Influenza vaccination for terminally ill cancer patients receiving palliative care: A preliminary report

Context: Cancer patients have impaired humoral and cellular immunity, and are more susceptible to infections; their immunological response is expected to be less effective than that of healthy people. Objectives: To assess the immune response to influenza vaccine in terminally ill cancer patients in a home palliative care unit. Methods: During the fall of 2000-2001, 2005-2006, and 2006-2007, terminally ill cancer patients treated by our home palliative care unit were vaccinated against influenza with Vaxigrip®. Blood samples were taken before and four weeks after vaccination. Influenza immunological response parameters accepted in the literature were calculated. Results: Eighteen terminal cancer patients were vaccinated against influenza strains predicted for that year; 13 completed the study. The other five patients died within less than a month from the time of vaccination. The serum protection rate increased from 15.4% before to 61.5% after vaccination, and the serum response rate was 53.8% for all the three strains of vaccination. Mean-fold increase was 24.9 for influenza A-H1N1, 15.4 for influenza A-H3N2, and 2.8 for influenza B. Geometric mean titer was increased for influenza A-H3N2 from 8.3 before vaccination to 159.4 after vaccination; for influenza A-H1N1 from 5.2 to 124.3, and for influenza B from 5.7 to 44.6. Conclusion: The results indicate that influenza vaccination is probably effective and can be offered to terminally ill cancer patients with a life expectancy of about three months in a home care palliative care unit.