immunologically favorable reactions to influenza vaccination. Patients actively receiving treatment typically have suboptimal responses, but few studies show an absence of responsiveness. Although the ideal time to administer the vaccination during a treatment cycle is unclear, the furthest time point from chemotherapy appears to be preferable. Those with hematologic malignancies tend to have inferior responses to those with solid tumors, but given the possibility of response and the favorable adverse effect profile of vaccination, the risk/benefit ratio favors this intervention. Immunotherapies like rituximab may negatively impact the immune response to influenza vaccination.
The study reinforces that influenza vaccination in patients with cancer is safe, minimally invasive, and inexpensive. Vaccination of all household contacts, and prophylactic use of antiviral treatments in patients with known exposures, is recommended.
The CDC recommends immunization with inactivated H1N1 vaccine for patients with cancer receiving chemotherapy, followed by a revac- cination 3 months after completion of treatment if it is still influenza season.
Source article: Journal of Clinical Oncology, May 2010.
