Cancer Patients Miss Routine Vaccinations in PCP-Specialist Gap

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA