Vaccination rates in patients with cancer remain low, yet these individuals are at increased risk of severe outcomes from vaccine-preventable illnesses.1 Primary care providers are often uncertain about the safety of vaccines in this population and vaccine recommendations for these patients.2,3 This article reviews vaccination in patients who are receiving cancer treatment, including safety, timing, and optimization of response to vaccination. Hematopoietic stem cell transplant, chimeric antigen receptor T-cell therapy, and travel vaccinations are outside the scope of this article.
Vaccines can be categorized broadly as live and non-live.4,5 Live vaccines are attenuated and must replicate within the host to create an immune response (Table 1).6-11 Live vaccines are contraindicated in immunosuppressed patients.6,7,12 Non-live vaccines include inactivated, toxoid, subunit, conjugate, mRNA, and viral vector vaccines. Non-live vaccines can be administered to patients receiving cancer therapies; however, immunosuppression may diminish immune response, so consideration of a patient’s treatment schedule is important to optimize response to vaccination.8 Even with suboptimal response, there is minimal risk with non-live vaccines and the possibility of some benefit. Primary care providers should also consider vaccination of patients’ family members and close contacts to further protect patients receiving cancer treatment.13
Vaccine safety and administration considerations: Clear sections indicate unsafe vaccination circumstances for immunosuppressed patients while shaded sections indicate safe vaccination circumstances in this population.
Cancer therapies are diverse and include corticosteroids, endocrine therapy, radiation therapy, chemotherapy, targeted therapies, and immunotherapies. Immunosuppression will vary with each of these treatment types and, as such, recommendations regarding vaccination will vary according to treatment. Specific considerations for differing cancer therapies are reviewed in Table 2.4-6,14-22 Ideally, patients should receive any outstanding immunizations before initiating cancer therapy; however, many patients may require time-sensitive vaccines such as those for influenza or COVID-19 while concurrently receiving therapy.15,16 Patients are no longer considered immunosuppressed 3 months after cessation of treatment for cancer.6
Cancer therapies and implications for vaccination
Conclusion
This concise article is intended to provide practical support for primary care providers when vaccinating their patients who have been diagnosed with cancer. The recommendations in this brief will increase primary care providers’ familiarity with administration of vaccines in patients receiving cancer therapy, ideally enabling improved uptake and prevention of severe illness in this population.
Footnotes
Competing interests
None declared
- Copyright © 2022 the College of Family Physicians of Canada
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