Vaccination Recommendations Against Infections for Adults With Cancer

Infections are the second most common cause of noncancer deaths during the first year after a cancer diagnosis. The leading cause of noncancer death is cardiovascular events. This highlights the need for oncologists to ensure that patients remain up to date with their core vaccinations. Guidelines published by the American Society of Clinical Oncology (ASCO) provide guidance on vaccinating patients with cancer and their household members. Protection against infection is particularly vital for people receiving cancer treatment because their immune systems are weakened.

The updated ASCO guideline on vaccination for adults with cancer considered the following:

• The expert panel developing this updated vaccination guideline reviewed the available evidence and made recommendations for vaccinating adults with solid tumors (originating in tissues or organs) or cancers originating in blood or bone marrow. This included patients receiving hematopoietic stem cell transplantation (HSCT), chimeric antigen receptor T-cell (CAR T-cell) therapy, and B-cell-depleting therapy. Guidance was also provided on vaccinating patients' household members and contacts.
• The panel reviewed 102 publications, including 24 systematic reviews, 14 randomized controlled trials, and 64 nonrandomized studies.
• Vaccines evaluated included COVID-19, influenza, hepatitis A and B, respiratory syncytial virus (RSV), Tdap (tetanus, diphtheria, pertussis), human papillomavirus (HPV), inactivated polio, and rabies vaccines.
• The authors noted that patients' underlying immune status and cancer treatments may affect vaccination and revaccination strategies compared with recommendations for the general adult population without cancer.

Vaccines and Specific Recommendations

The first step is to establish vaccination status and ensure that newly diagnosed adults with cancer (and their family members) are up to date with seasonal and age- or risk-based vaccines before cancer treatment begins. If vaccinations are missing, patients should ideally receive them 2-4 weeks before starting cancer treatment; however, non-live vaccines may be given during or after treatment.

COVID-19 Vaccine

Non-live (inactivated) vaccine.

COVID-19 has posed a major threat to public health worldwide. All patients with cancer and their household members should receive the seasonal COVID-19 vaccine.

After HSCT or CAR T-cell therapy, patients should receive a COVID-19 vaccine at least 3 months after completing treatment. Patients receiving B-cell-depleting therapy should be reassessed for COVID-19 vaccination at least 6 months after completing treatment.

Influenza (Flu) Vaccine

Both live (nasal spray) and inactivated (injected) forms are available. The inactivated form is generally recommended for patients with cancer. The inactivated form is available in Turkey.

Influenza can cause serious complications in patients with cancer. All patients with cancer and their household members should receive an annual flu vaccine.

After HSCT or CAR T-cell therapy, patients may receive a flu vaccine at least 3 months after completing treatment.

Shingles Vaccine

Shingles (herpes zoster) is a disease characterized by a painful rash that occurs when the immune system is weakened. Patients with cancer have a 3-9-fold higher risk of shingles than the general population, particularly during chemotherapy and immunosuppressive treatment. The recombinant zoster vaccine (RZV) is therefore recommended as an important means of protection for patients with cancer. A non-live vaccine, RZV has an established efficacy and safety profile. Ideally, it may be given before or during cancer treatment and is highly successful at preventing shingles and complications such as postherpetic neuralgia. Recommending the shingles vaccine to patients is therefore a critical step oncologists can take in infection control.

Hepatitis A and B Vaccines

Inactivated vaccine.

Hepatitis A and B are viruses that cause liver infections. Patients with cancer and their household members should receive hepatitis A and B vaccines; these become particularly important when assessing risk before travel.

Respiratory Syncytial Virus (RSV) Vaccine

Inactivated vaccine. Not yet available in Turkey.

RSV is a virus that can be dangerous, particularly for young children and people with weakened immune systems.

There is currently no general recommendation for RSV vaccination in patients with cancer, but future vaccine studies are important for people at risk.

Tdap (Tetanus, Diphtheria, Pertussis) Vaccine

Inactivated vaccine.

The Tdap vaccine protects against tetanus, diphtheria, and pertussis. Patients with cancer and their household members should follow the recommended Tdap vaccination schedule.

Human Papillomavirus (HPV) Vaccine

Inactivated vaccine.

HPV is a virus that can cause certain cancers. The HPV vaccine is particularly important for young adults and people at risk. Patients with cancer are advised to discuss with their doctors whether they can receive the HPV vaccine.

Inactivated Polio Vaccine

Polio is a virus that can cause severe paralysis. Patients with cancer and their household members should receive the inactivated polio vaccine, particularly according to the risk in the region they plan to visit.

Rabies Vaccine

Inactivated vaccine.

Rabies can be fatal. Patients with cancer should receive a rabies vaccine, particularly if traveling to high-risk regions where they may come into contact with animals.

In Practice

Vaccinating patients with cancer and their household members reduces infection risk and may improve the success of cancer treatment. Clinical specialists should inform and guide patients and caregivers about vaccination. Access to accurate and current information is vital in this process.

The importance of vaccination as a strategy to protect against infections during cancer care cannot be overlooked. ASCO's guidelines provide the latest information in this area, guiding both health professionals and patients with cancer. This comprehensive approach emphasizes the importance of a holistic perspective on cancer care and helps protect patients' overall health.