“Oncology patients have a 3 times higher risk of dying from infections than a patient who does not have cancer. This is the first fact that the oncologist should have in mind.” Furthermore, “the risk of having bacterial superinfections has also tripled which”, with the problem “at a global level of resistance to common antibiotics”, proves to be “a very important issue”, above all because “we must consider that a third of the infections that have our patients are caused by these multi-resistant germs.” Angioletta Lasagna, oncologist at San Matteo di Pavia, said this while participating in the event on ‘Vaccinations in cancer patients’ by the Aiom Foundation, the Italian Association of Medical Oncology, organized online with the unconditional support of GSK.
“Vaccination – explains Lasagna – prevents a cascade of events including hospitalization and the use of antibiotic therapies, prolonged hospital stay, increase in all costs, with a disruptive impact on the quality of life because the oncologist must suspend treatments oncology on a temporary or permanent basis. And this is another important fact that must be taken into consideration in addition to the impact that antibiotic and antiviral therapy can have on the intestinal microbiota – dysbiosis has a negative effect on the immunotherapy response, a class of extraordinary drugs that we are using substantially in all disease setting – and on the increased risk of immune-mediated events. Therefore, vaccination not proposed and not carried out can cause a whole series of “negative” events, “as well as obviously preserving the patient’s best quality of life”.
The oncologist “should have all these aspects in mind when not carrying out vaccination counseling – observes the specialist – which is a dialogue, not an imposition, but a moment in which these various aspects are explained to the patient”. Of course it is not easy to insert it at “the moment of the first oncological visit, but a series of data on various types of vaccinations” show “that the vaccine is still effective, protective and safe even during oncological treatments”. Therefore it can also be proposed “as a second step”, preferably by sharing the information with “other specialists” and, possibly, using an “information leaflet”.
The first sensitization “is from the oncologist – reiterates Lasagna – If he is the one who proposes it to the patient – we have also demonstrated this in a work we did here in San Matteo – there is a statistically significant result. The ideal time for vaccination would, in theory, be before starting treatments, but it is also possible to do it during treatment. There are some precautions – avoid the same day and the days surrounding it – to avoid the possible accumulation of adverse events such as pain in situ of inoculation or feverish episode. In the case of breast pathology, for example, just pay attention to mammograms and PET scans immediately after vaccination – as the extensive Covid literature teaches – postponing the inoculation for at least 2-4 weeks”.
A concept to be stressed concerns safety – concludes the oncologist – also in a prospective vision, that is, safety to reduce the risk not only of infection but also of complications from infection. This applies to all vaccines. Perhaps the anti-flu vaccine is the one that has been cleared through customs better, more easily. The other vaccinations, anti-herpes zoster and anti-pneumococcal, are still little known, rarely offered by the oncologist and therefore, in cascade, also requested by the patient”. The hope is, “with the Aiom guidelines” in progress, “to be able to reinforce this message, make it pass more strongly to the oncologist and therefore also to the patients”.
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