Influenza Vaccination Rates during the First Year after Diagnosis of Diffuse Large B Cell Lymphoma

Objective: Influenza infection is a significant cause of morbidity and mortality in patients with cancer, and thus the National Comprehensive Cancer Network (NCCN) recommends annual influenza vaccination for all individuals with cancer. We sought to examine the documentation rate of influenza vaccination administration, refusal, or discussion of vaccination in the first year after diagnosis of diffuse large B cell lymphoma (DLBCL) for patients across three hospitals in two healthcare systems.

Methods: Medical records were reviewed for 114 patients with a new diagnosis of DLBCL between February 2015 and October 2017 who presented to either Emory St. Joseph Hospital (a community hospital setting), Winship Cancer Institute at Emory University (an academic medical center), or Grady Memorial Hospital (a county hospital). Documentation of administration, refusal, or discussion regarding influenza vaccination by physicians, advanced practice providers, or nursing staff during the period of influenza vaccine availability for the first influenza season after diagnosis was assessed.

Results: Among 114 patients with newly diagnosed DLBCL, 54% were male, and 46% were over 60 years of age with a median age of 59 years (range 21-88 years). One patient was excluded from analysis as she was enrolled in hospice prior to influenza season. Documentation of influenza vaccination status within 1 year of diagnosis of DLBCL was performed for 56% (63/113) of patients. Nearly 75% (47/63) of documentation regarding vaccination was performed by inpatient nursing staff at time of admission. Documentation of influenza vaccination status was performed by the primary oncologist in 4% (5/113) of all cases and 8% of the documented cases respectively (5/63). The county hospital and the academic medical center had higher documentation of vaccination rates (62% [5/8] and 60% [27/45], respectively) compared with the community hospital (50% [5/10]). Of the patients with documentation of influenza vaccination status, vaccine refusal was documented for 41% (26/63) of patients, and counseling regarding the importance of vaccination was not documented for any patient.

Conclusions: Our study shows that documentation of education and administration of influenza vaccination is suboptimal in these 2 healthcare systems. Although vaccinations that occurred outside of these healthcare systems by primary care providers, pharmacies, and other providers would not be recorded in this dataset unless the patient had a hospital admission, these data suggest a gap in patient care and education that could lead to increased risk of worse outcomes from influenza infection. Routine outpatient vaccination screening and counseling in oncology clinics will be explored to improve documentation of influenza vaccination and influenza vaccination rate. Additionally, strategies for sharing patient information about vaccination between providers in different healthcare systems could improve vaccination compliance in patients with lymphoma. Further work is needed to determine the effectiveness of routine influenza vaccination in patients receiving anti-cancer therapy.