Fall is quickly approaching, along with the colors it also brings the influenza. For most people influenza is a bother, but for cancer survivors it brings many unique concerns not shared with the general population. It brings serious illness, hospitalizations and possibly death!

During an influenza epidemic, between 21% and 33% of cancer survivors who are hospitalized with respiratory symptoms end up testing positive for influenza. Since cancer patients are weaker the influenza mortality rate is higher than the general population, with reports of between 11% and 33% for patients with cancer.

When you do have influenza not only are you weaker and more susceptible to serious consequences, but your on-going treatments often need to be delayed. Delaying treatment can affect the eventual outcome of the cancer treatment itself.

Also comes the questions, should cancer patients receive the influenza vaccine? Given that many cancer treatments are immunosuppressive, how well does the vaccine really protect cancer patients from getting the flu? How do the new targeted cancer treatments react with the vaccine?

VACANCE Study: Immunogenicity of A/H1N1v

In the 2009 H1N1 influenza outbreak this concern was expressed for immune-compromised patients, including cancer survivors on immune-suppressant treatments.

The immunogenicity and safety of the A/H1N1v vaccine was examined in the VACANCE study, which was a prospective, open-label study. The study vaccinated 65 cancer patients with two doses. The first dose was given on Day 7 of chemotherapy for those receiving chemotherapy every 2 or 3 weeks, and the second dose was given 3 weeks later. When baseline antibody titers against A/H1N1v were measured on Day 1, 5% of the patients had antibody titers ?1:40. At Day 21, 44% of patients had an immune response to the vaccine, while 72.7% of the patients did at Day 42. Side effects and reactions to the vaccine were all mild to moderate. The authors concluded that two doses of influenza vaccine are needed for most cancer patients, though those receiving targeted therapies had satisfying results after one dose.

It has been suggested that because cancer patients are immune-compromised, several strategies may be helpful:

1- Patients actively receiving chemotherapy have their vaccinations at the furthest possible time point away from treatment in a given cycle.

2- An influenza vaccination series with two shots may be more beneficial for cancer patients to compensate for their depressed immune system.

3- All household contacts should be vaccinated to limit the actual exposure to the illness

These guidelines should be considered for all men with advanced prostate cancer. Have a vaccination, have all your family members have a vaccine, if you are on an active treatment that is suppressing your immune system have the vaccine timed to be as far as possible from the treatment and consider doubling the shots.

Health care providers should also keep in mind that all live vaccines are contraindicated in patients receiving cancer therapy and within 6 months of its end, and the killed influenza vaccine should be administered as an alternative.

Joel T. Nowak, M.A., M.S.W.