Supportive Care in Cancer

, Volume 24, Issue 5, pp 2317–2321 | Cite as

Vaccination of chemotherapy patients—effect of guideline implementation

  • Michelle S. Toleman
  • Katharine Herbert
  • Noel McCarthy
  • David N. ChurchEmail author
Original Article



Despite substantial morbidity and mortality of influenza and pneumococcal infections in cancer patients treated with chemotherapy, vaccination against both illnesses is infrequent. We evaluated the impact of implementation of clinical guidelines on vaccination of chemotherapy patients treated in our institute.


We performed a prospective audit before (2012) and after (2013–2014) the introduction of immunisation guidelines for chemotherapy patients in a UK tertiary cancer centre.


Guideline implementation was associated with a significant increase in the rate of pneumococcal vaccination compared to the 2012 baseline (47 vs. 25 %, P = 0.0018), though this was not sustained the following year (34 %, P = 0.13, vs. baseline). Influenza vaccine coverage was high (∼70 %) throughout. There was a marked disparity between patients aged ≤65 and those >65 years in the rate of pneumococcal vaccination in both 2013 and 2014 (38 vs. 68 % and 17 vs. 53 %, respectively, both P < 0.001), and, to a lesser extent, in the rate of influenza vaccination in the same period (64 vs. 82 %, P < 0.1, and 63 vs. 85 %, P = 0.009, respectively).


The implementation of clinical vaccine guidelines was associated with a significant increase in pneumococcal vaccination, though continued effort appears required to deliver persistent improvement. Initiatives to increase vaccination uptake in patients aged ≤65 are merited.


Influenza Streptococcus pneumoniae Vaccination Immunisation Chemotherapy Cancer 



The authors would like to thank Dr. Andrew Pollard and Dr. Tony Berendt for their input into the local immunisation guidelines, and the staff of the Oxford Cancer Centre Day Treatment Unit for distributing questionnaires to patients.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no competing interests.


DC is a recipient of an Academy of Medical Sciences/Health Foundation Clinician Scientist award and has received research funding from the Oxford Cancer Research Centre for other projects. MT and KH receive research funding from the Wellcome Trust. NM receives funding from the UK National Institute for Health Research. No funding was obtained to conduct this audit.

Ethical approval

Not required

Supplementary material

520_2015_3037_MOESM1_ESM.pdf (75 kb)
Supplementary data 1 (PDF 75 kb)
520_2015_3037_MOESM2_ESM.pdf (79 kb)
Supplementary data 2 (PDF 78 kb)


  1. 1.
    Kunisaki KM, Janoff EN (2009) Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis 9(8):493–504CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cooksley CD, Avritscher EB, Bekele BN, Rolston KV, Geraci JM, Elting LS (2005) Epidemiology and outcomes of serious influenza-related infections in the cancer population. Cancer 104(3):618–628CrossRefPubMedGoogle Scholar
  3. 3.
    Beck CR, McKenzie BC, Hashim AB, Harris RC, Nguyen-Van-Tam JS (2012) Influenza vaccination for immunocompromised patients: systematic review and meta-analysis by etiology. J Infec Dis 206(8):1250–1259CrossRefGoogle Scholar
  4. 4.
    Goossen GM, Kremer LC, van de Wetering MD (2013) Influenza vaccination in children being treated with chemotherapy for cancer. Cochrane Database Syst Rev 8:Cd006484Google Scholar
  5. 5.
    Pollyea DA, Brown JMY, Horning SJ (2010) Utility of influenza vaccination for oncology patients. J Clin Oncol 28(14):2481–2490CrossRefPubMedGoogle Scholar
  6. 6.
    Arrowood JR, Hayney MS (2002) Immunization recommendations for adults with cancer. Ann Pharmacother 36(7–8):1219–1229CrossRefPubMedGoogle Scholar
  7. 7.
    Eliakim-Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M (2013) Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev 10:Cd008983Google Scholar
  8. 8.
  9. 9.
  10. 10.
    Meidani M, Rostami M, Dehghani F (2011) Why coverage of influenza vaccine is not enough in patients receiving chemotherapy? Int J Prev Med 2(3):186–187PubMedPubMedCentralGoogle Scholar
  11. 11.
    Loulergue P, Mir O, Alexandre J, Ropert S, Goldwasser F, Launay O (2008) Low influenza vaccination rate among patients receiving chemotherapy for cancer. Ann Oncol 19(9):1658CrossRefPubMedGoogle Scholar
  12. 12.
    Ring A, Marx G, Steer C, Prendiville J, Ellis P (2003) Poor uptake of influenza vaccinations in patients receiving cytotoxic chemotherapy. Int J Clin Pract 57(6):542–543PubMedGoogle Scholar
  13. 13.
    Earle CC (2003) Influenza vaccination in elderly patients with advanced colorectal cancer. J Clin Oncol 21(6):1161–1166CrossRefPubMedGoogle Scholar
  14. 14.
    Urun Y, Akbulut H, Demirkazik A, et al. (2013) Perception about influenza and pneumococcal vaccines and vaccination coverage among patients with malignancies and their family members. J BUON: Off J Union Oncol 18(2):511–515Google Scholar
  15. 15.
    Chin-Yee BH, Monkman K, Hussain Z, Minuk LA (2011) Attitudes toward vaccination for pandemic H1N1 and seasonal influenza in patients with hematologic malignancies. J Support Oncol 9(4):156–160CrossRefPubMedGoogle Scholar
  16. 16.
    Lachenal F, Sebban C, Duruisseaux M, Biron P, Blay JY, Ghesquieres H (2010) Influenza vaccination in patients with haematologic malignancies: analysis of practices in 200 patients in a single center. Bull Cancer 97(4):E33–E36PubMedGoogle Scholar
  17. 17.
    Berglund Å, Willén L, Grödeberg L, Skattum L, Hagberg H, Pauksens K (2014) The response to vaccination against influenza A (H1N1) 2009, seasonal influenza and Streptococcus pneumoniae in adult outpatients with ongoing treatment for cancer with and without rituximab. Acta Oncologica 53(9):1212–1220Google Scholar
  18. 18.
  19. 19.
    Jefferson T, Di Pietrantonj C, Rivetti A, Bawazeer GA, Al-Ansary LA, Ferroni E (2014) Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 3:Cd001269Google Scholar
  20. 20.
    Moberley S, Holden J, Tatham DP, Andrews RM (2013) Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 1:Cd000422Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Michelle S. Toleman
    • 1
  • Katharine Herbert
    • 1
  • Noel McCarthy
    • 2
  • David N. Church
    • 1
    • 3
    Email author
  1. 1.Oxford Cancer Centre, Churchill HospitalUniversity of OxfordOxfordUK
  2. 2.Warwick Medical SchoolUniversity of WarwickCoventryUK
  3. 3.The Wellcome Trust Centre for Human GeneticsUniversity of OxfordOxfordUK

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