Wu Szu-Yuan, Tung Ho-Jui, Huang Kuang-Hua, Lee Chiachi Bonnie, Tsai Tung-Han, Chang Yu-Chia
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan.
Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan.
Vaccines (Basel). 2022 Jul 19;10(7):1144. doi: 10.3390/vaccines10071144.
In elderly patients with newly diagnosed breast cancer, clarity is lacking regarding the effects of influenza vaccines, particularly on clinical outcomes. This study conducted two nationwide, population-based, and propensity score-matched cohorts to estimate and compare the protective effects of influenza vaccine in elderly women and elderly patients with breast cancer. Data were derived from the National Health Insurance Research Database and Cancer Registry Database. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. Adjusted odds ratios (aORs) were used to estimate the relative risks, and stratified analyses in the breast cancer cohort were performed to further evaluate elderly breast cancer patients undergoing a variety of adjuvant therapies. The GEE analysis showed that the aORs of death and hospitalization, including for influenza and pneumonia, respiratory diseases, respiratory failure, and heart disease, did not significantly decrease in vaccinated elderly patients with newly diagnosed breast cancer. Conversely, the aORs of all influenza-related clinical outcomes were significantly decreased in elderly women. No protective effects of influenza vaccination were found in the elderly patients with a newly diagnosed breast cancer. More studies focusing on identifying strategies to improve the real-world effectiveness of influenza vaccination to the immunocompromised are needed. Our clinical outcomes will be valuable for future public health policy establishment and shared decision making for influenza vaccine use in elderly patients with newly diagnosed breast cancer. According to our findings, regular influenza vaccine administration for elderly patients with newly diagnosed breast cancer may be reconsidered, with potential contraindications for vaccination. On the other hand, implementing the vaccination of close contacts of patients with breast cancer may be a more important strategy for enhancing protection of those fragile patients.
在新诊断出乳腺癌的老年患者中，流感疫苗的效果，尤其是对临床结局的影响尚不明确。本研究进行了两项全国性、基于人群且倾向评分匹配的队列研究，以评估和比较流感疫苗对老年女性和老年乳腺癌患者的保护作用。数据来源于国民健康保险研究数据库和癌症登记数据库。采用广义估计方程（GEEs）比较接种疫苗组和未接种疫苗组的结局。调整后的优势比（aORs）用于估计相对风险，并在乳腺癌队列中进行分层分析，以进一步评估接受各种辅助治疗的老年乳腺癌患者。GEE分析表明，在新诊断出乳腺癌的接种疫苗老年患者中，死亡和住院（包括因流感和肺炎、呼吸道疾病、呼吸衰竭及心脏病）的aORs并未显著降低。相反，老年女性中所有与流感相关临床结局的aORs均显著降低。在新诊断出乳腺癌的老年患者中未发现流感疫苗的保护作用。需要开展更多研究，聚焦于确定提高流感疫苗对免疫功能低下患者实际效果的策略。我们的临床结局对于未来制定公共卫生政策以及为新诊断出乳腺癌的老年患者使用流感疫苗进行共同决策具有重要价值。根据我们的研究结果，对于新诊断出乳腺癌的老年患者，可能需要重新考虑定期接种流感疫苗，并存在潜在的接种禁忌。另一方面，对乳腺癌患者的密切接触者进行疫苗接种可能是加强对这些脆弱患者保护的更重要策略。
