Microsoft word - immunizations.docx

Immunizations Facts for Adult Cancer patients
Should cancer patients get immunizations?

Yes. Patients with cancer are often at increased risk to get the very infections that immunizations aim
to prevent. Those patients receiving radiation, chemotherapy, or other treatments that lower immunity are at an even greater risk, and immunizations may help protect from infectious diseases. • Ideal y patients with cancer would receive their immunizations prior to starting treatments like radiation or chemotherapy. However, cancer treatments should not be delayed just to administer

• Patients may receive some immunizations during their cancer treatments. The effectiveness of those
immunizations given during treatment (i.e., whether or not they wil work) is not always known. • While the ideal time for patients on chemotherapy to get vaccinated is not known, most physicians prefer to administer immunizations when a patient’s immune system is best recovered from the last dose of treatment. What immunizations should cancer patients receive?

• Most adult cancer patients over 50 should receive immunizations for pneumonia (pneumococcus) and
influenza (flu). Younger cancer patients should receive influenza vaccine and may benefit from
pneumonia immunization as wel .

• Other immunizations should be specifical y discussed with your oncologist.

• Influenza immunizations are given once a year (usual y in Autumn). Only the injection (flu shot) is

• The true effectiveness of flu shots administered during cancer treatment is uncertain. However, most
providers feel it is better for patients to receive the flu shot prior to influenza season rather than waiting until their treatment has been completed.
• New ACIP guidelines for pneumonia vaccine in cancer patients advise:
o Patients who have previously received the traditional pneumonia vaccine (PPSV23) should be given a single dose of a new pneumonia shot (PCV13), provided it has been at least one year since the first immunization.
o For cancer patients who have never received any pneumonia vaccine, they should first receive
a shot with PCV13, fol owed by a dose of PPSV23 at least 8 weeks later.
o Pneumonia immunizations are general y repeated once every 5 years
What immunizations should cancer patients avoid?

• Many cancers (and treatments for cancer) can severely weaken a patient’s immune system. This can make some immunizations potential y dangerous for these patients. • Patients with weakened immune systems due to their cancer or their cancer treatments should not receive any LIVE immunizations, including :
o Intranasal Influenza (e.g., Flumist). Traditional flu shots are fine. o Varicel a (chickenpox) o Zoster (Shingles) o Measles, Mumps, and rubel a (MMR) o Other less common vaccines like Typhoid, Yel ow Fever, etc. • Patients can consider receiving these immunizations 3-6 months after completing treatments depending on the type of cancer they have, remission status, and the status of their immune system at the time. • The decision to receive any of these immunizations should be discussed with the patient’s cancer doctor (oncologist) prior to administration.
Are there any unique circumstances to know about?

• Patients who have had their spleen removed (or may undergo surgery to remove the spleen) are at
risk for specific infections as a consequence. These patients should receive 3 specific vaccines
o Haemophilus influenza o Streptococcus pneumonia (pneumonia) o Neisseria meningitides (bacterial meningitis) • Patients who have received the drug Rituxan (rituximab) may have prolonged difficulty mounting a sufficient response to immunizations due to the drug’s effect on their immune system. In spite of this possibility, these patients should stil receive immunizations once their chemotherapy is completed. • Patients on chronic immune-suppressing treatment (like many cancer patients) should also avoid any live viral immunizations (see section above). Drugs in this category include : o Prednisone, dexamethasone, and other steroids o Cyclosporine (Sandimmune, Neoral, Gengraf) o Tacrolimus (FK506, Prograf) o Azothioprine o Mycophenolate mofetil (Cel cCept) • Patients with liver cancer may want to receive vaccinations against viral hepatitis A and hepatitis B. • Patients who have undergone intense chemotherapy for aggressive blood cancers like leukemia or lymphoma (or patients who have undergone a bone marrow transplant) may want to avoid immunizations until their immune systems are recovered. Their doctor(s) may prefer they take anti-viral medications to prevent infection rather than attempting to immunize.


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