Vaccine Hesitancy in Patients With Solid Tumors: You Can Improve the Situation
—A recent survey revealed factors driving vaccine acceptance—or hesitancy—in a group of cancer patients, highlighting the importance of vaccine counseling by the oncologist.
The use of certain vaccinations throughout life has been shown to reduce the spread of vaccine-preventable diseases (VPDs) and to mitigate disease burden on both the individual and the health care system.1 However, according to the investigators of a newly published study on vaccine hesitancy among patients with solid tumors, vaccination rates in this population remain suboptimal despite the fact that these patients have regular interaction with the healthcare system.2 The investigators note that patients undergoing cancer treatment are at increased risk for complications from VPDs and may need to suspend oncological treatment—increasing their risk for hospitalization—if they contract a VPD. Talking to cancer patients about vaccination is complicated by patient concerns over their possible impact on their cancer therapies or on the cancer itself.2
For this prospective, cross-sectional survey, Lasagna and colleagues surveyed 309 patients with a median age of 67 years (range: 59-79 years) actively undergoing oncological cancer treatment between February 12–March 1, 2024, at the Medical Oncology Unit at Fondazione IRCCS Policlinico San Matteo, in Pavia, Italy.
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The investigators aimed to understand attitudes toward vaccine acceptance among cancer patients and the factors influencing their choices. The goal was to provide more information to clinicians so they can better support their patients’ vaccination decisions. Evaluating the proportion of vaccinated cancer patients in the cohort was the primary study endpoint. Secondary endpoints included analyzing the proportion of vaccination against specific VPDs: flu, SARS-CoV-2, pneumococcal disease, and Herpes Zoster (HZ). Patients who agreed to answer the survey did so anonymously, not in the presence of their oncologist, and the survey itself was a closed-form survey. Thus, patients were unaware of the nature of the survey, with the goal of avoiding selection bias by having only those more aware of vaccinations answering the survey.2
The investigators determined that 273 patients received at least 1 vaccination (0.88, 95% confidence interval [CI] 0.84–0.91). Of the surveyed patients, 231 (74.76%) indicated that their oncologist recommended vaccination at their first oncology visit, mostly for flu (92.21%) and SARS-CoV-2 (83.55%). Vaccinations for pneumococcal disease (42.42%) and HZ (37%) were less frequently recommended at the first oncology visit. Vaccine acceptance, measured by univariate analysis, was significantly associated with age over 75 years (P=.041), marital status (P=.003), and the oncologist’s vaccine recommendation during the first visit (P<.001). In a multivariable analysis, vaccine willingness was independently associated with these variables.2
A lack of oncologist recommendation (55.41%, n=128) and a lack of awareness of vaccination importance in the context of oncological care (49.35%, n=114) were the primary reasons for vaccine hesitancy among this population. Comorbidities, treatment type, and cancer type were not significantly associated with vaccine acceptance in general.2
For the secondary endpoints, the researchers noted that “[t]he only variable that confirms the statistically significant associations for all four vaccines is the oncologist’s vaccine counseling. (P<.001).” Age over 75 years was associated with vaccine acceptance for the flu and HZ vaccines (P=.004 and P<.001, respectively), while sex was associated with vaccine acceptance for the SARS-CoV-2 vaccine (P=.006). Finally, comorbidities did play a part with acceptance for the HZ vaccine, but the authors wrote that patients “tend not to get it because their treating oncology rarely recommends it or because the patient himself does not consider it indispensable while receiving oncological treatments.”2
The single-center survey design of the study is a limitation since the generalizability of the study results is affected by selection bias. Also, future trends may not be reflected in this cross-sectional study. A potential bias stemming from oncologists being involved in explaining the survey to patients also existed, since patient responses may have been influenced by wanting to please their oncologist.2
“To our knowledge, this is the first survey to investigate the acceptability of four different types of vaccines among cancer patients,” the authors wrote. “Overall in our cancer population, the two main reasons for vaccine hesitancy were represented by the lack of recommendation by the oncologist and the lack of awareness of the importance of vaccination in the context of oncological care.” But oncologists, the researchers concluded, hold considerable influence when patients are weighing the importance of vaccination against their apprehensions. They can help motivate patients to receive appropriate vaccines “by addressing doubts and concerns about the potential negative impact of the vaccine on cancer and cancer therapies.”
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