University of Western Ontario, London, Ontario, Canada.
London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
J Clin Oncol. 2019 Oct 20;37(30):2795-2804. doi: 10.1200/JCO.19.00354. Epub 2019 Aug 29.
Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer.
We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time.
We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies ( .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer.
Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
尽管存在疾病或治疗相关免疫抑制的担忧，但癌症患者仍被推荐接种季节性流感疫苗。本研究的目的是评估癌症患者接种流感疫苗对实验室确诊流感的疫苗有效性（VE）。
我们对 2010-2011 至 2015-2016 流感季节期间在加拿大安大略省接受流感检测的年龄在 18 岁及以上的已确诊癌症患者进行了一项观察性的病例对照设计研究。我们将个体层面的癌症登记、呼吸道病毒检测和健康管理数据进行了链接，以确定研究人群和结局。疫苗接种情况通过医生和药剂师的计费记录来确定。我们使用多变量逻辑回归来估计 VE，调整了年龄、性别、农村/城市比例、收入五分位数、癌症特征、化疗暴露、合并症、既往医疗保健使用、流感季节和日历时间。
我们确定了 26463 名接受流感检测的癌症患者，其中 4320 例为检测阳性（16%），11783 例（45%）接种了疫苗。平均年龄为 70 岁，52%为男性，平均确诊后时间为 6 年，69%为实体瘤恶性肿瘤，23%接受了活性化疗。实验室确诊流感的 VE 为 21%（95% CI，15%至 26%），实验室确诊流感住院的 VE 为 20%（95% CI，13%至 26%）。对于实体瘤恶性肿瘤患者，VE 为 25%（95% CI，18%至 31%），而对于血液恶性肿瘤患者，VE 为 8%（95% CI，-5%至 19%）（P<.015）。活性化疗的使用并未显著影响 VE，尤其是对于实体瘤癌症患者。
我们的结果支持为癌症患者接种流感疫苗的建议。血液恶性肿瘤患者的 VE 降低，而接受活性化疗的实体瘤癌症患者的 VE 没有显著差异。需要制定策略来优化癌症患者的流感预防。
