Recommended Vaccinations for Adult Cancer Patients
Adult cancer patients should receive multiple vaccinations including influenza, pneumococcal, COVID-19, recombinant zoster, tetanus/diphtheria/pertussis, human papillomavirus, and meningococcal vaccines based on their specific risk factors to reduce morbidity and mortality from preventable infections. 1
Core Vaccinations for All Adult Cancer Patients
Influenza vaccine: Annual vaccination with inactivated influenza vaccine is recommended for all cancer patients. Only inactivated vaccines should be used as live attenuated influenza vaccines are contraindicated in immunocompromised patients. 1, 2
Pneumococcal vaccine: The pneumococcal conjugate vaccine (PCV20) should be administered to adults newly diagnosed with cancer who are pneumococcal vaccine-naïve. Alternatively, PCV15 can be given, followed by pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later. 1
COVID-19 vaccine: All persons with cancer, or who have been previously treated for cancer, should receive COVID-19 vaccination according to the latest CDC schedule for immunocompromised individuals. For those who have recently had COVID-19 infection, postpone vaccination for 2-3 months. 1, 3
Recombinant zoster vaccine (RZV): Recommended for adult patients aged ≥50 years and those ≥18 years who are at increased risk for herpes zoster. The RZV vaccine is given in 2 doses ≥2–6 months apart. 1
Tetanus/diphtheria/pertussis (Tdap): Given every 10 years. One dose of Tdap, followed by Td or Tdap booster every 10 years. 1
Additional Vaccinations Based on Risk Factors
Human papillomavirus (HPV) vaccine: Should be offered to patients of all sexes up to 26 years of age and may be considered in patients up to 45 years of age. Administered as a 3-dose series (0,1-2,6 months). 1
Meningococcal vaccine: Recommended for patients at increased risk for meningococcal disease including those with persistent complement component deficiencies, those taking complement inhibitors (e.g., eculizumab, ravulizumab), or those with anatomic or functional asplenia. Both quadrivalent MenACWY vaccine series and monovalent meningococcal serogroup B vaccine series should be administered. 1
Hepatitis B vaccine: Recommended for adults 19-59 years and those 60 years and older with risk factors. For adults 20 years and older, use high antigen (40 mg) formulation administered as a three-dose or four-dose series. 1
Respiratory syncytial virus (RSV) vaccine: Approved for those ≥60 years, though its effectiveness in cancer patients is unknown. 1
Timing of Vaccination
Optimal timing for vaccination is before starting cancer treatment whenever possible. 1, 4
If vaccination before treatment initiation is not possible, vaccines should be administered early in the treatment process. 1
For influenza vaccination during chemotherapy, evidence suggests that administration on day 1 of chemotherapy may be preferable to day 11 due to reduced risk of adverse effects (13% vs. 32%), while maintaining similar seroprotection rates. 1
For patients undergoing hematopoietic stem cell transplantation (HSCT), influenza vaccination response seems to be best if vaccinated >6 months after transplantation. 1
Special Considerations
Live vaccines (including live attenuated influenza vaccine) should be avoided in immunocompromised cancer patients. 1
Vaccination of household contacts and healthcare providers is strongly recommended to provide additional protection through herd immunity. 1, 4
Patients with cancer may have a suboptimal serologic response to vaccination due to disease- or treatment-related immunosuppression, but vaccination still provides significant clinical benefit in reducing infection severity, hospitalizations, and mortality. 1, 5
Physician recommendation, especially from the oncologist, is a strong predictor of vaccination compliance among cancer patients (OR 10.7,95% CI 5.4-21.2). 6
Implementation Strategies
Document vaccination status at the first patient visit to identify patients who need vaccinations. 1
Align revaccination after HSCT, CAR-T therapy, or B-cell–depleting treatments with the expected time of immune reconstitution. 1
Partner with primary care providers, pharmacists, and nursing colleagues to collect and respond to vaccination data. 1, 4
Provide patient education to overcome vaccine hesitancy and misconceptions related to vaccine use during cancer treatment. 1, 4