Skip to main content

Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center

Journal of Cancer Education volume 32, pages 871–877 (2017)Cite this article

Abstract

Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011–2012 and 2012–2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005–2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011–2012) and 9.4 % (2012–2013) compared to an average 6.9 % during influenza seasons 2005–2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35–40.3 %) and 56.1 % (95 % CI 40.9–73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012–2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. (2010) Estimates of deaths associated with seasonal influenza—United States, 1976-2007. MMWR Morb Mortal Wkly Rep 59(33):1057–1062

  2. Molinari NA, Ortega-Sanchez IR, Messonnier ML et al (2007) The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 25(27):5086–5096

    Article  PubMed  Google Scholar 

  3. Francisci D, Labianca R, Roila F (2010) Prevention and treatment of pandemic influenza in cancer patients. Ann Oncol 21(12):2301–2303

    CAS  Article  PubMed  Google Scholar 

  4. Casper C, Englund J, Boeckh M (2010) How I treat influenza in patients with hematologic malignancies. Blood 115(7):1331–1342

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 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):618–628

    Article  PubMed  Google Scholar 

  6. Kunisaki KM, Janoff EN (2009) Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis 9(8):493–504

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nichol KL (2008) Efficacy and effectiveness of influenza vaccination. Vaccine 26(Suppl 4):D17–D22

    CAS  Article  PubMed  Google Scholar 

  8. Baluch A, Pasikhova Y (2013) Influenza vaccination in oncology patients. Curr Infect Dis Rep 15(6):486–490

    Article  PubMed  Google Scholar 

  9. Mariotti J, Spina F, Carniti C et al (2012) Long-term patterns of humoral and cellular response after vaccination against influenza A (H1N1) in patients with hematologic malignancies. Eur J Haematol 89(2):111–119

    CAS  Article  PubMed  Google Scholar 

  10. Nordoy T, Aaberge IS, Husebekk A et al (2002) Cancer patients undergoing chemotherapy show adequate serological response to vaccinations against influenza virus and Streptococcus pneumoniae. Med Oncol 19(2):71–78

    Article  PubMed  Google Scholar 

  11. Pollyea DA, Brown JM, Horning SJ (2010) Utility of influenza vaccination for oncology patients. J Clin Oncol 28(14):2481–2490

    Article  PubMed  Google Scholar 

  12. (2012) Prevention and control of influenza with vaccines: recommendations of the advisory committee on immunization practices (ACIP)—United States, 2012–13 influenza season. MMWR Morb Mortal Wkly Rep 61:613–618

  13. 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):1658

    CAS  Article  PubMed  Google Scholar 

  14. 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):542–543

    CAS  PubMed  Google Scholar 

  15. Hull S, Hagdrup N, Hart B, Griffiths C, Hennessy E (2002) Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice. Br J Gen Pract 52(482):712–716

    PubMed  PubMed Central  Google Scholar 

  16. Kwong JC, Stukel TA, Lim J et al (2008) The effect of universal influenza immunization on mortality and health care use. PLoS Med 5(10):e211

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S (2012) Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA 307(16):1702–1708

    CAS  Article  PubMed  Google Scholar 

  18. Moniz MH, Hasley S, Meyn LA, Beigi RH (2013) Improving influenza vaccination rates in pregnancy through text messaging: a randomized controlled trial. Obstet Gynecol 121(4):734–740

    Article  PubMed  Google Scholar 

  19. Dombkowski KJ, Harrington LB, Dong S, Clark SJ (2012) Seasonal influenza vaccination reminders for children with high-risk conditions: a registry-based randomized trial. Am J Prev Med 42(1):71–75

    Article  PubMed  Google Scholar 

  20. Duncan IG, Taitel MS, Zhang J, Kirkham HS (2012) Planning influenza vaccination programs: a cost benefit model. Cost Eff Resour Alloc 10(1):10

    Article  PubMed  PubMed Central  Google Scholar 

  21. FluView: a weekly influenza surveillance report prepared by the influenza division. Accessed 2 July 2013

  22. Earle CC (2003) Influenza vaccination in elderly patients with advanced colorectal cancer. J Clin Oncol 21(6):1161–1166

    Article  PubMed  Google Scholar 

  23. Machado CM, Cardoso MR, da Rocha IF, Boas LS, Dulley FL, Pannuti CS (2005) The benefit of influenza vaccination after bone marrow transplantation. Bone Marrow Transplant 36(10):897–900

    CAS  Article  PubMed  Google Scholar 

  24. Musto P, Carotenuto M (1997) Vaccination against influenza in multiple myeloma. Br J Haematol 97(2):505–506

    CAS  PubMed  Google Scholar 

  25. Vinograd I, Eliakim-Raz N, Farbman L et al (2013) Clinical effectiveness of seasonal influenza vaccine among adult cancer patients. Cancer

Download references

Acknowledgments

We thank the UMCCC patients and families, administrators and leaders, health care providers, nurses, nursing managers, medical assistants, clerks, and social media managers for their significant contributions in implementing the intervention steps. We thank Gary Jankowski and Harriet Kramer (MCIT) and Kent Griffith (Department of Biostatistics) for their assistance with the data collection and analysis. We also specially thank Drs. Alissa Weber, Raymond Esper, Sadakatsu Ikeda, Binu Malhotra, Dawit Aregawi, and Arnold Monto, as well as Felicia Hurst, Louise Salamin, and Joann Sherman, for their critical input in this project.

Author information

Author notes

    Affiliations

    1. Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA

      Petros D. Grivas

    2. Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA

      Sumana Devata, Rami Khoriaty, Jeffrey Smerage, Kathleen A. Cooney & Francis P. Worden

    3. University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

      Rami Khoriaty, Jeffrey Smerage, Kathleen A. Cooney & Francis P. Worden

    4. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

      Philip S. Boonstra

    5. Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA

      Joshua Ruch

    6. Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA

      Kevin McDonnell

    7. Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA

      Leonel Hernandez-Aya

    8. Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA

      Joshua Wilfong

    9. Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

      Michael G. Ison

    10. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

      Joseph N. S. Eisenberg

    11. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

      Maria Silveira

    12. Department of Urology, University of Michigan, Ann Arbor, MI, USA

      Kathleen A. Cooney

    Authors
    1. Petros D. Grivas
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Sumana Devata
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Rami Khoriaty
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Philip S. Boonstra
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Joshua Ruch
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Kevin McDonnell
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Leonel Hernandez-Aya
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Joshua Wilfong
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Jeffrey Smerage
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Michael G. Ison
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Joseph N. S. Eisenberg
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Maria Silveira
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Kathleen A. Cooney
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Francis P. Worden
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Petros D. Grivas.

    Ethics declarations

    The Institutional Review Board of the University of Michigan granted a waiver to conduct this QI project for the ’11–’12 and ’12–’13 seasons. This project was conducted according to institutional policies and medical ethics. The intervention was implemented across the entire UMCCC population as excluding patients may have been considered unethical.

    Funding

    There was no external funding.

    Additional information

    Petros D. Grivas and Sumana Devata are co-first authors.

    Petros D. Grivas and Sumana Devata contributed equally to this work.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    ESM 1

    (DOCX 338 kb)

    Rights and permissions

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Cite this article

    Grivas, P.D., Devata, S., Khoriaty, R. et al. Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center. J Canc Educ 32, 871–877 (2017). https://doi.org/10.1007/s13187-016-1017-2

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s13187-016-1017-2

    Keywords

    • Influenza
    • Quality improvement
    • Vaccine
    • Immunization
    • Cancer center