The often-compromised immune systems of patients with cancer put them at heightened risk for infection, highlighting the need for oncologists to partner with primary care providers to obtain vaccine history and address intervention for vaccine-preventable diseases. The American Society of Clinical Oncology (ASCO) has engaged with the Centers for Disease Control and Prevention, Council of Medical Specialty Societies, and other professional organizations to improve vaccination rates among patients with cancer. As part of this agreement, a new ASCO vaccination guideline was published in March 2024 to provide recommendations for optimizing vaccination status among patients with cancer, specifically for adults with solid tumors or hematologic malignancies.
The guideline includes recommended vaccines and revaccinations for patients with cancer, as well as timing for those vaccines. The recommended immunizations for adults with cancer include influenza (annually); respiratory syncytial virus; COVID-19; tetanus and diphtheria or tetanus, diphtheria, and pertussis; hepatitis B; recombinant zoster vaccine; pneumococcal vaccine; and human papillomavirus. Additional vaccinations and revaccinations are recommended for adults undergoing hematopoietic stem cell transplantation (HSCT), CD19 chimeric antigen receptor (CAR) T-cell treatment, or B-cell–depleting therapy, as well as for adults with cancer who are traveling outside the United States. There is also guidance for vaccinations for household and close contacts of adults with cancer.
Implementing these recommendations will require documentation of vaccination status at the time of the first patient visit; alignment of revaccination after HSCT, CAR T therapy, or B-cell–depleting treatments; active partnerships with patients’ primary care providers, pharmacists, and nursing colleagues; patient education to overcome vaccine hesitancy and common misconceptions; and emphasis on vaccination of household contacts and caregivers.
High level
This ASCO vaccination guideline emphasizes the importance of vaccines in preventing severe disease and enhancing cancer-related outcomes by reducing infection-related complications. Implementation of a vaccination protocol can help optimize vaccination status among patients with cancer. Looking to the future, more research is needed to better understand the mechanisms and remedies for acute and chronic immunocompromised conditions in patients with cancer and into how the immune system processes and responds to vaccine and disease exposure in this patient population.
Ground level
The ASCO vaccination guideline recommends administration of vaccines before starting cancer treatment to give patients the best protection from infection-related complications. Clinicians play a critical role as the vaccine resource for patients, and open communication is essential. To optimize vaccination status among patients with cancer, clinicians should assess a patient’s need for vaccination, attitudes and beliefs around vaccination, and potential barriers when developing individualized approaches to care. Education on the potential benefits and risks of recommended vaccinations can help support better outcomes.
