Adherence to vaccination recommendations in the adult cancer population.

Abstract

11148 Background: In 2024, the American Society of Clinical Oncology (ASCO) published a strong recommendation that clinicians should ensure that all adults with cancer are up to date on seasonal and age- and risk-based vaccinations. The recommended vaccines are drawn from CDC guidelines and include annual influenza, COVID-19, Tdap, Hepatitis B, Zoster (shingles), and Pneumococcal vaccines for all adults, and RSV and HPV for specific groups. Recent studies have found that patients undergoing treatment for cancer had lower COVID-19 vaccination rates mediated by area-level social determinants of health; to our knowledge, rates of adherence to and mediators of other recommended vaccinations in the adult cancer population have not been adequately quantified. Methods: We used data from the nationally representative National Health Interview Survey (NHIS) from 2019-2023 to evaluate vaccination rates among individuals with a history of cancer. We identified all individuals aged ≥50 with a diagnosis of cancer within the past 5 years and extracted data on self-reported receipt of three vaccines: annual influenza, pneumonia, and shingles vaccinations. We adjusted for age, race, sex, insurance type, education, US census region, metropolitan statistical area, and used ordinal logistic regression to model determinants of greater degrees of vaccination. Results: Between 2019 and 2023, only 30.6% (95% CI [29.3, 31.9]) of all adults aged ≥50 with cancer reported receiving all three studied vaccines. Individually, 69.6% (95% CI [68.2, 71.0]) received the influenza vaccine, 58.4% (95% CI [56.9, 59.9]) received the pneumococcal vaccine, and 42.5% (95% CI [41.0, 44.0]) received the shingles vaccine. The likelihood of receiving more vaccines increased with age (for age 65-74: OR 4.16, CI [3.63, 4.76], p <0.001; for age 75+: OR 5.33, CI 4.62-6.15, p<0.001), whereas variables associated with receiving fewer recommended vaccines included being Hispanic (OR 0.70, CI [0.52, 0.93], p=0.01) or Black (OR 0.61, CI [0.49, 0.77], p<0.001), having Medicaid (OR 0.77, CI [0.63, 0.95], p=0.01), and having high school education or less (OR 0.65, CI [0.59, 0.73], p<0.001). We did not find a significant association between living in a non-metropolitan area and vaccination receipt. Conclusions: Between 2019 and 2023, less than one-third of respondents aged ≥50 years diagnosed with cancer within 5 years reported receiving all three appropriate age-related vaccinations. Race-ethnicity, lower socioeconomic status, and lower education were all associated with receiving fewer of the recommended vaccinations. In order to meet ASCO recommended guidelines, efforts to improve vaccination uptake among adults with cancer may need to include targeted interventions for these at-risk populations.