Vaccination of chemotherapy patients – effect of guideline implementation


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Michelle Toleman1, Noel McCarthy2, David Church1
1Oxford Cancer Centre, Oxford, UK, 2Public Health England, Didcot, UK

Background

Cancer patients treated with chemotherapy are at increased risk of contracting influenza and Streptococcus pneumoniae and have higher rates of complications from infection. The DH recommend seasonal influenza and a single pneumococcal vaccination for patients due cytotoxic chemotherapy, and evidence demonstrates that these vaccines are safe and effective during treatment. However, anecdotal investigation in our institution suggested that vaccination uptake was variable. We performed a prospective audit before and after the implementation of clinical guidelines to evaluate this.

Method

An anonymous questionnaire was given to chemotherapy patients on the Day Treatment Unit in January 2012 (responses: 72).To improve vaccination uptake, we developed clinical guidelines, a summary poster for clinic rooms, and a GP letter. These were publicised within the Cancer Centre and the audit repeated in January 2013 following implementation (responses: 88).

Results

We found a substantial and significant improvement in the rate of pneumococcal vaccination from a low baseline following guideline implementation (47% vs. 25%, p=0.0018), though no increase in uptake of influenza vaccine was demonstrated from a relatively high baseline level (72% vs. 68%, p=NS). There was also an increase in the proportion of patients who recalled advice from their oncologist regarding immunisation (46% vs. 25%, p=0.016). We found a disparity in the frequency of vaccination between patients aged <65 vs. those ≥65 for pneumococcal vaccination (30% 70%, p =0.0005) and a trend to similar findings influenza immunisation (62.5% 82.5%,>

Conclusion

An intervention of local guidelines, clinician education and a GP letter was associated with an improvement in pneumococcal vaccination uptake in chemotherapy patients, though no increase in the frequency of influenza immunization was evident. Our results are comparable with the rate of national uptake of seasonal vaccinations in high-risk patients (≥65/at risk) nationally in 2011-2012 (74%). However, vaccination uptake in patients aged <65 who are not routinely invited by GPs remains poor. Further work is needed to improve vaccination of chemotherapy patients overall, and particularly those <65.