As winter approaches, oncologists might be approached by patients and/or their caregivers about the relative benefits and risks of seasonal vaccinations against respiratory viruses. Historically, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has been the source for this information in general. In recent years, an independent authority—The Vaccine Integrity Project—was developed in collaboration with the American Medical Association to provide additional evidence-based analyses of vaccine benefits and risks and to develop yearly recommendations. The results of their analyses for the upcoming season were recently published in JAMA (overall commentary; influenza; COVID-19; respiratory syncytial virus [RSV]).
For patients who are immunocompromised, such as those with cancer, The Vaccine Integrity Project refers to guidelines from the Infectious Diseases Society of America (IDSA) for further details. All of these guidance materials are supported by evidence-based independent assessments and recommend utilization of this year’s COVID-19, influenza, and RSV vaccinations in most patients with cancer, who are especially susceptible to severe respiratory infections.
For the IDSA, immunocompromising conditions especially relevant to oncology include hematologic malignancy, autoimmune disease treated with immunosuppressants or biologics, solid organ or hematopoietic stem cell transplant, chimeric antigen receptor T-cell therapy, or solid-tumor chemotherapy.
In patients with cancer, the IDSA recommends that vaccinations be administered when the cancer is controlled and ideally before initiating cytotoxic therapy, or between cycles when counts have recovered. As immune responses might be diminished in these patients, they stress avoidance of live vaccines by not only the patients but also their close contacts. Vaccination is still widely recognized as the most effective preventive intervention available, significantly reducing hospitalization and other severe outcomes in immunocompromised patients, although outcomes remain worse than in the general population. Given the somewhat reduced (but still significant) efficacy of vaccinations in immunocompromised patients, the IDSA further recommends that their household members and close contacts also consider seasonal vaccinations against viral respiratory diseases to reduce the risk of exposing the patient to these viruses.
Assessing the relative benefits and risks of vaccinations and booster inoculations for individual patients and their caregivers will likely require coordination with primary care and infectious disease colleagues. The resources provided herein could be useful for maintaining the evidence base for these discussions.
High Level
Tables 1, 3, and 5 of the IDSA vaccine guidance may be useful tools for the development of educational materials on viral prophylaxis for COVID-19, influenza, and RSV, respectively, in patients with cancer. If institutional or expert society guidelines differ from these recommendations, consider discussing the evidence base and rationale for vaccine administration with your colleagues to determine whether the IDSA guidelines committee should be contacted for suggested updates.
Ground Level
The publication of the general vaccination recommendations from the Vaccine Integrity Project in JAMA will likely result in widening awareness, whereas the specific IDSA guidance for immunocompromised patients (although mentioned in the JAMA publications) will be less widely recognized. Nonetheless, all of these resources could be useful for discussions with patients and caregivers about whether and when they should receive seasonal respiratory virus vaccinations. As always, personal clinical insights will be instrumental in optimizing the plan of care to balance the risks of treatment vs the risk of severe infections.