Eighteen million American adults are currently living with a diagnosis of cancer. In addition to the challenges inherent to cancer treatment and survivorship, the disease- and treatment-related immunosuppression experienced by many patients with cancer increases their risk of morbidity and mortality when exposed to viral or bacterial pathogens. For example, patients with cancer who contract influenza are more likely to experience complications, require hospitalization, or die when hospitalized than otherwise healthy individuals.

Vaccination is a cornerstone of helping to prevent infection in patients with cancer and is recommended by national and international organizations such as the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Spanish Society of Medical Oncology. However, vaccination rates in patients with cancer remain suboptimal, resulting in avoidable healthcare costs, treatment delays, and diminished outcomes. These coverage gaps can be attributed to a range of patient, provider, and health system factors, including:

• Vaccine hesitancy (fueled by misinformation and inadequate provider-patient communication)
• Fragmented care delivery
• Limited awareness of vaccination guidelines
• Complex and inconsistent reimbursement structures

Adequate immunization against vaccine-preventable diseases remains a significant public health issue,1-3 particularly for individuals whose immune defenses are compromised.2,3 A recent analysis of 2021 National Health Interview Survey data indicates that 6.6% of adults in the US—roughly 17 million people—may be immunocompromised.4,5 Patients with cancer represent a sizeable proportion of this high-risk group.6-8

As of January 2022, the American Cancer Society estimated that 18 million American adults were living with a history of cancer, including approximately 5 million individuals who were within 5 years of diagnosis.9 An analysis of US cancer and mortality statistics from the Surveillance, Epidemiology, and End Results registries projected that more than 690,000 Americans would be living with metastatic breast, prostate, lung, colorectal, melanoma, or bladder cancer by January 2025.10

The immune defenses of these individuals can be weakened in a variety of ways— encompassing both the disease process and its treatment—that can persist for months or even years after treatment has been completed.11,12 The impact of these deficits is evident in the increased morbidity and mortality experienced by cancer patients who contract vaccine-preventable respiratory diseases:

• Individuals living with cancer may be 3 to 10 times more likely to be hospitalized with influenza-related infections (depending on age) and up to 10 times more likely to die while hospitalized than the general population.13,14
• In patients with recently diagnosed cancer, SARS-CoV-2 infection was associated with a 7-fold increase in death.15
• Compared with the general population of healthy adults, patients with hematological cancers or solid tumors have been found to have a 38-fold and 23fold higher risk, respectively, of invasive pneumococcal disease (IPD).16 Patients with multiple myeloma have been reported to have a 62.8 times greater risk.17

The disproportionate impact of these conditions on patients with cancer illustrates the unique vulnerability of this group to infectious diseases and the importance of vaccines in protecting this vulnerable population.11,18 In this white paper, we will explore the potential of vaccinations to help reduce the morbidity, mortality, and healthcare costs associated with vaccine-preventable diseases in patients with cancer and cancer survivors, with a focus on:

• How cancer and its treatment increase the risk of both contracting vaccinepreventable diseases and experiencing adverse outcomes—during and after treatment
• Current vaccine recommendations for patients with cancer from NCCN and ASCO
• Gaps in vaccine coverage of cancer patients and survivors
• Evidence-based strategies to optimize vaccination and minimize infectious disease risk in cancer patients, including vaccination of healthcare providers and household contacts
• Actionable recommendations for key stakeholders and decision makers

It is noteworthy that despite wide recognition that patients with cancer are at high risk of vaccinepreventable diseases, these authors found that limited data are available on vaccine coverage, benefits, and barriers specific to patients with cancer in the United States. This gap underscores both the need for greater awareness of the role of vaccines in the care of patients with cancer and the need for more research on optimizing vaccine coverage in the US.

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